Angina pectoris (angina pectoris) symptoms, treatment, restrictions for the patient

Angina is also called “angina pectoris” in another way. For the first time such a name was proposed in 1768 by an English doctor, William Heberden, when he described the attacks of angina pectoris in his patients: “as if their heart is compressing and strangling something from the inside”.

Risk of mortality in angina pectoris: up to 10% per year.

Pain with angina pectoris develops due to the fact that the heart muscle experiences a sharp lack of oxygen. This is called myocardial ischemia. This is due to the narrowing of the vessels that feed the heart. In approximately 90-95% of cases, the cause is atherosclerosis – the deposition of particles of cholesterol on the inner layer of blood vessels and the formation of plaques.

Angina pectoris is a clinical syndrome that is recognized as the most common form of coronary heart disease (CHD). Its prevalence ranges from 30 to 40 thousand per 1 people. Basically, people over 000 suffer from it, most often they are men (ratio with women 000: 40). This division is explained by the fact that female sex hormones have the ability to slow the development of atherosclerosis.

Situations predispose to the development of angina pectoris because of which the myocardium needs more oxygen than usual. These include high blood pressure (especially a hypertensive crisis), rhythm disturbances, accompanied by increased heart rate (tachyarrhythmias), various heart defects, diabetes, anemia, physical inactivity, obesity, bad habits – smoking, alcohol abuse, etc.

High blood cholesterol is considered one of the main risk factors for CHD. If your close relatives suffered from coronary heart disease, then the likelihood that it will develop in you, significantly increases.

In more rare cases, the cause of angina pectoris is a spasm of the coronary arteries, a congenital anomaly in the structure of the vessels that feed the heart, etc. In ICD-10, angina pectoris has an I20.0 code.

Any disease is easier to prevent than to cure. And angina pectoris is no exception. For its prevention, it is necessary to avoid bad habits, severe stress, exercise regularly, monitor your weight and blood pressure. After 40 years, you need to periodically (at least once a year) be diagnosed in the clinic – take a biochemical blood test to check blood cholesterol, do an ECG.

The essence of pathology

Angina pectoris is a form of ischemic heart disease, characterized by bouts of sternal pain due to myocardial ischemia. The disease is familiar to many as “angina pectoris”, but this name is not used in official medicine, although it is he who, in essence, most accurately characterizes the condition of a person during an attack. This is a strong pressing pain in the heart area with a sensation of suffocation. Pain with angina pectoris of any genesis is a consequence of a violation of coronary blood flow.

As a symptom of coronary heart disease, angina pectoris occurs in more than half of patients. In men – more often, moreover, with age, the percentage of prevalence increases. The mechanism for the development of pain attacks is an imbalance between the nutritional requirement of the myocardium and the ability of coronars to provide the necessary blood supply to the heart muscle.

Provoked ischemia disrupts redox processes in cardiocytes. Under-oxidized acids accumulate in the cells, which block the synthesis of ATP – a source of muscle tissue energy.

An imbalance of oxidation-reduction causes a violation of the conduction of the heart, the result of this “cascade” is the spastic state of not only coronars, but also the myocardium at the time of diastole. The heart does not have time to recover, so with the next even insignificant load, there is an attack of cardialgia.

The main difference between angina pectoris and AMI is the reversibility of the process, the absence of necrosis of heart tissue. But it should be understood that in the absence of proper treatment, angina pectoris easily transforms into a heart attack.

Symptoms

The main clinical signs of angina pectoris are attacks of pain in the middle of the chest, which are felt as a strong squeezing, burning or squeezing. However, this is not the only place where pain occurs. She can give in the left hand, neck, shoulder, lower jaw, under the scapula, upper abdomen. This is a kind of “calling card” of ischemic pain that separates it from all other types.

The duration of the attack varies from 1-2 to 20 minutes. Most often, the pain is provoked by physical exertion (running, lifting weights, climbing stairs) or emotional stress.

Depending on the degree of load causing the pain, angina pectoris is divided into the so-called functional classes (FC) – from 1 (when pain occurs only with very intense muscle work) to 4 (pain can develop even with the slightest movement or at rest).

A distinctive feature of pain in angina pectoris is its disappearance after a person stops the load or takes Nitroglycerin. In some cases, instead of pain, there is a sharp difficulty in breathing (shortness of breath) or coughing.

The main symptom of angina pectoris is pain, which has characteristic features:

  1. she is paroxysmal;
  2. by nature – oppressive, compressive;
  3. localized in the upper or middle part of the sternum;
  4. pain gives in the left hand;
  5. the pain increases gradually and stops quickly after taking nitroglycerin or eliminating the cause that caused it.

Can provoke an attack of pain:

  1. brisk walking, climbing stairs, carrying heavy loads;
  2. increased blood pressure;
  3. cold;
  4. plentiful meal;
  5. emotional stress.

The main feature of pain in this disease: pain appears suddenly during walking, often after eating; the pain is short-term, stops when the person stops. Men suffer from angina pectoris several times more often than ladies.

Angina pectoris can cause acute pain in the heart.

For angina, the following symptoms are characteristic:

  • acute, sudden course of an attack;
  • pain, uncomfortable pressing or constricting sensation in the heart, behind the sternum;
  • irradiation of pain in the arm, back, lower jaw, neck;
  • palpitation;
  • shortness of breath, cold sweat;
  • a burning sensation is possible along with pain;
  • sudden fatigue, dizziness, nausea and shortness of breath;
  • sometimes, especially during night attacks – lack of air, suffocation.

Often the appearance of an angina pectoris is associated with physical activity or stress for the body (psycho-emotional stress, temperature changes, plentiful food). Do not wait long until the attack passes by itself. This can be dangerous, so use nitroglycerin or another medicine prescribed by your doctor.

Symptoms of angina pectoris are quite characteristic, and often their description is enough to correctly determine the diagnosis. But in the presence of unusual symptoms and other pathologies, doctors can use additional examination methods – an electrocardiogram, daily ECG monitoring, bicycle ergometry, coronary angiography, blood analysis and others.

We list the signs by which you can recognize that it is angina that bothers you:

  • It is similar to an attack, that is, it has a clearly defined time of occurrence, as well as termination (subside);
  • It is characterized by certain conditions (circumstances) of occurrence;
  • It is characterized by abatement or complete cessation if nitroglycerin is taken.

Angina pectoris often worsens while walking, especially if:

  • to accelerate the movement;
  • climb the mountain;
  • there is a sharp headwind;
  • walk after eating;
  • carry a heavy burden.

Heavy physical work or emotional shock can trigger an angina attack. Symptoms and signs of angina pectoris are manifested by pain, which is caused by physical exertion, which is manifested in the fact that during their (exertion) continuation or increase, the intensity of pain necessarily increases, and if the exertion is stopped, the pain will subside or disappear in a few minutes.

An attack is a classic symptom, it is perceived by the patient as ordinary heart pain, the person lies down and does not move, any attempts to do anything cause pain.

The burning sensation in the region of the heart does not stop by itself, the burden on the soul is not easy to remove, you need to open the window, lay the person and put a wet bandage on his head.

With such pain it is difficult to breathe, a person tries to reduce activity in principle, since any movement causes unpleasant painful sensations under the shoulder blade.

If relatives have a nitroglycerin tablet, then it must be put under the tongue. It happens that a seizure goes away on its own, but this is the exception to the rule rather than the rule.

Summing up, we can safely say that the main symptoms of angina pectoris are pain, which has the following characteristic features:

  • she’s figurative;
  • by nature – oppressive, compressive;
  • localized in the upper or middle part of the sternum;
  • pain gives into the left upper limb of a person, that is, his hands;
  • discomfort grows slowly, but quickly stops after taking nitroglycerin or eliminating the cause that caused it.

Can provoke pain:

  • brisk walking, climbing stairs, carrying any heavy objects;
  • increased blood pressure (hypertension);
  • cold;
  • severe overeating;
  • emotional shock or stress.

Pectoral toad begins with burning pain in the chest, suffering is accompanied by sweating, vomiting.

It feels as though a soldering iron is being heated inside a person, and the pain pulsating over time covers the entire abdominal cavity.

The inability to raise the left arm and leg should alert the patient’s relatives, breathing becomes abrupt and frequent.

Angina pectoris, regardless of type, is clearly visualized. A person feels severe pain in the chest area of ​​a cutting or oppressive nature. A characteristic sign is the pressing of a fist to the heart by the patient, which he tries to show in place of the concentration of pain. Such a gesture is instinctive. Pain during an attack of the disease does not appear pointwise in the chest.

