Angina pectoris – causes, symptoms, diagnosis and treatment

The leading cause of the disease is atherosclerotic plaques located in the coronary arteries. They block the lumen of the vessel, causing a shortage of blood supply. With narrowing of the lumen of the coronary artery by more than half, the clinical manifestations of the disease begin. There are also certain risk factors that contribute to a greater degree to the development of myocardial ischemia and the occurrence of sternal angina pectoris. These include:

  • high cholesterol;
  • BMI (excess body weight);
  • arterial hypertension;
  • age over 45 years;
  • diabetes;
  • smoking.

Expanding atherosclerotic plaques burst into the lumen of the artery. Platelets settle on the surface of the broken capsule and a thrombus forms, which even more overlaps the vessel. Simultaneously with these processes, a spasm of the coronary artery occurs and blood flow to the myocardium sharply decreases. Because of this, the progression of coronary heart disease and the occurrence of unstable angina pectoris occur.

The following factors can provoke the development of seizures:

  1. Excessive physical activity.
  2. The aggravation of arterial hypertension and chronic heart failure.
  3. Alcoholism.
  4. Exacerbation of chronic diseases.

Pain behind the sternum and in the region of the heart, radiating to other parts of the body marked in the image

The main complaints with unstable angina are pain behind the sternum and in the heart. Discomfort worries mainly in the left half of the chest. The pain most often radiates to the left half of the neck and lower jaw, to the left arm or shoulder blade. Sometimes it is localized in a particular of the above places. Often, patients complain of girdle pain in the abdomen. Along with these symptoms, fear of death, lack of air, and dizziness appear.

Criteria for unstable angina pectoris:

  • increased pain attacks;
  • increase in pain intensity;
  • attacks are longer, reach 15 or more minutes;
  • the occurrence of pain in response to performing less than usual physical exertion;
  • the appearance of attacks at rest;
  • an increase in the need for taking Nitroglycerin and a decrease in its effect.

With progressive and first-occurring angina pectoris, the above symptoms worry for a month. With post-infarction pain, they may appear already on the second day after myocardial infarction.

Prinzmetal angina (vasospastic angina) is the occurrence of ischemia due to excessive spasm of the coronary artery. She has a very poor prognosis. This is due to the possible development of focal heart attack in the first months after an attack. Typically, this variant of angina is diagnosed in men of a younger age.

In addition to the complaints, the doctor, without fail, assesses the general condition of the hemodynamics of the patient. The rhythm, frequency and strength of the pulse wave filling is studied, blood pressure is measured. An important diagnostic criterion is the reaction to Nitroglycerin.

It is imperative to record the electrocardiogram in at least 12 leads (standard ECG). Signs of ischemia (criteria for unstable angina):

  • decrease or rise in the ST segment;
  • negative or excessively high pointed T waves;
  • a combination of both of these features.

Holter monitoring

  1. General blood analysis. Leukocytosis is possible – an increase in the number of leukocytes.
  2. LHC (biochemical blood test). Here the enzymes KFK, AST, LDH change, the level of troponin rises.
  3. Daily Holter ECG study. Allows you to identify all cases of ischemia during the day and correlate them with emerging pain in the heart. It is possible to identify episodes of heart rhythm disturbance.
  4. Ultrasound of the heart (echocardiography). Using ultrasound to determine the violation of the contractility of the sections of the heart muscle due to ischemia.
  5. Radionuclide scintigraphy. It is performed if the clinical manifestations and laboratory data are not consistent. It allows you to distinguish areas of myocardial necrosis from ischemic tissues.
  6. Angiography of the coronary arteries. It allows you to determine the degree of patency of the coronary arteries and solve the question of the appropriateness of their stenting.

In cases where pain occurs (there is precisely cardiological pain), however, there are no changes on the ECG, the patient should also be hospitalized. This is due to the fact that the electrocardiographic signs of ischemia may be delayed relative to clinical manifestations by several days. For this reason, the volume of examinations must be completed in full.

In the treatment of unstable angina, timely diagnosis of the disease is important. For this reason, any periodic

should be examined. In case of intense pain behind the sternum, which cannot be relieved by taking Nitroglycerin, you need to call an ambulance to immediately eliminate myocardial infarction or acute ischemia.

Inpatient treatment of unstable angina should be carried out in the therapeutic or cardiology departments. In especially severe cases or life-threatening conditions, the patient is constantly in the intensive care and resuscitation department.

Even before hospitalization, immediately when pain occurs, you need to take 1-3 tablets of Nitroglycerin and Aspirin tablet. The last drug is taken to prevent the formation of blood clots in the problem coronary vessel.

General principles for the treatment of unstable angina pectoris:

  1. Restriction of physical activity with the appointment of half-bed or bed rest.
  2. Frequent meals in small portions up to 6 times a day.
  1. Intravenous drip of nitrates, especially in the early days of the disease (Isosorbide dinitrate, Isoket). Further, drugs from this group are gradually canceled.
  2. Introduction of Heparin. In the first hours, intravenously, then subcutaneously about four times a day. In parallel, blood coagulation is monitored.
  3. Aspirin at a dose of 100 – 200 mg per day. To prevent complications of the gastric mucosa, enteric forms of Aspirin (Cardiomagnyl, Aspirin-cardio) are used.
  4. ACE inhibitors (enalapril, perindopril).
  5. Beta-blockers (Propranolol, Metoprolol). Contraindicated in diseases of the lungs and angina of Prinzmetal.
  6. In the case of Prinzmetal angina, calcium channel antagonists are prescribed (Verapamil, Nifedipine, Corinfar). With vasospastic angina pectoris have a more pronounced effect than nitroglycerin.
  7. Diuretics (diuretics). Appointed with concomitant congestive heart failure (Furosemide, Hydrochlorothiazide, Indapamide).
  8. Narcotic analgesics with severe non-stopping pain syndrome (Morphine, Fentanyl).

