Angina pectoris – causes, symptoms, diagnosis and treatment_1

– condition in which to

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  1. Alcohol and heart disease. Risk and benefit.
  2. 1. Antiplatelet drugs (acetylsalicylic ac >Binding SS treatments are antiplatelet drugs (antiplatelet agents), of which the most often use acetylsalicylic acid (ASA). Antithrombotic the action of ASA is based on irreversible cyclooxygenase inhibition platelet count. As a result of this, platelets lose their ability to synthesize thromboxane A2 (TX A2), which induces platelet aggregation and has vasoconstrictor properties. IN the result is reduced
  3. How can one support the heart? Can I drink vitamins or take a course of treatment?
  4. Doctor’s advice
  5. Clinical case
  6. Clove of garlic
  7. Aloe infusion on honey
  8. Vegetable juice
  9. What complications can occur with coronary heart disease?
  10. Cholesterol. About norms and interpretation of results
  11. What is the basis for the prevention of coronary heart disease complications?
  12. What concomitant diseases worsen coronary heart disease?
  13. There is a lot of talk now about operational and high-tech methods for treating coronary heart disease. Can an operation solve all my problems?
  14. What are the main methods of surgical treatment in such a situation? Which method is the best?
  15. No less talk now about coronarography as a method for the diagnosis of coronary heart disease, do I need it?
  16. How can one support the heart? Can I drink vitamins or take a course of treatment?
  17. I was prescribed too many pills to drink at different times. This is very inconvenient and I constantly miss reception times. What do i do?
  18. I am recommended to undergo inpatient treatment 1-2 times a year
  19. I have confirmed the diagnosis of angina pectoris, how long do I need to be treated?

Alcohol and heart disease. Risk and benefit.

Alcohol and cardiovascular disease. Alcohol and ish .

Angina pectoris is a symptom complex caused by myocardial ischemia.

Most often, ischemia is caused by an atherosclerotic lesion of the coronary arteries.

The picture shows a fragment of an artery affected by the atherosclerotic process, where you can clearly see how

narrows the lumen of the vessel.

The functional class of angina reflects the level of patient tolerance of physical activity

  • The first functional class (coronary heart disease, angina pectoris FC I *) – means that angina attacks are provoked by increased physical activity, for example, ascent to the 5th floor
  • The second functional class (coronary heart disease, angina pectoris FC II *) – angina attacks are provoked by normal physical exertion
  • The third functional class (IHD, angina pectoris FC III *) – angina attacks are provoked by minimal physical exertion
  • The fourth functional class (CHD, angina pectoris FC IV *) – angina attacks are observed at rest

* an example of a diagnosis in a doctor’s opinion

1. Antiplatelet drugs (acetylsalicylic ac >Binding
SS treatments are
antiplatelet drugs
(antiplatelet agents), of which the most
often use acetylsalicylic
acid (ASA). Antithrombotic
the action of ASA is based on irreversible
cyclooxygenase inhibition
platelet count. As a result of this, platelets
lose their ability to synthesize
thromboxane A2 (TX A2), which induces
platelet aggregation and has
vasoconstrictor properties. IN
the result is reduced

the opportunity
platelet aggregation and formation
blood clot. Long-term use
antiplatelet agents is justified in all patients,
without obvious contraindications
to drugs of this series – ulcerative
stomach diseases, blood system diseases,
hypersensitivity and other side effects
actions (ulcerogenic and hemorrhagic)

less in individuals receiving ASA in low
doses. Extra security
provide ASA preparations coated
enteric coating. At
impossibility for any reason
destination ASK can be used
clopidogrel as a means with proven
efficiency and safety.
Prophylactic Inhibitors
proton pump or cytoprotectors,
commonly used to treat ulcers
stomach and duodenum,
patients taking ASA in doses of 75-150
mg / day, not recommended.

and ticlopidine are
non-competitive blockers of ADP receptors
and antiplatelet activity
comparable to aspirin. Clopidogrel
is an alternative antiplatelet
a means that does not directly
effects on the gastric mucosa
and less commonly causes dyspeptic symptoms,
however the risk of gastrointestinal
bleeding may increase with

any antiplatelet agents.

How can one support the heart? Can I drink vitamins or take a course of treatment?

Starting treatment of angina pectoris, the maximum elimination of all provoking factors is necessary. With a pain attack, sublingual nitroglycerin is most effective. In a planned manner, to prevent episodes of ischemia, prolonged-acting nitrates (isosorbide dinitrate, isosorbide mononitrate, nitroglycerin patch or ointment), antiplatelet agents (acetylsalicylic acid), b-adrenergic blockers (atenolol, betaxolol, metoprolol), calorie blockers .

If symptoms of angina pectoris persist despite medical therapy, or according to angiography, there is a high risk of death, the choice is made in favor of surgical tactics. With angina pectoris, endovascular angioplasty and stenting of the coronary arteries, coronary artery bypass grafting, and mammary coronary artery bypass grafting are possible.

The effectiveness of cardiac surgery for angina pectoris is 90-95%. Possible complications are restenosis, resumption of angina pectoris, myocardial infarction.