The following symptoms indicate an attack:

  • physical or emotional stress prior to the attack,
  • blanching
  • lack of sensitivity in the fingers,
  • expression of suffering on the face
  • sweat on the forehead
  • intermittent rare breathing
  • rapid pulse.

In most cases, with a stable form of the disease, an attack occurs immediately after the cessation of physical activity.

The main symptom of angina pectoris is pressing pain radiating to the neck, lower jaw, teeth, under the shoulder blade, sometimes to the elbow or wrist joints, mastoid processes. Pain can be accompanied by shortness of breath, increasing weakness.

But the symptomatology of the disease does not develop immediately, there are first signs indicating an approaching attack. They are different for men and women.

Signs of pathology in women Signs of pathology in men
Cardialgia with sternal localization, radiating to the neck or back Pain of a pressing, burning character in the region of the heart
Choking with or without cough (congestion in the pulmonary circulation), rapid, shallow breathing Dyspnea
Sweating Pallor of the skin
Vertigo, fainting state Heartbeat, the patient hears his heartbeat
Increased anxiety, fear of death Anxiety, fear due to the inability to assess the situation
Growing fatigue, apathy High blood pressure
Numbness of the fingertips Cold limbs

They provoke an attack of angina pectoris of the load, with their exception, the symptoms disappear on their own, after some time. Only a doctor can establish the exact cause of the pathology, but each close patient with IHD should be able to distinguish the signs of angina pectoris from developing heart attack.

AMI Angina pectoris
Acute pain with mandatory radiation to other parts of the body Pressing, burning pain (“angina pectoris”), irradiation is optional
Blood pressure drop, subfebrile condition, tachycardia, profuse cold sweat Increase in blood pressure, slight sweating, temperature never rises
The attack lasts more than 15 minutes, Nitroglycerin is useless The attack can stop if you just relax, it always stops with Nitroglycerin, never lasts more than 10 minutes

Causes

Almost every angina pectoris is somehow associated with atherosclerosis, since atherosclerotic plaques clog vascular lumen and blood circulation, respectively, the oxygen supply to the myocardium is disrupted.

Also, the pathology can be caused by myocardial infarction, vasospasm, heart defects, acute tachycardia. and various diseases, especially in acute conditions (exacerbation of stomach ulcers, cholelithiasis, pulmonary insufficiency, osteochondrosis) and severe psychological stresses and loads. There are cases when angina pectoris occurs reflexively and is not directly related to any heart disease.

Angina pectoris is divided into three varieties – tension and rest angina, in addition there is a special form of angina pectoris – Prinzmetall disease.

Atherosclerosis causes a narrowing of the lumen of the vessels that feed the heart, which leads to an attack of angina pectoris

The main causes of angina pectoris:

  • atherosclerosis of the heart vessels;
  • acute myocardial infarction, which formed post-infarction cardiosclerosis;
  • spasm of coronary arteries that are sclerotic;
  • heart defects;
  • arterial hypertension;
  • pronounced tachycardia and tachyarrhythmia.

In almost 100% of cases in patients with angina pectoris, hyperlipidemia is noted:

lipid fractions manifests itself in atherogenicity, changes vascular walls, causes a risk of thrombosis.

  • extra pounds: the constant use of high-calorie foods leads to obesity, the amount of fat in patients with angina pectoris should not exceed 300 mg / day, and salt can be consumed no more than 5 g; dietary fiber is balanced; from 30 g / day;
  • a sedentary lifestyle is another important risk factor in the development of the disease, which contributes to impaired lipid metabolism, fat deposition, and the formation of atherosclerotic plaques;
  • nicotine addiction – contributes to an increase in the content of carboxyhemoglobin in the blood (carbon monoxide erythrocyte hemoglobin), which provokes myocardial hypoxia, spasm of blood vessels, jumps in blood pressure, transformation of angina into a pre-infarction state, heart attack;
  • hypertension – stimulates the progression of coronary heart disease, and therefore angina pectoris: systolic pressure rises, myocardial oxygen demand increases;
  • anemia – is accompanied by a restriction in the transport of oxygen to the heart, which automatically causes an attack of angina pectoris;
  • provokes cardialgia with angina pectoris intoxication of any genesis – causes vascular spasm, disrupts the nutrition of the heart muscle;
  • diabetes mellitus of any type doubles the risk of developing pathology: diabetic vascular atherosclerosis is a precursor to heart attack or stroke, especially in elderly patients;
  • the risk of thrombosis (thrombophlebitis) with angina is correlated with blood viscosity, which varies in proportion to metabolic disorders in the myocardium;
  • psycho-emotional lability is the cause of angiospasm, which causes narrowing of the lumen of the coronars: stress can affect the state of the vessels so much that sudden cardiac arrest occurs;
  • angina pectoris is closely related to the state of the immune system – the body’s vulnerability to infections, inflammation of various origins, autoimmune reactions;
  • in the development of pathology, the state of vascular endothelium (atherosclerotic plaques, blood clots) is important;
  • a risk factor is considered constant tachycardia;
  • another reason for the debut of the disease is changes in the hormonal background in women, the use of oral contraceptives that correct the estrogenic defense of the body.

Most often, the development of the disease requires a combination of at least two or more risk factors.

Perhaps the main cause of angina pectoris is a narrowing of the lumen of the coronary arteries (their spasm), which occurs against the background of pathological processes in these arteries. As a result of a spasm, a mismatch appears between the oxygen demand of the myocardium and its delivery. The most common (92%) pathological process – the cause of arterial spasm – is atherosclerosis, sometimes it can be combined with thrombosis. Another cause of stenosis may be a violation of the function of the endothelium (inner membrane) of the vessels.

Fig. 1. Causes of narrowing of the coronary arteries.

In recent years, researchers have identified risk factors that can lead to coronary atherosclerosis. All of them are divided into 3 main groups.

1 group – a way of life.

Risk factors of this group are modifiable, i.e. mutable:

  • a diet high in cholesterol (egg yolks, caviar, cheeses, margarine, pork, etc.);
  • tobacco smoking;
  • excessive drinking;
  • low physical activity (lack of exercise).

Group 2 – physiological characteristics, which are also modifiable features:

  • elevated levels of total cholesterol in blood plasma (normally it should be 3,6-5,2 mmol / l);
  • high blood pressure;
  • low levels of “good” cholesterol (HDL cholesterol);
  • elevated plasma triglycerides (normal – less than 1,7 mmol / l);
  • diabetes;
  • obesity.

Group 3 – personality characteristics (non-modifiable factors):

  • age (over 45 years for men and 55 years for women);
  • male gender;
  • burdened family history of atherosclerosis.

The combination of several risk factors significantly increases the likelihood of developing atherosclerosis and, as a consequence, coronary heart disease and its form – angina pectoris. Today, IHD is the main cause of mortality. According to the State Research Center (State Research Center) of preventive medicine in Russia, about 10 million able-bodied people suffer from coronary heart disease.

It must be borne in mind that angina pectoris as the beginning of coronary heart disease occurs in almost 50% of patients. At the same time, about 40-50% of these people are aware of their disease, while 50-60% of cases of the disease remain unrecognized and untreated. It is for these reasons that it is very important to recognize angina pectoris in time and seek help from a doctor.

An attack of angina pectoris begins suddenly and does not stop until an ambulance is called.

The reasons for the attack are many, it can cause abundant nutrition, overeating, obesity, excitement, temperature changes, stress, drinking alcohol on an empty stomach and smoking.

According to statistics from the health center, the causes of angina are:

  • smoking – quit smoking; smoking narrows blood vessels (tubular organs);
  • do not overeat, elevated cholesterol is a sure sign of beginning changes in the vessels;
  • quit smoking, take measures to lower blood pressure, lower high blood cholesterol. Start with physical education. Diabetes exacerbates the course of the disease.

IHD (coronary heart disease) and angina pectoris, as its special case, begins with a narrowing of blood vessels. Blood nourishes the heart muscle less, a feeling of general weakness of the body begins, plaque formation on the walls of the tubular organ, stress and constant overfatigue aggravate the situation.

Unpleasant painful sensations arise from the fact that starving pain receptors react to a lack of oxygen by impulses.

This condition is called an attack. Tubular organs lose their elasticity, pain intensifications begin to arise from normal loads. This condition is not corrected, called chronic heart failure.