In case of complications in the form of pulmonary edema or myocardial infarction, further symptomatic therapy is carried out in the cardioreanimation departments. In some cases, diagnostic coronary angiography becomes a therapeutic measure – supplemented by plastic surgery of the vessel or its stenting. Another surgical treatment for angina pectoris is coronary artery bypass grafting.

The main reason for stable angina pectoris is atherosclerotic lesion of the blood vessels of the heart, leading to their severe stenosis (in 90-97% of patients). For the development of an attack of stable angina, the loss of lumen of the coronary arteries should be more than 50-75%.

A sharp decrease in the blood supply to the heart muscle can be caused by a prolonged spasm at the level of small intramyocardial coronary vessels associated with local hypersensitivity of smooth muscle cells of the vascular wall to various stimuli and a change in the tone of the autonomic nervous system. In elderly patients, a sore throat can reflexively accompany bouts of gallstone disease, pancreatitis, sliding hernia of the esophagus, and a tumor of the cardiac section of the stomach.

Stable angina pectoris can develop with rheumatoid damage to the connective tissue, dystrophy of the coronary arteries with amyloidosis, relative coronary insufficiency due to aortic stenosis or hypertrophic cardiomyopathy.

Provoke an attack of stable angina can be plentiful food, cold windy weather, stress. Risk factors for the development of coronary artery atherosclerosis and stable angina pectoris include arterial hypertension, hypercholesterolemia and obesity, diabetes mellitus, a genetic predisposition, smoking, hypodynamia, in women – premature menopause, prolonged use of COCs. The more pronounced the pathology of the coronary arteries, the lower the threshold for the development of an attack of stable angina in response to provocative factors.

Depending on the level of tolerated load, 4 functional classes of stable angina are distinguished.

Class I stable angina includes mild forms with initial manifestations of the disease. Angina attacks rarely occur, only with prolonged and excessive physical effort and disappear when the load is stopped or slowed down. Normal loads (walking at a speed of 5 km / h) are well tolerated and do not cause discomfort.

Grade III is manifested by a pronounced decrease in physical activity, the appearance of chest pain attacks during normal walking at a distance

Patients with IV functional class belong to the most difficult group and are not able to perform minimal physical work without developing an attack. Symptoms of stable angina develop when walking less than 100 meters slowly, getting up from a chair, putting on shoes, even at rest.

Stable angina pectoris is manifested by the occurrence of anginal attacks during walking, physical exertion, or intense emotional stress. Patients with stable angina pectoris usually complain of discomfort in the chest (heaviness, pressure, suffocation) or clear pain behind the sternum, which has a compressive, bursting, pressing or burning character. The pain radiates to the left shoulder and arm, the interscapular region, the lower jaw, the epigastric region, less often on both sides of the chest, posterior parts of the neck, below the navel.

During an attack of stable angina pectoris, patients cannot breathe fully, usually they press a palm or fist against the sternum, try to slow down the pace of movement, freeze, take a standing or sitting position. The pain syndrome is accompanied by a feeling of “fear of death”, rapid fatigue, sweating, nausea, vomiting, increased blood pressure (less often hypotension), increased heart rate (tachycardia).

The attack of stable angina pectoris gradually increases, lasts from 1 to 10-15 minutes and quickly subsides after the load is stopped or nitroglycerin is taken (usually within 5 minutes). If the pain attack lasted more than 15-20 minutes, it should be assumed that it develops into myocardial infarction. In young patients, the phenomenon of “passing through pain” sometimes manifests itself, in which the pain decreases or disappears with an increase in the intensity of the load due to the lability of vascular tone.

With a typical manifestation of stable angina, the diagnosis in 75% of cases can be established on the basis of anamnesis, examination data, auscultation, and ECG. The main criterion is a clear connection of the pain syndrome with walking, physical exertion, emotional experiences and disappearance at rest or after taking nitroglycerin.

ECG changes at rest in most patients with stable angina pectoris are not observed; on an ECG performed during a sore throat, a sign of acute ischemia is a decrease in the ST segment, flattening or inversion of the T wave in many chest leads, heart rhythm disturbance. If there is doubt in the diagnosis of stable angina, daily ECG monitoring is performed, revealing the alternation of painful and painless episodes of myocardial ischemia and determining the duration of ischemic changes.

Bicycle ergometry and a treadmill test allow you to assess the level of tolerated physical activity without developing an attack while recording heart rate and ECG, and measuring blood pressure. The criterion for a positive stress test for VEM is an ST segment shift of more than 1 mm, a duration of more than 0,08 s, or the development of an attack of stable angina. If it is impossible to perform a VEM and a treadmill test, transesophageal electrocardiostimulation (CPEX) is performed to artificially increase heart rate and provoke an anginal attack.

EchoCG alone is used for differential diagnosis of pain with stable angina pectoris with chest pain of non-coronary origin. More informative and sensitive stress echocardiography reveals ischemic disorders, local areas of ventricular myocardial akinesia, hypokinesia and dyskinesia, which were not at rest.

Myocardial perfusion scintigraphy (with Tl-201 or Tc-99), supplemented with physical activity or pharmacological breakdown, is performed to assess myocardial blood supply, identify insufficiently perfused areas, the degree of damage to the coronary arteries.