It all starts with a state of tension on duty, doctors call this condition angina pectoris, the patient is increasingly resorting to pills for heart pain, loved ones are required to measure his pressure.

A feeling of heaviness in the chest is a sign that medical help is needed. The state will not let go, as people say, you can’t expect angina that it will go away on its own, this disease is insidious, the attack catches a person in the stairwell, at work, in transport.

How to recognize an attack of angina pectoris

In most patients, an attack of angina pectoris does not occur “out of the blue”. It must be preceded by some action that increases the myocardial oxygen demand – physical or emotional stress. Also, pain can occur when going outside in cold weather, with a sharp tilt of the body during shoeing.

In my practice, I have met patients in whom the smell of tobacco smoke was capable of causing pain in the heart.

Often during an attack, a person becomes covered with cold, sticky sweat, his head begins to feel dizzy, he is sick. Some people experience anxiety, fear of death. In such situations, it is very important to distinguish angina pectoris from panic attacks, in which “neurotic symptoms” come first. However, one must always remember that these attacks alone can cause angina pectoris.

You can find out what you need to do during an attack of angina pectoris and how to remove it at home here.

If a person has overtaken angina pectoris, urgent need to provide first aid. The following will help to interrupt the disease:

  • Everyone has heard that nitroglycerin is considered a panacea for heart disease, although aspirin can also be used with equal success. Yes, it is proven that it is toxic, but what to do? Validol is ineffective, after taking aspirin, it is necessary to take a stationary horizontal position and be in a room with fresh air.
  • A relaxing massage is shown to patients, it helps to quickly move away from an acute attack, sometimes patients do self-massage, you need to massage the areas of the face and neck that are close to the heart, that is, on the left side. Hand massage is also effective, especially if the attack lasts a long time.
  • A vasospasm affects the brain, a strong pain appears in the head, the pain medication is taken according to the doctor’s testimony, usually it is analgin, if the pulse exceeds 120 beats, you need to drink anaprilin.
  • If aspirin is in the form of a powder, it is poured into a glass, poured with warm water (not cold, cold increases the spasm). Strong vasoconstriction, in which pallor and cold sweat are observed, indicate a decrease in pressure, in which case you can not drink nitroglycerin.
  • The relief of the attack at rest and in irritation is different, the attack overtook lying down? Lift the person so that the legs are below the head, inversely proportional to the position during fainting.

Of the substances that cause pleasure, namely, fats of harmful genesis, psychoactive substances and alcohol, there is not a single substance that has a positive effect on health. Accept the thought that all that is pleasant is harmful.

If there is a desire to restore the functioning of the heart muscle and the state of blood vessels – you need to start cleansing the body of toxins and toxins, if you eat improperly and have lots of bad habits, even the most intelligent and talented doctor will not help a person, if you are not lucky, even a surgeon will not be able to save a life. It all depends on the patient.

Classification

According to WHO recommendations, the disease is usually divided into a stable and unstable form. Each has its own classification.

Stable angina pectoris (exertional angina) is a pain syndrome that is provoked by any exertion, is well stopped by Nitroglycerin. According to this principle, several classes of the disease are distinguished:

  • I functional class (FC) – cardialgia occurs only with excessive loads;
  • II FC – a pain attack is provoked by walking fast, changing weather conditions, emotions, the first hours after waking up from sleep;
  • III FC – pain is caused by normal walking, climbing to the 1st floor of the building;
  • IV FC – an attack of pain occurs even during sleep, in a state of complete rest.
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An unstable form of angina pectoris is more complicated and dangerous. This is an intermediate condition between a stable form of symptom and acute heart attack. Pathology does not correlate with loads, progresses on its own, is fraught with death. In fact, this may include:

  • first occurred (recurrence of chest pains up to 30 days from the time of the first attack);
  • actually unstable (constantly progressing);
  • spontaneous angina (vasospastic, sudden, which is also called variant or Prinzmetal angina);
  • angina pectoris, which develops within 14 days after a heart attack.
With a stable variety With an unstable variety
The level of stress provoking an attack is constant There is no concept of tension, an attack occurs spontaneously, at rest
Breast discomfort no more than 10 minutes The average duration of an attack is 15 minutes
Stopped by Nitroglycerin Nitroglycerin practically does not work

In medicine, a stable and unstable form of the disease is shared.

Functional Class (FC) Angina Pectoris Characterization of the functional class of angina pectoris
I Stable angina pectoris of the first FC occurs with intense and prolonged physical or emotional stress.
II The second FC of stable angina is diagnosed if the patient develops an attack in cases of walking at a distance of 500 meters or more, walking at an accelerated pace in frosty weather, climbing stairs two or more floors.
III The third FC is given to a patient whose attack occurs after a hundred meters of walking in a calm rhythm. This functional class of stable angina pectoris leads to severe limitations in physical activity.
IV Pain occurs even at rest or during sleep. Any physical activity leads to angina pectoris.

An unstable form of the disease is a more complex diagnosis. The complexity of the diagnosis is that there is no relationship between the loads and manifestations of the disease. In the medical hierarchy, the unstable form takes an intermediate place between the stable form and acute myocardial infarction.

The unstable form requires constant monitoring by a doctor. The danger of an unstable form of angina pectoris is that seizures occur without obvious prerequisites and there is a risk of myocardial infarction or sudden death.

There are three classifications of unstable angina pectoris.

Unstable angina class Characteristic class of unstable angina
I It is characterized by the recent onset of angina pectoris in severe or progressive form. An exacerbation of coronary heart disease is observed, according to the patient, for two or less months.
II Subacute form of angina pectoris at rest and tension. The patient has a history of angina attacks in the last 30 days, but their absence over the past two days.
III The acute form of angina pectoris. Over the past two days, several attacks of anginal pain at rest.
Unstable angina class Synonymous class name for unstable angina Characteristic class of unstable angina
А Secondary unstable angina The development of unstable angina pectoris occurs against a background of concomitant factors: anemia, respiratory failure, hypotension, uncontrolled hypertension.
В Primary unstable angina Unstable angina is observed in the absence of factors that exacerbate the process of insufficient blood supply to the heart.
С Early post-infarction unstable angina Unstable angina pectoris develops in the period of two weeks after a general myocardial infarction.
Unstable angina class Characteristic class of unstable angina
1 Therapy was absent or was present minimally.
2 Adequate protocol therapy was present.
3 The treatment was carried out in three groups of antianginal drugs, including intravenous nitroglycerin.

Features in men

For males, the so-called typical clinical picture of angina pectoris (burning / pressing pain behind the sternum, developing after physical work) is characteristic. However, often the pain makes itself felt too late, and its intensity does not match the degree of damage to the coronary arteries. Those. slight discomfort in men occurs already against the background of a pronounced decrease in vascular lumen.

I constantly have to diagnose coronary heart disease in men only when they enter the cardiopulmonary resuscitation department with myocardial infarction.

Complications

Symptoms of angina pectoris can mimic a heart attack, stomach ulcer, osteochondrosis, herpes zoster, pneumonia. But the most dangerous is the development of complications against the background of pain attacks. There are several options for the negative consequences of progressive angina pectoris:

  • AMI (acute myocardial infarction) with the result of the assignment of a disability group, a possible fatal outcome;
  • metabolic, organic disorders in the structure of heart tissues: cardiosclerosis, calcification, cicatricial stricture of valves, chords, septa;
  • heart failure in acute and chronic form with a poor prognosis.

Coronary heart disease and angina pectoris, as its special case, have common features. Chronic heart failure is a clear consequence of fatigue. With the disease, the legs swell, shortness of breath and heaviness in the chest appear.

Changes in pressure are natural, the wear of the heart muscle is directly proportional to the increase in pressure. The end point is a heart attack, but it can occur from scratch.

Arterial spasm (tubular organs that feed the heart), atherosclerosis, plaques, the result of a clot in a coronary artery. In any case, there is only one result – a heart attack, the heart loses its ability to work adequately.

Also, each attack will entail such serious diseases as:

  • arrhythmia;
  • tachycardia;
  • ventricular blockade;
  • heart failure;
  • shock;
  • heart inflammation;
  • blood clots.

Specificity in women

In contrast to men, in women, on the contrary, pain is more pronounced with a completely satisfactory vascular patency.

Also, I often observe atypical symptoms of an attack of angina in women, i.e. instead of pain in the heart, the patient experiences a sharp shortage of air (asthmatic form), or discomfort in the epigastric region (gastralgic variant), which greatly complicates the recognition of angina pectoris. The nature of pain in women also does not always correspond to the classical one – it can be, for example, stitching.

Laboratory diagnosis of angina pectoris

To diagnose angina pectoris, I use the following research methods:

  • blood tests;
  • electrocardiography;
  • ECG with load;
  • daily (Holter monitoring) ECG;
  • echocardiography;
  • myocardial scintigraphy;
  • coronary angiography.

For all patients with angina pectoris attacks, I prescribe a biochemical blood test to determine the concentration of total cholesterol and its fractions – low and high density lipoproteins. They are also called “bad” and “good” cholesterol. I also check everyone’s glucose level for diabetes.

The further examination algorithm has some nuances with different forms of angina pectoris. We will analyze these methods in more detail.

With unstable angina, blood is first taken to determine the enzymes that indicate necrosis (death) of the heart muscle. These are the so-called cardiospecific enzymes. These include troponins I and T, the MV fraction of creatine phosphokinase, myoglobin, lactate dehydrogenase. With unstable angina, they are within normal limits or slightly overestimated. Their analysis is necessary to exclude myocardial infarction (MI).

Since clinically unstable angina and myocardial infarction are indistinguishable from each other, in practical medical practice they are combined by the term “acute coronary syndrome” (ACS).

Electrocardiography is the main instrumental method for diagnosing angina pectoris:

    Stable – a typical change in the ECG during a pain attack – a decrease in the ST segment by more than 1 mm, sometimes a negative T wave. Since the cardiogram may be normal at rest, I appoint an ECG with a stress breakdown to confirm the diagnosis, i.e. during physical exercises – a treadmill test (walking or running on a treadmill) and bicycle ergometry (r >

Often these changes on the ECG are accompanied by cardiac arrhythmias – supraventricular tachycardia, atrial fibrillation, slowing of atrioventricular conduction, blockade of the bundle of the bundle, etc.

Echocardiography (Echo-CG, ultrasound of the heart) allows me to evaluate morphological changes – myocardial contractility, degree of hypertrophy and expansion of the chambers, check the structure of the valves, the presence of aneurysms and intracardiac blood clots.

Myocardial scintigraphy is a study of the state of blood flow in the myocardium using a radioactive preparation (thallium-201 or technetium-99-m). I use this method in patients with stable angina pectoris, with severe cardiac arrhythmias, because of which it is impossible to see changes in the ST segment.

The essence of scintigraphy: the drug is administered to the patient, he begins to perform physical activity on a treadmill or bicycle ergometer, and images are obtained on a special gamma-ray tomograph. Areas of impaired circulation (ischemia) have a weak glow.

Coronary angiography is the gold standard for the diagnosis of coronary artery disease, allowing to assess the patency of coronary arteries. With its help, it is also determined whether surgical intervention is necessary for this patient, or whether drug therapy can be dispensed with.

The algorithm for examining a cardiac patient is standard. Diagnosis of angina pectoris includes the following research methods:

  • collection of complaints, medical history, physical examination of the patient;
  • OAK, OAM – screening of the state of health of the subject; biochemistry: blood sugar, lipids. AST, ALT, triglycerides, levels of lactate dehydrogenase, creatine kinase;
  • study on troponins – markers of myocardial damage;
  • ECG, echocardiography;
  • Halter
  • stress tests: bicycle ergometry, test on a footpath;
  • echocardiography, scintigraphy, including with physical and medical loads;
  • computed multispiral tomography (for differentiating angina pectoris from other diseases);
  • coronarography.

Depending on the type of angina pectoris, the risk of transformation of the attack in AMI, the scope of research can be expanded

Confirmation of a diagnosis in a clinical setting is a complex and lengthy process that requires several instrumental tests:

  • electrocardiogram at rest,
  • electrocardiogram under physical exertion,
  • daily monitoring of electrocardiography,
  • resting echocardiography,
  • scintigraphy under physical or pharmacological loads,
  • echocardiography under physical or pharmacological loads.

In parallel with this complex of instrumental studies, laboratory tests are carried out to identify pathologies that can provoke coronary heart disease.

Selective angiography of the heart vessels

  • Electrocardiogram (ECG) – electrodes are attached to the body and a special device removes electrical signals from your heart. Only a few minutes and the doctor has the information necessary for diagnosis. Absolutely painless.
  • Coronary angiography – a special catheter in the form of a thin tube is passed through an artery in the groin or arm to the most coronary arteries that feed the heart. Next, a special marker substance is introduced and the patient is placed under continuous radiological imaging. An excellent diagnostic method, but not very pleasant and not entirely harmless.
  • Stress test – a simple test during which you will be asked to run or pedal on a stationary bike. At this time, the doctor measures various indicators such as blood pressure and changes in heart rate.
  • Biochemical analysis to assess blood cholesterol.

It is the doctor’s responsibility to help the patient; hospitalization is recommended for examination and therapy.

Diagnosis is based on these tests. The doctor prescribes strong painkillers, as well as oxygen therapy.

Immediate procedures and measures to relieve the effects of a blood clot, the appointment of thrombolytics, angioplasty (vasodilation, a plastic balloon is used).

The currently popular coronary artery bypass grafting (shunting from English translates as a workaround, bypass) corrects the problem of blood supply to the heart vessels, after the operation rehabilitation is indicated.

First of all, patients need a tonometer. You can choose a tonometer in a budget category, it will allow you to control pressure and keep a diary of hypertension.

Nitrates (nitroglycerin) are prescribed to the patient to reduce the frequency of seizures and their strength. Their action usually lasts 10-14 hours, usually consists of tablets and spray, the forms of such drugs may vary, some of them are taken 4 times a day, with a feeling of heaviness in the chest or with chronic conditions.

Nitrates help to remove the effect, not the cause, unfortunately, in acute attacks, only hospitalization helps, although beta-blockers and calcium antagonists are prescribed for discharge to the patient. Doctors often prescribe acetylsalicylic acid, it reduces the risk of blood clots, and helps eliminate the consequences of heart complications in the form of myocardial infarction.

Each person has his own pace of life – remember this!

Do not complex, do not equal healthy young people. No need to set new records, do not listen to stupid people who will begin to shame you and your opportunities. Angina pectoris is subject to disability, and therefore the body’s capabilities should be considered limited.

An active lifestyle can and should be led, especially before the heavy stresses of a forced nature (saving your life, swimming, running away from danger) you still have to face. Drink a nitroglycerin drug before vigorous activity, it will save!

What types of angina pectoris are

Depending on the severity, nature of the course, the reason underlying the mechanism of pain development and the approach to therapy, the following types of angina are distinguished:

  1. Stable (angina pectoris) – the most common form, divided into FC.
  2. Unstable – exacerbation of angina pectoris, or pre-infarction condition. The pain appears already at a minimal load and does not stop even after taking Nitroglycerin. There is a process of thrombus formation, but insufficient to cause necrosis of the heart muscle. It is considered an emergency and, in terms of symptoms, is indistinguishable from myocardial infarction, but can lead to it. The following types of unstable angina pectoris exist:
    • The first occurrence is the appearance of symptoms of angina pectoris in a person who has not previously experienced such pains. It requires special attention, since the literacy of treatment determines whether the pathology goes into a stable form or progresses;
    • Progressive – attacks become longer and more frequent, Nitroglycerin helps worse and worse (transition from FC I to III or IV in 2 months);
    • Post-infarction – the occurrence of seizures no later than 2 weeks after myocardial infarction. This is the most unfavorable form, since it is characterized by a high probability of death;
  1. Vasospastic (variant, spontaneous, Prinzmetall angina) is angina due not to atherosclerotic stenosis of the coronary arteries, but to their spasm, i.e. strong contraction of the muscles of the vessels. Typically, this species is found in young men. Pain can appear at any time, it is not connected with physical activity in any way. More often develops at night or early in the morning. For this species, a series of seizures are specific (from 2 to 5), following one after another with an interval of 10 minutes to 1 hour.

Separately, a special variety of angina pectoris is distinguished – cardiac X syndrome, or microvascular angina, in which there are typical bouts of pain during physical effort with ECG signs with normal or slightly changed coronary arteries (vascular patency more than 50%). It is observed mainly in women with neurotic disorders during menopause and premenopause (40-50 years). The exact cause of its occurrence is still unknown.