Clinical and laboratory diagnosis of stable angina pectoris is more of an auxiliary value: the determination of hematocrit, glucose levels, total cholesterol, LDL and HDL, LDH, AST and ALT, creatinine, T3, T4, TSH is important for identifying concomitant pathology, risk factors, eliminating other causes of pain syndrome.

Diagnostic CT coronary angiography is a reference method for diagnosing the condition of the coronary bed: it allows you to determine the type of myocardial blood supply, the presence of coronary atherosclerosis, assess the severity of stenosis, identify the abnormal anatomy of the coronary arteries, determine the choice of treatment for stable angina pectoris.

The goal of treating stable angina pectoris is to reduce the frequency and intensity of attacks and reduce the risk of complications: myocardial infarction, heart failure, sudden death. The basis of pharmacological therapy is the appointment of three main groups of anti-ischemic drugs: nitrates, b-blockers and slow calcium channel blockers, which reduce myocardial oxygen demand.

For quick relief of a pain attack of stable angina pectoris, nitroglycerin is used sublingually – tablet form or spray. Sustained nitrates (isosorbide dinitrate, pentaerythritol tetranitrate) are prescribed for the prevention of attacks of stable angina with a frequency of development of 1 time per week.

With stable angina pectoris, the use of b-blockers is advisable: non-selective (propranolol, nadolol), cardioselective (bisoprolol, atenolol), causing peripheral vasodilation (carvedilol). Calcium channel blockers – verapamil, nifedipine, their combination, as well as retard forms are effective in treating stable angina pectoris. Mandatory therapy for stable angina pectoris are antiplatelet agents, lipid-lowering drugs.

Surgical treatment of stable angina pectoris consists of myocardial revascularization, and includes percutaneous angioplasty (balloon dilatation) or stenting of a portion of the coronary artery narrowed by an atherosclerotic process; coronary artery bypass grafting with the creation of anastomosis between the aorta and coronary artery distal to the site of narrowing.

Stable angina pectoris over the years may not show a tendency to progression. With proper treatment and management of such patients, a cardiologist can control the symptoms of the disease (stop the attacks and avoid their re-development). The prognosis of stable angina pectoris is relatively favorable, depending on the degree of coronary obstruction and the number of affected coronary arteries. Seven-year survival of patients with adequate therapy is 97%. With the progression of stable angina pectoris, the risk of developing myocardial infarction and sudden cardiac death increases.

To prevent stable angina pectoris, it is necessary to exclude risk factors for coronary heart disease: limit the intake of fats, salt, sugar, reduce body weight, stop smoking. It is also important to ensure the normalization of blood pressure and the correction of disorders of carbohydrate metabolism.

The leading cause of angina pectoris, as well as coronary heart disease, is constriction of the coronary vessels caused by atherosclerosis. Angina attacks develop with narrowing of the lumen of the coronary arteries by 50-70%. The more pronounced atherosclerotic stenosis, the more severe angina pectoris. The severity of angina pectoris also depends on the extent and location of stenosis, on the number of affected arteries. The pathogenesis of angina pectoris is often mixed, and along with atherosclerotic obstruction, processes of thrombosis and spasm of the coronary arteries can occur.

Sometimes angina pectoris develops only as a result of angiospasm without arteriosclerosis of the arteries. In a number of pathologies of the gastrointestinal tract (diaphragmatic hernia, gallstone disease, etc.), as well as infectious-allergic diseases, syphilitic and rheumatoid vascular lesions (aortitis, periarteritis, vasculitis, endarteritis), reflex cardiospasm caused by disturbance of the higher nerve can develop arteries of the heart – the so-called reflex angina pectoris.

A typical sign of angina pectoris is pain behind the sternum, less often to the left of the sternum (in the projection of the heart). Pain can be compressive, pressing, burning, sometimes cutting, pulling, drilling. Pain intensity can be from tolerant to very pronounced, causing patients to moan and scream, to fear a near death.

Pain radiates mainly to the left arm and shoulder, lower jaw, under the left shoulder blade, into the epigastric region; in atypical cases – in the right half of the trunk, legs. Irradiation of pain in angina pectoris is caused by its spread from the heart to the VII cervical and IV thoracic segments of the spinal cord and further along the centrifugal nerves to the innervated zones.

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Pain with angina often occurs at the time of walking, climbing stairs, effort, stress, can occur at night. The attack of pain lasts from 1 to 15-20 minutes. Factors that facilitate an attack of angina pectoris are nitroglycerin intake, standing or sitting.

During the attack, the patient experiences a shortage of air, tries to stop and freeze, presses his hand to his chest, turns pale; the face takes a pained expression, the upper limbs grow colder and numb. At first, the pulse quickens, then slows down, possibly the development of arrhythmias, often extrasystole, increased blood pressure. A prolonged angina attack can develop into myocardial infarction. Long-term complications of angina pectoris are cardiosclerosis and chronic heart failure.

When recognizing angina pectoris, patient complaints, nature, localization, irradiation, duration of pain, conditions of their occurrence and attack relief factors are taken into account. Laboratory diagnosis includes a study in the blood of total cholesterol, AST and ALT, high and low density lipoproteins, triglycerides, lactate dehydrogenase, creatine kinase, glucose, coagulogram and blood electrolytes. Of particular diagnostic significance is the definition of cardiac troponins I and T – markers indicating myocardial damage. Identification of these myocardial proteins indicates a microinfarction or myocardial infarction and prevents the development of post-infarction angina pectoris.