It is assumed that a decrease in the concentration of female sex hormones (estrogens) leads to spasm of microvessels. Also important is the increase in the threshold of pain sensitivity for anxiety and depression.

A distinctive feature of the symptoms in cardiac syndrome X is that the attacks of angina pectoris disappear after the cessation of stress, rest or taking Nitroglycerin, but this takes much longer than with other types of angina pectoris.

Treatment

When treating angina pectoris with folk methods, two rules must be followed:

  • any prescription of traditional medicine must be approved by the attending physician;
  • folk methods are helpers of traditional drug methods.

There are many alternative methods of treatment. They are based on the main points of the traditional treatment of the disease: a healthy diet and a healthy lifestyle.

Detonic – a unique medicine that helps fight hypertension at all stages of its development.
Detonic for pressure normalization

The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.

Detonic not addictive and withdrawal syndrome, since all components of the product are natural.
Detailed information about Detonic is located on the manufacturer’s page www.detonicnd.com.

Clove of garlic

A common clove of garlic is an alternative to nitroglycerin during an attack of angina pectoris. After chewing a clove of garlic, pain in the chest area will pass after 20 minutes. This recipe is found in many old collections of traditional medicine recipes. In principle, if an attack occurs unexpectedly, such a recipe is a good way to deal with pain.

The most popular stenocardia prophylaxis is a mixture of garlic, lemon and honey. To prepare it, you need to put one liter of honey in a three-liter jar, juice squeezed out of ten lemons and five medium heads of garlic, peeled on cloves.

Mixing the resulting mixture is not easy, but the contents need to be well mixed. Then close the jar with a lid and put for a week in a dark place with a cool temperature. The prepared infusion should be taken in two tablespoons before breakfast, dissolving it in your mouth. The course of admission is until the entire prepared infusion is over.

Aloe infusion on honey

It strengthens the heart and the infusion of aloe on honey. This prescription of traditional medicine is especially effective at the first manifestations of the disease.

Five large aloe leaves and three large lemons are passed together through a meat grinder. The resulting slurry is mixed with a half liter of honey, heated in a water bath. Next, the mixture is put in the refrigerator for several days and taken on a tablespoon on an empty stomach. As in the previous recipe, the course of taking aloe vera infusion on honey is until the infusion is over.

Vegetable juice

This recipe is suitable for the prevention of many heart problems. It helps with both arrhythmia and coronary heart disease.

To prepare vegetable juice, you need to mix a liter of carrot juice, 600 grams of celery juice, 500 grams of spinach juice and 250 grams of parsley juice. Such a vegetable mix should be drunk in two glasses daily. There are no time limits on the course of admission. If possible, this juice should be made a permanent part of your daily diet.

The most common treatment is aimed at eliminating an attack of angina pectoris. This does not eliminate its cause, but is nevertheless necessary.

How to relieve an attack of angina pectoris?

If possible, the patient stops the load and the influence of stress factors (movement, smoking), takes a calm horizontal position and takes a nitroglycerin tablet. It is also advisable to take a sedative drug – corvalol, valerian.

We expect 5-10 minutes and if the pain does not subside, you should take the nitroglycerin tablet again, and if you are in severe pain, you can use an analgesic (analgin, aspirin) and rather call an ambulance, as it is possible that myocardial infarction is already developing . Be sure to tell your emergency doctor about your medications!

A doctor who is periodically suffering from angina attacks is prescribed prolonged-action nitrates in addition to glycerin. Also, antihypertensive agents are used in treatment to reduce blood pressure and, accordingly, reduce myocardial oxygen demand, beta-blockers (anaprilin) ​​have the same effect.

Also, sedatives, vasodilators, calcium ion antagonists, drugs for lowering cholesterol are used in drug treatment. In serious cases, when there is a threat to the patient’s life, coronary angioplasty is performed – special support is installed in the diseased vessel, thereby restoring normal blood flow. It is carried out in the same way as angiography, that is, it is a less traumatic operation.

The goal of the treatment of the disease is to solve several problems: eliminate the symptoms of the disease, reduce the number of attacks, prevent the transformation of the pathology into a heart attack or sudden death. Treatment of angina does not imply a complete recovery, but includes several options for temporary relief of the pathological process.

First aid

Untimely relief of an angina attack is a guarantee of negative consequences. But, unfortunately, the relatives of patients suffering from a symptom of coronary heart disease, meeting with manifestations of angina pectoris, do not always know what it is, than to help the patient in the first minutes. The action algorithm is, in fact, simple. Necessary:

  • help make a person comfortable, better sitting;
  • ensure a free flow of fresh air, unfasten a tight collar, loosen a tie;
  • give a tablet of Nitroglycerin under the tongue or a few drops of the drug solution per piece of sugar (for severe headaches from nitrates, you can reduce the dose to half the tablet, take Citramon, Val >

Nicotine addiction is one of the strongest risk factors in the development of symptoms of angina pectoris, smoking leads to a narrowing of the lumen of blood vessels, impairs blood flow, myocardial nutrition, so the rejection of cigarettes is required.

  • even with IV FC, when a person is practically incompetent, physical activity is necessary: ​​the doctor selects the dose of the load, self-activity is dangerous, since any deviation from the chosen physical activity can provoke irreparable consequences;
  • with angina pectoris, a strict diet with a restriction of fats in favor of dietary fiber is needed, food can be varied, but low-calorie;
  • stress is one of the main enemies of a person with angina pectoris, learning how to manage your emotions is vital: yoga, meditation, oriental practices;
  • traditional medicine also refers to non-drug treatment methods: garlic – an alternative to Nitroglycerin during an attack of angina pectoris, a mixture of garlic, lemon and honey – the most popular combination for the treatment of cardialgia, aloe juice infused with honey, prevents angina pectoris, herb juice is effective motherwort, decoctions of valerian root with dill seeds, a string, marigolds, tea from hawthorn.

All recipes of traditional medicine are agreed with the doctor.

To stop the symptoms of angina pectoris, reduce the risk of a pain attack, seven pharmacological groups are used.

Name of the drug Mechanism of action
Anticoagulants, antiplatelet agents: Cardiomagnyl, Aspirin, Thrombo ACC, Clopidogrel, Warfarin Reduce the clumping of red blood cells and platelets, prevent thrombosis (thrombophlebitis), are used for all types of angina pectoris, reduce the risk of transformation of an attack into a heart attack
Group of lipid-lowering drugs: Simvastatin, Atorvastatin, Rosuvastatin Prevent the formation of atherosclerotic plaques in coronaries, balance lipid metabolism, control cholesterol
Beta-blockers: Bisoprolol, Nebivolol, Carvedilol Medications normalize heart rate, arrhythmia, lower blood pressure
Calcium Antagonists: Nifedipine, Diltiazem, Norvask, Verapamil The essence of the action is the expansion of the vascular lumen, a decrease in blood pressure, restoration of the electrical conductivity of nerve impulses along the myocardium due to a decrease in calcium ions in myocardiocytes
Inhibitors of the LF channels of the sinus node: Ivabradin, Koraksan, Bravadin Drugs control spontaneous diastolic depolarization in the sinus node and regulate heart rate
ACE Inhibitors: Candesartan, Perindopril, Ramipril, Valsartan Block angioenzyme, reducing vascular spasm
Short nitrates (up to an hour): Nitroglycerin, Isacardine, Nitrosorbide;

moderate (up to 6 hours): Cardicet 20, Monosan, Corvaton;

long (up to XNUMX hours) action: Pectrol, Olikard retard, Nitrong-forte

Tablets stop the main symptom of angina pectoris – pain due to the removal of angiospasm, the appointment is correlated with FC pathology, taken before the planned loads to prevent an attack

  • balloon stenting (angioplasty) – after coronary angiography with the determination of the exact localization of stenosis, a special balloon is introduced, which is pumped with air, expands the lumen by pressing an atherosclerotic plaque into the artery wall, the balloon is removed, a metal stent is installed in its place, which maintains the achieved lumen volume until the patient’s life ;
  • bypass surgery – laying of an additional collateral site for feeding the myocardium bypassing damaged coronaries (the vessels of the patient themselves are shunted), which excludes the development of ischemia and heart attack.

Today, angioplasty is considered the most effective method of surgical treatment.

What is this disease and how is it dangerous

Eating vegetables and fruits slows the development of atherosclerosis.

The appearance of angina attacks is almost always a consequence of atherosclerosis of the coronary arteries. You need to direct all efforts to slow the development of atherosclerosis.

If nothing is done, then over time, the risk of developing a heart attack increases sharply. Surgery becomes inevitable.

In the best case, this is ballooning or stenting (angioplasty) with a special metal mesh of vessels affected by atherosclerosis, which will not restore your health, but only reduce the frequency of attacks and the likelihood of a heart attack.

Please be treated in a timely manner!

Treatment of an attack of angina pectoris, of course, is an important link in preventing the progression of coronary heart disease and the development of complications. Treatment is carried out in three directions:

  1. exposure to modifiable risk factors;
  2. drug treatment;
  3. surgical methods.

The second and third deposition are carried out only with the help of a specialist doctor, but each person can affect the risk factors.

The recommendations of the American College of Cardiology include a list of activities whose usefulness and effectiveness in order to prevent angina pectoris and coronary heart disease has been proven and does not raise doubts among experts. Such events include:

  1. Treatment of arterial hypertension, with the target pressure level being numbers below 130/80 mm Hg. Preference is given to such groups of drugs as β-blockers, calcium antagonists, ACE inhibitors. Medication is selected by a doctor!
  2. To give up smoking. In smokers, the risk of developing myocardial infarction (acute ischemic heart disease) is 2 times higher than in non-smokers, and the risk of sudden death is 2-4 times. An interesting fact: the risk of developing coronary artery disease due to smoking is completely eliminated after 2-3 years after a person stops smoking.
  3. Treatment (adequate compensation) of diabetes. Uncompensated diabetes mellitus, as a concomitant disease, accelerates the progression of coronary atherosclerosis and, as a consequence, angina pectoris. Type 2 diabetes mellitus increases the risk of death by 2 times in men and 4 times in women. And with type 1 diabetes mellitus, this risk increases by 3-10 times, so the need for optimal hypoglycemic therapy is widely recognized.
  4. Physical training. In people with a predominantly sedentary lifestyle, the risk of developing coronary heart disease is increased by 1,5-2 times. Experts recommend exercising for 30 minutes at least 4 times a week, or even better every day. The best sports that have a positive effect on the whole body are swimming, jogging, Nordic walking, gymnastics, aerobics, cycling. Remember: the best medicine for the heart is to train its stamina.
  5. Hypolipidemic therapy (therapy aimed at lowering blood lipids) is prescribed by a doctor and is an important component of the treatment of coronary artery disease.
  6. Reducing overweight in the presence of arterial hypertension is an important component of the treatment of patients with coronary artery disease. It is important to adhere to a hypocaloric diet with a sufficient amount of fiber-rich plant foods.

Experts found a very interesting dependence of the risk of coronary heart disease on alcohol by conducting an analysis that combined the results of 34 studies from different countries (USA, England, Japan, Germany, Russia, France, Australia, and many others). Scientists have concluded that moderate alcohol consumption reduces mortality from coronary heart disease. Experts described the so-called U- or J-shaped relationship between alcohol consumption and mortality from coronary heart disease.

Fig. 2. J-shaped curve of the dependence of the risk of coronary heart disease on alcohol.

1 – a group of people who abuse alcohol;

2 – a group of people who drink alcohol moderately;

bold line – no alcohol at all.

It can be seen from the graph that there is an increased risk among people who do not drink alcohol and those who drink excessively compared to those who drink moderately. Under moderate alcohol consumption, understand no more than 1 fluid ounce (28,41 ml) of pure ethyl alcohol per day. According to the study, the consumption of 10-30 g of absolute alcohol per day reduces the risk of coronary heart disease by 20-50%, and stroke and sudden coronary death by 20-30%.

It also follows from the graph that mortality is minimal when drinking alcohol on average 5-10 grams, and relatively safe doses at which mortality is the same in all study groups are 30-40 grams of ethanol.

The question of the influence of psychosocial factors on the risk of developing coronary heart disease remains controversial. The book of Ecclesiastes teaches: “Envy and anger shorten life.” Many convincing scientific evidence suggests that hostility, anger, anger may be associated with the risk of coronary heart disease, but final conclusions have not yet been made. The relationship of IHD with stress can be traced to the fact that, being in frustrated feelings, a person smokes a lot, drinks, overeats, quits sports – and all this directly increases the risk of IHD. Therefore, to prevent the development of coronary heart disease, relaxation and psycho-training are recommended as a method of reducing chronic stress.

Prevention of angina pectoris is important because the prognosis of the disease is unfavorable. Events that prevent the rapid progression of pathology are divided into primary and secondary.

Primary prevention includes:

  • balanced diet, dietary restrictions for life;
  • dosed motor activity;
  • annual medical examination with control of cholesterol and blood sugar;
  • taking medications, according to a scheme developed by a doctor individually, taking into account somatic pathologies;
  • refusal of alcohol, nicotine, drugs.

Secondary prevention measures that improve the prognosis of the disease include:

  • psychological training, control of the emotional sphere, lack of stress;
  • lack of excessive physical activity:
  • taking drugs before the planned load, which prevent the development of an attack;
  • treatment of concomitant diseases, rehabilitation of foci of chronic infection;
  • observation by a cardiologist.

Angina pectoris can lead to disability, there is a constant risk of spontaneous cardiac arrest, so only constant monitoring of your health and careful implementation of all the recommendations of your doctor can help improve the prognosis of angina pectoris.

Prevention of angina pectoris is important because the prognosis of the treatment of the disease is unfavorable. It is impossible to cure the disease with conservative methods. And the risk of it developing into myocardial infarction or sudden death is quite high.

Therefore, you need to start thinking about heart health when it is healthy. It is recommended that you make the few rules below a part of your lifestyle. Prevention of angina pectoris can fit into four simple truths:

  • constant physical activity
  • lack of emotional overstrain,
  • to give up smoking,
  • health monitoring.

Let us examine these truths in more detail.

The human heart is a muscle. Maintaining her tone requires regular exercise.

The loads can be different: walking, running, physical work, gym classes. And all of them will positively affect the state of the heart and strengthen it.

If you are not a professional athlete, do not exhaust the body with exhausting loads. But sitting all day in an office chair is not worth it. You need a middle ground. It is enough to walk a few kilometers daily or to run several circles around your block in the mornings. The main thing is constancy, and then the heart will be ready for exertion.

Stress is your enemy in preventing heart problems. Constant hassle and anxiety negatively affect the resource of the heart muscle. Everyone understands that you can’t put yourself in the sideboard and not worry about anything. But, thinking about your body, you need to properly prioritize.

Не стоит распылять эмоции на проблемы, которые этого не заслуживают. Уже давно отмечено, что неконфликтные люди намного реже стыкаются с проблемами с сердцем. Это касается и стенокардии.

Поэтому, берем за правило: чтобы снизить риск развития «грудной жабы», необходимо снизить количество стрессов в жизни.

Отказ от курения

Курение и профилактика стенокардии – понятия несовместимые. Кислород, который должен доставляться к сердцу кровеносными сосудами, при курении замещается вредными соединениями из табачного дыма. Автоматически мы получаем усугубление одного из факторов развития болезни – ухудшенного снабжения сердца кислородом.

Этот факт касается и борьбы с заболеванием, и его профилактики. Каждой сигаретой мы ухудшаем питание сердца и приближаем момент, когда случится первый приступ боли в груди. Стенокардия намного ближе к тем, кто курит.

В отношении алкоголя существует интересное мнение: спирт отлично расщепляет жировые соединения, которые закупоривают сосуды и приводят к атеросклерозу. Основываясь на этом факте ряд специалистов считает, что алкоголь в умеренных дозах полезен в качестве профилактики стенокардии и других проблем с сердцем.

В пользу этого утверждения говорит и то, что многие старожилы регулярно выпивали бокал вина или рюмку коньяка.Но нельзя принимать этот факт, как руководство к действию.

Если человек ведет здоровый образ жизни, испытывает регулярные физические нагрузки, избегает стрессов, то лучшим решением будет полный отказ от алкоголя.

Нужно держать в уме, что вероятность возникновения стенокардии повышается при сопутствующих заболеваниях. Заболевания легких, печени, сахарный диабет, проблемы с ЖКТ – все это факторы повышения риска развития «грудной жабы».

Регулярные профилактически осмотры у терапевта позволят любые проблемы со здоровьем диагностировать на ранних стадиях. Ранняя диагностика позволяет избавляться от проблем проще всего.