An ECG taken at the height of an attack of angina pectoris reveals a decrease in the ST interval, the presence of a negative T wave in the chest leads, impaired conduction and rhythm. Daily ECG monitoring allows you to record ischemic changes or their absence with each attack of angina pectoris, heart rate, arrhythmia. Increasing heart rate before an attack allows you to think about angina pectoris, normal heart rate – about spontaneous angina pectoris. Echocardiography with angina reveals local ischemic changes and impaired myocardial contractility.

Velgoergometry (VEM) is a breakdown that shows what maximum load a patient can tolerate without the risk of developing ischemia. The load is set using an exercise bike until the submaximal heart rate is reached with simultaneous recording of the ECG. With a negative test, submaximal heart rate is achieved in 10-12 minutes. in the absence of clinical and ECG manifestations of ischemia. A sample is considered positive, accompanied at the time of loading by an attack of angina pectoris or a shift of the ST segment by 1 or more millimeters. Detection of angina pectoris is also possible by inducing controlled transient myocardial ischemia using functional (transesophageal atrial stimulation) or pharmacological (isoproterenol tests with dipyridamole) stress tests.

Myocardial scintigraphy is performed to visualize perfusion of the heart muscle and identify focal changes in it. The radioactive drug thallium is actively absorbed by viable cardiomyocytes, and with angina pectoris accompanied by coronary sclerosis, focal zones of myocardial perfusion are detected. Diagnostic coronarography is performed to assess the localization, degree and prevalence of damage to the arteries of the heart, which allows you to decide on the choice of treatment method (conservative or surgical).

It is aimed at stopping, as well as preventing attacks and complications of angina pectoris. Nitroglycerin serves as a first-aid drug for an attack of angina pectoris (keep on a piece of sugar in the mouth until completely resorbed). Pain relief usually occurs after 1-2 minutes. If the attack has not stopped, nitroglycerin can be reused at intervals of 3 minutes. and no more than 3 times (due to the danger of a sharp drop in blood pressure).

Routine drug therapy for angina pectoris includes the use of antianginal (anti-ischemic) drugs that reduce the oxygen demand of the heart muscle: nitrates of prolonged action (pentaerythritol tetranitrate, isosorbide dinitrate, etc.), b-adrenergic blockers (anaprilin, oxprenolol, etc.), calcidomin (verapamil, nifedipine), trimetazidine, etc.

In the treatment of angina pectoris, it is advisable to use antisclerotic drugs (a group of statins – lovastatin, simvastatin), antioxidants (tocopherol), antiplatelet agents (acetylsalicylic acid). According to indications, prophylaxis and treatment of conduction and rhythm disturbances are carried out; with angina pectoris of a high functional class, surgical myocardial revascularization is performed: balloon angioplasty, coronary artery bypass grafting.

The main cause of angina pectoris is coronary atherosclerosis. With angina pectoris, there is usually a severe (usually three-vessel) lesion of the coronary arteries. An atherosclerotic plaque, often complicated by thrombosis and arterial spasm, is a morphological substrate of dynamic coronary obstruction. Angina pectoris attaches to angina pectoris as narrowing of the lumen of the coronary vessels progresses, aggravating the course of the latter.

In addition to atherosclerotic lesions, other diseases accompanied by an increase in the oxygen demand of the heart muscle can contribute to the occurrence of myocardial ischemia: arterial hypertension, hypertrophic cardiomyopathy, stenosis of the aortic orifice, coronaritis, partial blockage of the coronary arteries by thromboembolas or syphilitic gum, and others. develop during sleep, it is assumed that the pathogenesis of the disease is due to an increase in the tone of the vagus nerve.

The development of angina pectoris is often facilitated by conditions that exacerbate myocardial ischemia (fever, anemia, hypoxia, infection, tachyarrhythmia, diabetes mellitus, thyrotoxicosis). Among a number of non-modifiable (unremovable) risk factors for angina pectoris are considered age over 50-55 years, menopause in women, Caucasoid race, heredity; modifiable (potentially removable) factors include obesity, smoking, lack of exercise, metabolic syndrome, increased blood viscosity, etc.

Attacks of anginal pain with rest angina develop against the background of complete physical calm, when a person is in a horizontal position in bed, more often during sleep or in the early morning hours. The role of a kind of load that causes myocardial ischemia in case of resting angina pectoris is performed by an increase in venous inflow to the heart in the supine position.

A sudden attack of angina pectoris forces the patient to wake up from sudden asphyxiation or a feeling of compression in the chest. Attacks of resting angina pectoris occur during REM sleep, when there are dreams, so often the patient reports that in a dream he had to quickly run or lift weights. According to modern ideas, the REM phase represents endogenous stress, accompanied by excitation of the autonomic nervous system and the release of catecholamines.

An attack of angina pectoris is accompanied by a state of increased anxiety, anxiety, fear of death. The pain syndrome is sharply intense; the pains are localized behind the sternum, have a compressive, pressing character, extend to the jaw, shoulder blade, and left arm. The pain makes the patient freeze in one position, because the slightest movement causes unbearable suffering. An anginal attack is characterized by a longer duration (5-15 minutes) and severity compared with angina pectoris; Often, to stop it, taking 2-3 tablets of nitroglycerin is required.