Помним, что сердце – мотор организма. Но любые проблемы с другими органами повышают нагрузки на сердце и существенно сокращают его ресурс.

Как и чем лечат

Лечение стенокардии не предполагает полного устранение проблемы.Задача терапии:

  • снизить риск перехода приступов в инфаркт миокарда или во внезапную смерть;
  • снизить частотность проявления симптомов;
  • устранить проявления болезни.

Разделить лечение можно на четыре группы:

  • снятие симптомов,
  • медикаментозная терапия для снижения риска проявления симптомов,
  • изменение образа жизни,
  • хирургическое вмешательство.

Снять симптомы болезни можно, используя препараты группы нитратов короткого действия.Терапевтический эффект нитратов основан на расширении:

Это улучшает питание ишемических участков миокарда, снижает периферическое сопротивление, улучшает коронарный кровоток.Уменьшение сдавливающей боли в области грудной клетки достигается за счет гемодинамической разгрузки миокарда и снижения объема нагрузок на сердце. Последний факт уменьшает потребности сердца в кислороде.

То есть, поставки кислорода к сердцу после приема нитратов не увеличиваются. Уменьшается потребность в них.Среди нитратов короткого действия распространен единственный препарат: нитроглицерин.Выпускается в форме таблеток или подъязычного спрея и стоит в аптеках от 66-ти рублей.

Для купирования симптомов таблетку нитроглицерина ставят под язык и держат там до полного рассасывания. Чтобы ускорить эффект от приема лекарства, таблетку нитроглицерина можно предварительно раскусить на несколько частей и также поставить под язык.

Для снижения риска возникновения стенокардии, в различных комбинациях назначаются препараты семи групп.Антитромбоцитарные препараты подавляют агрегацию тромбоцитов. Это снижает риск формирования тромбов.

Среди антитромбоцитарных препаратов используется аспирин, эффективный и при стабильной, и при нестабильной стенокардии. Уменьшение риска возникновения коронарного тромбоза снижает риск развития общего инфаркта миокарда.

Гиполипидемики – препараты для предотвращения формирования липидов в крови, которые провоцируют атеросклероз.

Препарат Цена Описание
Симвастатин от 54 руб. В каждой таблетке, в зависимости от дозировки, 10 или 20 мг симвастатина. В упаковке от десяти до ста таблеток.
Аторвастатин от 52 руб. Препарат выпускается в форме таблеток. Каждая содержит 10, 20 или 40 мг аторвастатина. Упаковка может содержать от десяти до ста таблеток.
Розувастатин от 154 руб. Таблетки с действующим веществом розувастатин. В каждой 5, 10, 20 или 40 мг действующего вещества. В упаковке 30 или 60 таблеток.

β-адреноблокаторы – группа препаратов, действие которых направлено на нормализацию частоты сердцебиения и уменьшение частоты сокращений сердечной мышцы.

Препарат Цена Описание
Бисопролол от 79 руб. Препарат в форме таблеток, в каждой из которых может быть по 2,5, 5 или 10 мг бисопролола. Выпускаются в упаковках по 30, 50 или 60 таблеток.
Небиволол от 187 руб. Таблетки с пятью миллиграммами небиволола гидрохлорида в каждой. В упаковке в зависимости от фасовки от 14-ти до 60-ти таблеток.
Карведилол от 69 руб. Выпускается в форме таблеток. В зависимости от дозировки, в каждой может быть 6,25, 12,5 или 25 мг карведилола. В упаковке 30 таблеток.
Препарат Цена Описание
Нифедипин от 28 руб. Выпускается в форме драже и таблеток. Вне зависимости от формы выпуска, одна единица препарата содержит 10 мг действующего вещества нифедипин. В упаковке 50 таблеток или драже.
Дилтиазем от 95 руб. Таблетки, содержащие 60 или 90 мг дилтиазема каждая, в упаковке по 30 штук.
Верапамил от 17 руб. Выпускается в форме таблеток. Действующее вещество верапамила гидрохрорид содержится, в зависимости от дозировки, в объеме 40, 80 или 240 мг в таблетке. Выпускается в упаковках по 50 таблеток.
Препарат Цена Описание
Кораксан от 1100 руб. Таблетки в пленочной оболочке, содержащие 5,39 мг ивабрадина гидрохлорида каждая. В упаковке 56 таблеток.
Бравадин от 392 руб. Таблетки с 5 или 7,5 мг действующего вещества ивабрадина. Упаковка содержит 28 или 56 таблеток.
Препарат Цена Описание
Кандесартан от 160 руб. Таблетки по 28 штук в упаковке, каждая из которых содержит 8, 16 или 32 мг кандесартана цилексетил.
Периндоприл от 66 руб. Таблетки по 30 штук в упаковке. Каждая, в зависимости от дозировки, содержит 4 или 8 мг периндоприла эрбумин.
Рамиприл от 87 руб. Выпускается в форме таблеток по 5 или 10 мг действующего вещества, по 30 таблеток в упаковке.
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Нитраты, о которых уже говорилось в разделе о симптоматической терапии стенокардии. Препараты этой группы различаются по времени действия:

  • короткого действия (до одного часа),
  • умеренного продленного действия (до шести часов),
  • значительного продленного действия (от шести до 24-ти часов).

Нитраты короткого действия Нитроглтицерин, Изакардин, Нитросорбид принимаются непосредственно перед нагрузками, чтобы предотвратить приступ стенокардии. Отсутствие эффекта – повод задуматься над правильностью постановки диагноза.

Функциональный класс Группа нитратов Основные препараты Особенности приема
I
II Нитраты короткого и умеренного продленного действия Кардикет 20, Моносан, Корватон Применение аналогично первому ФК с тем отличием, что временное покрытие нитратами дольше, в зависимости от предполагаемых нагрузок.
III Нитраты значительного продленного действия Пектрол, Оликард ретард, Нитронг-форте Стенокардия третьего функционального класса купируется препаратами значительного продленного действия. При этом обязательно сохранять определенный безнитратный период, чтобы избежать развития устойчивости к нитратам.
IV Нитраты значительного продленного действия Пектрол, Оликард ретард, Нитронг-форте Расписание приема нитратов составляется таким образом, чтобы их действием было покрыто все время.

Основная роль в купировании проявлений заболевания принадлежит образу жизни пациента.Начнем с физической активности.

Даже при стенокардии четвертого функционального класса, когда человек практически недееспособен, физическая активность необходима.Главный враг больного – бездеятельность. У тех, кто большую часть времени проводит в кресле или в кровати, купировать болезнь сложнее. Физические нагрузки для пациента подбирает врач. Даже если это будут всего пару шагов каждые несколько часов – они важны.

При этом запрещена самодеятельность в виде самостоятельного увеличения нагрузок при мнимом улучшении состояния. Приступ практически нельзя предугадать. Поэтому, любые корректировки в системе физических нагрузок возможны только с разрешения врача.

Дальше о курении.Эта вредная привычка – сильный фактор риска развития стенокардии. Связь между сигаретами и рассматриваемой болезнью прямая: курение сужает и повреждает сосуды, из-за чего ухудшается кровоток. Поэтому, при стенокардии отказ от курения – обязателен.При стенокардии альтернатив нет. Бросать курить необходимо

Теперь о питании.В этом вопросе также нет альтернатив. Только достаточно жесткая диета, которая, впрочем, укладывается в понятие здорового питания. Больному не нужно есть только овощи и пить воду. Еда может быть разнообразной.

Главный запрет –продукты, содержащие холестерин. Речь идет о жирах животного происхождения. Из мяса лучше выбирать птицу и рыбу.В остальном, диета при стенокардии проста: больше необработанного зерна в любом виде, больше фруктов и овощей.

И об эмоциях!Стресс – враг в борьбе со стенокардией. Негативных эмоций нужно избегать. С этой задачей помогают справляться дыхательные упражнения и восточные практики: йога, медитация.Задача больного – откорректировать жизнь так, чтобы неприятные ситуации встречались реже. Это сложно, но необходимо.

Хирургическое вмешательство при стенокардии назначается тогда, когда медикаментозная терапия не дала нужного результата. Методы хирургического лечения заболевания обладают достаточной эффективностью и приводят к результату, при котором приступы полностью прекращаются.При стенокардии используется один из двух видов хирургического вмешательства:

  • коронарное шунтирование,
  • баллонная ангиопластика.