Against the background of a sore throat, pronounced autonomic reactions develop: tachycardia, increased blood pressure, increased breathing, sweating, severe pallor or hyperemia of the skin, nausea, dizziness. In most cases, nighttime episodes of rest angina are accompanied by exertional angina during physical activity in the daytime. An attack of angina pectoris, which lasted up to 20-30 minutes, as well as an increase or increase in anginal pain, requires immediate hospitalization and observation by a cardiologist.

A patient with rest angina pectoris needs an in-patient examination with a full range of clinical, laboratory and instrumental diagnostics. On an ECG with resting angina pectoris, ST segment elevation or depression is usually detected, indicating the presence of critical stenosis of the coronary artery, rhythm disturbance and cardiac conduction; signs of post-infarction cardiosclerosis (abnormal Q wave and negative T wave).

Conducting stress tests (bicycle ergometry, treadmill test) with resting angina pectoris is not always informative – the results may be negative. Often, signs of ischemia can be detected only during daily ECG monitoring. Echocardiography is performed for all patients with rest angina pectoris, which allows assessing myocardial contractility and detecting concomitant cardiac pathology. Minimum biochemical blood tests include determination of total cholesterol, high and low density lipoproteins, AST and ALT, triglycerides, glucose; coagulogram analysis.

To assess the condition of the coronary arteries and determine therapeutic tactics, all patients with rest angina pectoris are shown to perform X-ray coronary angiography or its modern modifications (CT coronary angiography, multispiral CT coronary angiography). To identify areas of ischemia and assess coronary perfusion, a heart PET scan is performed (positron emission tomography). Pain from pleurisy, intercostal neuralgia, diverticulums of the esophagus, hernia of the esophageal opening of the diaphragm, ulcer and cancer of the stomach should be distinguished from rest angina.

An approach to the treatment of resting angina pectoris includes non-pharmacological measures to correct lifestyle, drug therapy, and surgical intervention for myocardial revascularization. The behavior model for resting angina pectoris requires the abandonment of smoking, drinking alcohol and energy drinks; following a diet that restricts cholesterol, animal fats, caffeine, salt; decrease in overweight.

In an acute anginal attack, rest is necessary, immediate administration of nitroglycerin under the tongue. With a protracted, non-stopping attack, an ambulance call is required. Routine treatment of rest angina pectoris is carried out by drugs of various groups; usually prescribed antiplatelet drugs (acetylsalicylic acid), beta-blockers (anaprilin, atenolol, propranolol), statins (atorvastatin, simvastatin), ACE inhibitors (enalapril), calcium ion antagonists (nifedipine, verapamonitrate nitrate, or isosorbide dinitrate).

With rest angina pectoris, as a rule, there are indications for cardiosurgical treatment. The operation of choice is balloon angioplasty and stenting of the coronary arteries. The results of coronary angioplasty are high – in patients angina attacks stop, myocardial contractile function improves. In some cases, the occurrence of restenosis – repeated narrowing of the artery.

In severe or multiple lesions of the arteries, coronary artery bypass grafting with the creation of alternative pathways for coronary blood flow is indicated. In 20–25% of patients undergoing CABG, angina pectoris resumes within 8–10 years, which requires repeated coronary artery bypass grafting.

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Classification

Unstable angina is inherently an exacerbation of chronic coronary heart disease (coronary heart disease). Under the influence of certain factors, the frequency of seizures, the duration of pain and their intensity increase. The tolerance of physical activity is reduced.

There are 4 types of unstable angina pectoris:

  1. The first arising angina pectoris.
  2. Progressive angina pectoris.
  3. Postinfarction angina pectoris.
  4. Prinzmetal’s angina pectoris.

Usually, any of the variants of unstable angina pectoris after treatment becomes stable angina pectoris, but with a decrease in exercise tolerance. In people, this disease is called a “pre-infarction condition” due to the fact that a complication of myocardial infarction often occurs.

Angina pectoris is a serious chronic disease of the cardiac system, in which pressing or burning pain occurs due to a sharp deficiency of oxygen in the cells of the heart muscles.

To determine the severity of symptoms, there is a classification or stress classes according to FC (functional class): FC 1, 2, 3, 4. What is it, let’s understand in more detail:

  • FC 1 is the first mild that does not affect daily activity, the degree of the disease. Pain appears only with intense and prolonged work, heavy physical exertion or severe stress.
  • With FC 2, there is a limitation of human activity. Pain occurs when walking more than 500 meters or climbing stairs for 2 flights. The likelihood of attacks increases when walking in cold weather, with emotional arousal or the first time after sleep, after a heavy meal.
  • FC 3 involves significant restrictions on physical activity. A pain attack can begin when walking from 100 to 200 meters, or climbing 1 flight of stairs. More often among the cores it is the class FC 3 that is common.
  • FC 4 is a form in which any physical work causes pain. This is a dangerous severe stage of the disease (disability), in which even at rest the patient may have an attack.

With the forms of FC 3 and FC 4, during attacks, there is a sharp pain in the left side of the chest, behind the sternum, sometimes with spreading to the left arm, shoulder blade, but severe shortness of breath, angry cough and general weakness can only appear.

According to the international classification adopted by WHO (1979) and the All-Union Cardiology Scientific Center (VKNC) of the Academy of Medical Sciences of the USSR (1984), the following types of angina are distinguished:

Angina pectoris – occurs in the form of transient episodes of sternal pain caused by emotional or physical stress that increases the metabolic needs of the myocardium (tachycardia, increased blood pressure). Usually the pain disappears at rest or is stopped by taking nitroglycerin. Angina pectoris includes:

The first arising angina pectoris lasting up to 1 month. from the first manifestation. It may have a different course and prognosis: to regress, go into stable or progressive angina pectoris.

Stable angina pectoris – lasting more than 1 month. According to the patient’s ability to tolerate physical activity, it is divided into functional classes:

  • Grade I – good tolerance of normal physical exertion; the development of angina attacks is caused by excessive loads, performed for a long time and intensively;
  • Grade II – normal physical activity is somewhat limited; the occurrence of angina attacks is provoked by walking on flat terrain for more than 500 m, climbing stairs more than 1 floor. The development of an attack of angina pectoris is influenced by cold weather, wind, emotional arousal, the first hours after sleep.
  • Grade III – normal physical activity is severely limited; angina attacks are caused by walking at the usual pace on flat terrain for 100-200 m, climbing stairs to the 1st floor.
  • Grade IV – angina pectoris develops with minimal physical exertion, walking less than 100 m, in the middle of sleep, at rest.

Progressive (unstable) angina pectoris – an increase in the severity, duration and frequency of seizures in response to the patient’s usual load.

Spontaneous (special, vasospastic) angina pectoris – caused by a sudden spasm of the coronary arteries. Angina attacks develop only at rest, at night or early in the morning. Spontaneous angina pectoris, accompanied by a rise in the ST segment, is called variant, or Prinzmetal angina.

Progressive, as well as some variants of spontaneous and first-occurring angina, are combined into the concept of “unstable angina.”

Symptoms of stable angina pectoris

  • recovery and return to normal activity;
  • stabilization of state;
  • development of cardiac pathologies;
  • sudden death.

The main symptoms and signs of unstable angina, in any form and classification, include a sudden onset of compression, pain in the sternum and radiating to other parts of the body, for the initial treatment and relieve pain, it is enough to stop active stress.

  • the first manifested (newly arisen) angina pectoris is an attack that manifests itself for the first time in life or for a long stable without an attack period;
  • progressive angina pectoris – a significant deterioration in the course of bouts of unstable angina, deterioration in general condition and reaction to drugs.
  • angina pectoris is a steadily recurring seizure upon the occurrence of certain conditions (overwork, stress, etc.);
  • angina pectoris – bouts of pain in the absence of obvious provocative manifestations.

Special types of unstable state in angina pectoris include:

  • post-infarction angina pectoris – recurrence of angina attacks during remission after a heart attack (up to 4 weeks);
  • angina pectoris after CABG – the occurrence of angina pectoris after surgical operations performed on the heart and blood vessels of the patient (for up to 5 weeks).
  • primary – provoked by diseases of the heart, large vessels or concomitant diseases (pressure and heart rhythm disturbances, atherosclerosis, varicose veins and others);
  • secondary – provoked by non-cardiological causes – infections, side effects of drugs, anemia, hypoxia and other factors.

The most dangerous are those forms of unstable angina, which have a different course, but provoking a deterioration in the work of the heart and the severity of the symptoms of its diseases in the patient. In all manifestations, there is a high risk of subsequent provocation of the development of pathologies of the heart and the death of the patient – these include the first or newly manifested angina pectoris, progressive forms of angina pectoris and post-infarction form.

Physical and emotional stress leads to the fact that the heart needs more oxygen. If there is not enough oxygen entering the myocardium, then ischemia develops. This condition is manifested mainly by pain in the heart, lack of oxygen. Angina pectoris: what is the pathology of heart disease?

  • People call angina pectoris “angina pectoris”.
  • This is one of the conditions that occurs as a result of the development of ischemia and atherosclerosis.
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History of pathology:

  • This pathology was first described by William Heberden in 1772.
  • His characteristic of this syndrome was: “A feeling of constriction appears in the chest, the patient experiences anxiety, especially after physical exertion.”
  • At first, the scientist could not relate these symptoms and heart disease, but after some time, new researchers proved the connection of angina pectoris and damage to the coronary arteries of the heart.

Today it is already known that angina pectoris develops against the background of narrowed vessels and acute insufficiency of coronary blood supply. A similar condition occurs with a mismatch in the volume of blood, which comes with a really necessary need.

  • Intense pain sensations of a burning, constricting or oppressive nature that can radiate to the neck, left shoulder blade, arm, lower jaw.
  • Dyspnea.
  • Feeling of fear.

Painful sensations last from 1 to 15 minutes and stop after stopping exposure to a provoking factor or taking Nitroglycerin. If the pain persists and lasts longer, you must seek medical help, as myocardial infarction may develop.

Doctors often describe one main symptom by which angina pectoris can be recognized – this is “pain of one finger”, when a person can point to the place where he has pain with just one finger. If there is a symptom of “pain of one fist”, then there is a likelihood of developing a heart attack. In this case, the patient urgently needs hospitalization.

Coronary heart disease occurs in connection with a decrease in the lumen of the coronary and coronary arteries, which provide the delivery of oxygen and necessary substances to the heart muscle. The most common cause of this condition is atherosclerosis. Significant narrowing, more than 50%, can cause oxygen starvation of a particular area of ​​the heart. This is the manifestation of the disease.

  • Pain in IHD and exertional angina has been described above.
  • If the patient can show where he hurts with one finger, then this is angina pectoris.
  • If the painful area is wider, as in the “fist” symptom, then there may be suspicion of the development of myocardial infarction.

To avoid the manifestation of such an ailment, carry out prophylaxis. Minimize emotions, stress, various nervous tensions. Do not forget to take “Nitroglycerin” at the first suspicion of an attack. Follow the advice of your healthcare cardiologist. This will help prolong life and live it without bouts. Read more about prevention below.