Коронарное шунтирование – это прокладка обходного участка на промежутке между аортой и коронарной артерией. В качестве обходного шунта используют артерии или вены, взятые непосредственно у пациента.

Для такой трансплантации берут часть внутренней грудной артерии, если нет противопоказаний этому. Обход участка кровотока со суженным просветом исключает недостаток кислорода под нагрузками и предупреждает развитие ишемии и инфаркта.

Балонная ангиопластика – менее травматическое хирургическое решение проблемы. На основании коронарографии выявляют место наибольшего сужения кровеносного сосуда. Во время операции в это место вводится баллон. Его накачивают в сосуде, расширяя просвет. Баллон после этого спускается и извлекается. Ранее на этом баллонная ангиопластика завершалась. Но сейчас эта процедура в чистом виде недостаточно эффективна.

Баллонную ангиопластику совмещают со стентированием. На место баллона вводится металлический стент, который остается там навсегда. Он удерживает просвет кровеносного сосуда на необходимом уровне.

Баллонная ангиопластика с последующим стентированием – наиболее эффективный вариант хирургического лечения стенокардии.

Стенокардия требует грамотного и разностороннего лечения, включающего применение медикаментов, хирургических вмешательств, коррекцию образа жизни.

Лечение при стенокардии я осуществляю при помощи следующих лекарственных средств:

  • бета-адреноблокаторы (Бисопролол, Метопролол) – уменьшают потребность миокарда в кислороде и улучшают его кровообращение;
  • блокаторы кальциевых каналов (Дилтиазем, Верапамил) – обладают сходным механизмом действия. К ним я прибегаю в случае противопоказаний к бета-блокаторам (например, при тяжелой бронхиальной астме);
  • антиагреганты (Ацетилсалициловая кислота, Клопидогрел) – препятствуют “склеиванию” тромбоцитов, тем самым предупреждают образование тромбов;
  • антикоагулянты (нефракционированный, низкомолекулярный гепарин) – также подавляют процесс формирования тромбов, воздействуя на плазменные факторы свертывания крови;
  • статины (Аторвастатин, Розувастатин) – позволяют замедлить процесс роста атеросклеротических бляшек путем снижения уровня холестерина в крови;
  • нитраты (Нитроглицерин, Изосорбида динитрат) и блокаторы кальциевых каналов дигидропиридинового ряда (Амлодипин, Нифедипин) – вызывают расширение коронарных артерий, что увеличивает приток крови к миокарду;

В стационаре

Клинический случай

Недавно я наблюдал классический пример стенокардии. В отделение неотложной кардиологии бригадой скорой медицинской помощи доставлен мужчина 62 лет. Со слов врача, у пациента в состоянии полного покоя появились сильные сжимающие боли в области сердца, отдающие в левую руку. Прием Нитроглицерина не облегчил боль.

Длительность приступа – около 30 минут. Вызвана »Скорая помощь». Медперсоналом снята ЭКГ – зарегистрировано снижение сегмента ST, даны таблетки Ацетилсалициловой кислоты, Клопидогреля и Метопролола, внутривенно введен низкомолекулярный гепарин. При поступлении в стационар взята кровь на сердечные ферменты. Так как пациент испытывал невыносимую боль, я назначил ему наркотическое обезболивающее средство – Промедол.

Проведена коронарная ангиография. Заключение: стеноз правой коронарной артерии – 75%. Выполнена ЧКВ со стентированием. Результаты анализа кардиологических ферментов исключили инфаркт миокарда. Клинический диагноз: «ИБС. Нестабильная стенокардия IIIB по Браунвальду». Для постоянного приема мною были назначены Ацетилсалициловая кислота, Клопидогрел, Метопролол, Розувастатин и Изосорбида мононитрат при болях.

После выписки

В основном медикаментозное лечение после выписки из стационара не меняется. Большинство препаратов пациент должен принимать пожизненно. Подробнее о схемах и дозировке лекарств можно прочитать здесь. Некоторые средства больному не показаны для длительного использования, например, антикоагулянты, за исключением, когда они необходимы для терапии сопутствующих заболеваний.

Если пациенту было проведено ЧКВ со стентированием, то он должен принимать 2 антиагрегантных препарата (Ацетилсалициловую кислоту и Клопидогрел) как минимум 1 год. Дальше ему нужно перейти на постоянный прием 1 лекарства – если у него нет язвенной болезни желудка и 12-перстной кишки, то Ацетилсалициловую кислоту, если есть – то Клопидогрел.

Для профилактики развития язвы я рекомендую свои пациентам добавить препараты, снижающие образование в желудке соляной кислоты – Омепразол, Пантопразол.

Советы специалиста: что можно, а что нельзя делать при стенокардии

Я всегда говорю своим больным: чтобы лечение оказалось успешным и сохраняло свой эффект, нужно соблюдать определенные правила и придерживаться следующих рекомендаций.

  • вредные привычки – обязательно нужно бросить курить, т.к. курение является одним из основных факторов прогрессирования атеросклероза. Также необходимо ограничить употребление спиртных напитков до 2-3 бокалов вина в неделю;
  • питание – желательно уменьшить в своем рационе продукты с высоким содержанием животных (насыщенных) жирных кислот (сало, жирное жареное мясо, копчености, сливочное масло и т.д.), при этом увеличив количество продуктов, богатых ненасыщенными (омега-3,6) жирными кислотами (рыба, овощи, растительное масло). Также ежедневное меню пациента должно содержать фрукты, орехи, крупы, злаки. Больным сахарным диабетом надо значительно снизить процент легкоусваиваемых углеводов (конфеты, шоколад, макароны, пирожные, торты, булочки и т.д.). Более полная информация о питании при стенокардии здесь ;
  • контроль артериального давления – он достигается ежедневным измерением АД, ограничением соли до 3 г в день, постоянным приемом лекарств для его понижения с соблюдением назначенных дозировок и кратности;
  • борьба с ожирением – этому способствуют диета и регулярные физические упражнения (бег, езда на велосипеде, плавание). При тяжелой стенокардии разрешена утренняя гимнастика и ходьба не менее 3 км в день;
  • секс – вопреки всем мифам, сексом при стенокардии заниматься разрешено, но с определенными нюансами. Подробнее о них можно узнать здесь .

Категорически запрещены курение, интенсивные нагрузки (тяжелая атлетика, экстремальные виды спорта), самовольное прекращение приема назначенных лекарственных препаратов. Все это может привести к резкому ухудшению состояния больного, повысить риск инфаркта миокарда и смерти.

Советы специалиста: что можно, а что нельзя делать при стенокардии

Я всегда говорю своим больным: чтобы лечение оказалось успешным и сохраняло свой эффект, нужно соблюдать определенные правила и придерживаться следующих рекомендаций.

  • вредные привычки – обязательно нужно бросить курить, т.к. курение является одним из основных факторов прогрессирования атеросклероза. Также необходимо ограничить употребление спиртных напитков до 2-3 бокалов вина в неделю;
  • питание – желательно уменьшить в своем рационе продукты с высоким содержанием животных (насыщенных) жирных кислот (сало, жирное жареное мясо, копчености, сливочное масло и т.д.), при этом увеличив количество продуктов, богатых ненасыщенными (омега-3,6) жирными кислотами (рыба, овощи, растительное масло). Также ежедневное меню пациента должно содержать фрукты, орехи, крупы, злаки. Больным сахарным диабетом надо значительно снизить процент легкоусваиваемых углеводов (конфеты, шоколад, макароны, пирожные, торты, булочки и т.д.). Более полная информация о питании при стенокардии здесь ;
  • контроль артериального давления – он достигается ежедневным измерением АД, ограничением соли до 3 г в день, постоянным приемом лекарств для его понижения с соблюдением назначенных дозировок и кратности;
  • борьба с ожирением – этому способствуют диета и регулярные физические упражнения (бег, езда на велосипеде, плавание). При тяжелой стенокардии разрешена утренняя гимнастика и ходьба не менее 3 км в день;
  • секс – вопреки всем мифам, сексом при стенокардии заниматься разрешено, но с определенными нюансами. Подробнее о них можно узнать здесь .

Категорически запрещены курение, интенсивные нагрузки (тяжелая атлетика, экстремальные виды спорта), самовольное прекращение приема назначенных лекарственных препаратов. Все это может привести к резкому ухудшению состояния больного, повысить риск инфаркта миокарда и смерти.

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.

Detonic