Proper selection of the drug will help reduce the frequency of heart attacks. It is impossible to say what is the best cure for angina pectoris, since for each patient, in each case, it will be his own. The doctor will prescribe beta-blockers for some, anticoagulants for other patients, and antianginal drugs for the third patient.

Here are the recommendations of doctors with angina pectoris:

  • Avoid heavy physical exertion.
  • Walk more walks, do morning exercises regularly.
  • Avoid temperature extremes. In winter, do not overcool, as the cold leads to spasm of the vessels, and this can cause an attack of angina pectoris.
  • Give up bad habits.
  • Perform an ECG regularly to monitor changes in heart function.
  • Always carry Nitroglycerin or another medicine that your doctor has prescribed for you to stop the pain if it suddenly appears.
  • Eat right and do not stick to any one mono-diet. This will only increase the load on the heart, which can lead to a worsening of the condition.
  • If you want to add or remove something to the diet, then consult a doctor. After all, it is important that the food is healthy – with a minimum sugar content, without harmful cholesterol.
  • Keep track of weight or reduce body weight when overweight. Harmful weight loss is also harmful to the body.
  • Be sure to include fruits and vegetables in your diet. It is necessary to eat at least 5 servings of raw vegetables and fruits per day.
  • Replace tea and coffee with decoctions of herbs or infusions of berries. Rosehip, hawthorn, mint and other herbs and fruits are useful.

Get tested and do all the diagnostic procedures your doctor recommends. This will help to timely notice changes in the heart and prevent complications.

Patients with angina pectoris must be under the supervision of a specialist and be registered in the dispensary. One of the directions in the treatment of heart disease is the prevention and prevention of serious consequences for the body, which carries an ailment.

Patients with a diagnosis of angina pectoris: how often are examined at the dispensary?

  • At first, after the detection of angina pectoris, a person is required to come for an outpatient examination every three months.
  • Such an observation will allow us to assess the dynamics of the development of the disease and not to miss the aggravating factors if they suddenly appear.
  • In the future, with a stable condition or a positive effect of treatment, visits to the cardiologist are reduced to once every six months.
  • If deterioration is observed, then such patients are examined unscheduled and on an indiv >

How many patients with angina pectoris live?

  • The life expectancy with the diagnosis is directly dependent on how much the patient is ready to cooperate with his doctor.
  • Such serious diseases of the heart system often lead to heart attacks.
  • There is no reliable data in medicine: how many heart attacks a person can survive.
  • After all, it all depends on the intensity of the attacks, the state of health, the presence of concomitant deviations in the functioning of the vital organs.

Life can be happy and long if the patient follows all the recommendations, leads a moderately active lifestyle, eats properly, takes the necessary medications.

Angina pectoris is an unpleasant disease and dangerous if you do not follow the doctor’s recommendations. In our country, many people suffer from heart disease. Health is affected by poor nutrition, lifestyle, bad habits. Often, when a person realizes that it is time to change his lifestyle, he is already diagnosed with “Angina pectoris”.

Cyril, 51 years old – “I am treating myself for angina pectoris, or the fight against the disease”

The first attack of angina pectoris began at my work, which was associated with physical labor. Suddenly it became bad, dizzy. An ambulance arrived and was taken to the hospital. Then examination and the diagnosis “Angina pectoris”. After discharge, it was still bad: I woke up at night, it was difficult to breathe, my heart ached.

I had to completely change my life. First I quit smoking, then I started to eat right. In general, I was afraid of this disease, because a friend of mine a year ago did not survive after such a diagnosis, because I ignored the recommendations of doctors and did not drink pills. I was prescribed a lot of drugs, but over time there were improvements and the doctor, after each of my admission, began to cancel the pills. Now I take only drugs about pressure and from a rapid pulse. The condition has become better, but we need to continue to fight the disease.

Further lifestyle with angina pectoris

Patients who have undergone angina pectoris and underwent treatment in a hospital are sent for rehabilitation in a sanatorium. Further administration of prescribed drugs is required. It is also important to continue to lead a healthy lifestyle with moderate physical exertion. Necessarily regular stay in the fresh air and a full sleep with rest.

A special diet and proper diet should be followed. Steaming, boiling or baking is recommended. Welcome reception of vegetables and fruits, juices and jelly, cereals and dairy products. Fatty meats and animal fats should be limited. Alcohol, spicy, fatty, smoked and salty dishes are excluded without fail. Salt intake is limited to a minimum.

For the prevention of repeated attacks and the maintenance of normal life, the lifelong administration of certain drugs prescribed by a cardiologist is extremely important. Recovery is possible after 2 weeks from the onset of the disease.

Complications and their prevention

The prognosis for resting angina pectoris is more serious than for angina pectoris: this is due to a more pronounced and, as a rule, multiple lesion of the coronary arteries. Such patients have a higher risk of developing myocardial infarction and sudden cardiac death.

Preventive work requires the complete elimination of modifiable risk factors and the treatment of concomitant diseases. All patients with rest angina pectoris should be constantly monitored by a cardiologist and, if necessary, be consulted by a cardiac surgeon.

Angina pectoris is a chronic, disabling heart disease. With the progression of angina pectoris, there is a high risk of developing myocardial infarction or death. Systematic treatment and secondary prevention help control the course of angina pectoris, improve prognosis and maintain working capacity while limiting physical and emotional stress.

Effective prophylaxis of angina pectoris requires the exclusion of risk factors: reducing excess weight, controlling blood pressure, optimizing diet and lifestyle, etc. As a secondary prophylaxis with an already established diagnosis of angina pectoris, it is necessary to avoid worries and physical effort, prophylactically take nitroglycerin before exercise, and prevention of atherosclerosis, conduct therapy of concomitant pathologies (diabetes mellitus, gastrointestinal tract diseases). Exactly following the recommendations for the treatment of angina pectoris, taking prolonged nitrates and dispensary monitoring by a cardiologist can achieve a state of prolonged remission.

To know how to avoid a particular disease, you need to understand the causes of its occurrence. Angina pectoris is a type of coronary heart disease caused by a lack of oxygen in the heart muscle. This is due to narrowing of the heart vessels caused by atherosclerotic plaques. Plaques, in turn, are formed from cholesterol deposits.

Methods for preventing angina pectoris include the following important aspects:

  • Refusal of bad habits – smoking, drinking alcohol.
  • Compliance with the rules of healthy eating.
  • Minimization in the diet of refined sugars, trans fats, bad cholesterol (formed in fried foods).
  • Avoidance of stress and other excessive emotional overload.
  • Maintaining an active lifestyle without exhausting loads – frequent walks in the fresh air will be a good option for hanging out with angina pectoris.
  • Scheduled consultations and examinations by specialists.

It is also worth remembering the use of pharmacological preparations aimed at reducing thrombosis, improving oxygen transport through the circulatory system. But such funds should be prescribed only by a doctor after examination. Self-medication can harm the body.

Another option for preventing any heart disease is the Zen religion. Read an article on the teachings of the great teachers of the East in Zen Buddhism on our website. If a person manages to achieve Zen, then there comes complete calm and peace. Meditate, learn to learn Zen and your heart will be calm and healthy.

The main dangerous conditions of the body, which can lead to unstable angina:

  • myocardial infarction;
  • acute heart failure including pulmonary edema;
  • the occurrence of arrhythmias (heart rhythm disturbance);
  • ventricular fibrillation and sudden death.

To prevent the development of complications, it is only important to consult a doctor on time and follow all the recommendations without fail until a full inpatient treatment course, regardless of the severity of the disease.

Prognosis and prevention

I was diagnosed with “Angina pectoris” 2 years ago. They prescribed a bunch of pills, but nothing helped. The condition was getting worse, constantly lying in the hospital. Due to a malfunction in breathing, a narrowing of the vessels occurred – as the doctor explained to me. But how to restore breathing, if the heart does not work well, just some kind of vicious circle.

Once I learned from a friend about a breathing simulator, and then the thought dawned on me that you could just learn to breathe correctly again. A sports doctor from one of the fitness centers suggested that physical activity restores breathing well. I began to go to training. The loads were minimal at first, I walked on a treadmill no more than 1 km per day.

Irina, 49 years old – “I open the vessels, the load is dosed”

I never thought that I would have heart problems. Mom worked as an actress in the theater, dad – a physical education teacher at school. Especially since childhood, they didn’t accustom me to anything, I chose my own lifestyle and I never loved sports, although Dad talked a lot about his work in the family. But I still had to get carried away with physical activity when I was diagnosed with Angina pectoris at 46.

I was very frightened then, my state was terrible, I felt sick, I felt dizzy, and there was very severe pain in my chest. After treatment in the hospital, my life completely changed: a different diet and exercise for me now – this is the main thing in life. Clogged vessels need to be opened in a dosed manner, so in the morning I run a couple of kilometers a day, in the evening I walk in the park. Now I feel better, but I do not forget to follow the doctor’s recommendations.

In the case of timely access to medical care and its full implementation, the prognosis is relatively favorable. However, despite all the efforts of doctors and the patient’s adherence to all the rules of treatment and a healthy lifestyle, about 20% of patients develop myocardial infarction. If complications occur, the prognosis depends entirely on their severity.

Based on this, we can conclude that unstable angina is a dangerous disease of the cardiovascular system, in which there is a high risk of death. But with timely treatment, the risk of fatal complications for the body can be reduced to a minimum.

Folk recipes for the fight against angina pectoris: how and what to treat?

Honey. Everyone knows about the beneficial properties of honey. Its rich composition has a positive effect on the whole body, including the heart muscle, saturating it with oxygen, improving blood circulation.

  1. Grind lemons through a meat grinder.
  2. To them add honey in equal proportions and a little crushed fresh garlic.
  3. Stir the delicacy well, leave to insist for a week in a dark place.
  4. Take a little – 3-4 times a day for two months.
  1. Grate horseradish on a fine grater and mix with honey in a ratio of 1: 4.
  2. Use a teaspoon 2 times a day for a month.

With aloe juice and dried fruits:

  1. The combination with dried fruits or aloe will increase the elasticity of blood vessels – 1: 1: 1.
  2. This sweetness can be included in your daily diet.

Tinctures. Alcohol in moderate doses dilates blood vessels, relieves spasms. The most popular for various heart diseases are tinctures of hawthorn, elecampane root, adonis stems. Any of these funds is taken only with the permission of the attending physician, without violating the dosage.

Herbal decoctions. Properly selected plant fees can alleviate any ailment:

  • Hawthorn (grass and inflorescences) insist in boiling water: 7 tbsp. l plants for 7 glasses of water. Drink strained liquid several times a day in 0,5 cups.
  • A rosehip drink can be used instead of tea. It will strengthen the vascular system, normalize blood density, saturate with beneficial elements.
  • Dried motherwort – two teaspoons of grass pour 500 ml of hot water and leave for 8 hours. Take 4 times a day, 50 ml.

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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.

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