Before starting treatment, I need to assess the risk, i.e. the likelihood of further complications (myocardial infarction and death) in the patient. This is necessary to choose the tactics of therapy.

For this, I pay attention to the following parameters:

  • The results of tests with physical activity (time to complete the load, after which the patient has an attack);
  • indicators of echocardiography, namely the adequacy of the pumping function of the heart;
  • intensity of luminescence on myocardial scintigraphy;
  • the prevalence of coronary artery atherosclerosis and the degree of narrowing of their lumen.

If the patient has a low or medium risk, then I limit myself to drug therapy. And if he has a high risk, then he needs a more aggressive treatment of angina pectoris in the form of surgical intervention.

The Braunwald Guide for the Therapy of Cardiac Diseases, the most authoritative publication, recommends the use of the following medications for stress angina pectoris:

  1. Beta-blockers (Bisoprolol, Metoprolol) – reduce the pulse rate and slow down the conduction of the nerve impulse, thereby reducing the need for myocardium in oxygen. In addition, due to an increase in the relaxation period (diastole) of the heart muscle, its blood circulation improves.
  2. Antagonists of slow calcium channels (Diltiazem, Verapamil) – have a similar mechanism of action. I use them in case of intolerance to beta-blockers or for contraindications to them.
  3. Antiplatelet agents – are necessary to prevent the formation of blood clots in the arteries that lead to a heart attack. First, I prescribe acetylsalicylic acid, and if the patient has a stomach ulcer or duodenal ulcer, then clopidogrel.
  4. Statins (Atorvastatin, Rosuvastatin) – reduce the concentration of cholesterol in the blood, thereby slowing down the formation of atherosclerotic plaques.
  5. ACE inhibitors (Perindopril, Lisinopril) – these medicines are needed for patients suffering from chronic heart failure or diabetes mellitus in addition to angina pectoris.
  6. Blockers of the If-channels of the cells of the sinus node (Ivabradin) are the so-called pulsating drugs. I use them when the patient has a very frequent pulse (more than 100).

Such a scheme allows me to achieve clinical improvement in the form of cessation of pain in some patients. If seizures persist during selected therapy, then I add nitrates (Nitroglycerin). These drugs relax the smooth muscle walls of the coronary arteries, which leads to their expansion and increase blood flow to the myocardium.

However, these drugs must be handled very carefully, since tolerance (addiction) quickly develops with their illiterate intake, and their therapeutic effect decreases several times. Therefore, I always recommend that my patients take nitrates only when the attack begins, or no more than 2 times a day, and so that the interval between doses is at least 12 hours.

In case of unsuccessful drug treatment, or if the patient has a high cardiovascular risk, surgery is performed.

There are 2 main types of operations:

  • Stenting, or percutaneous coronary intervention (PCI);
  • coronary artery bypass grafting (CABG)

The essence of PCI is the introduction of a special metal stent into the vessel, which improves its patency. The operation is performed under local anesthesia. Access is via the femoral artery. PCI is performed with stenosis in one vessel more pronounced than 50%.

When conducting CABG for the passage of blood bypassing the narrowed vessels, a message is created between the aorta and the coronary artery. CABG is an open abdominal operation with general anesthesia (anesthesia) and an opening of the chest. This method is justified if several arteries are affected or stenting is impossible.

In order to maximize the effect of medical and surgical treatment, I recommend that my patients adhere to a certain lifestyle, which includes several aspects:

  • bad habits – it is advisable to limit alcoholic drinks (up to about 300 ml of wine per week). Smoking is strictly prohibited;
  • diet – a decrease in the consumption of foods rich in saturated fats (meat, milk, butter) and an increase in food with a predominant content of omega-3,6 fatty acids (vegetables, fish, vegetable oil). Fruits, nuts, cereals must be present in the diet;
  • regular moderate physical activity or exercise therapy – aerobic exercises, such as swimming, running, cycling, are preferred;
  • body weight control – achieved by strict observance of the previous 2 points.
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Doctor’s advice

In addition to the generally accepted lifestyle changes described above, I strongly recommend that my patients monitor their blood pressure and take appropriate medications regularly.

If a person suffers from diabetes, he should regularly check the level of glucose in the blood and periodically take a test for glycated hemoglobin. This is important, since diabetes can several times worsen the course of angina pectoris and lead to complications.

Also, if it is not possible to often consume fish, you can take fish oil in the form of dietary supplements. They are in any pharmacy. As an argument for the benefits of fish oil, I want to give an example of Japan – a country in which heart diseases have extremely low rates, and fish as a food product occupies the top positions.

Clinical case

I want to provide an example from personal experience. A 52-year-old man came to an outpatient appointment with complaints of pressing pains in the heart area that arise when climbing stairs up to the 3rd floor and pass a few minutes after rest. The appearance of these pains began to be noted about a month ago. Suffers from type 2 diabetes and hypertension. Takes Metformin 1000 mg 2 times a day and Lisinopril 10 mg 1 time per day. The therapist was referred to a cardiologist, who prescribed an ECG and VEM (bicycle ergometry).

At rest when decoding the ECG was unchanged. When conducting VEM on an ECG, a 2 mm ST segment depression was detected. The patient was sent to a cardiological hospital for further examination with the diagnosis: coronary artery disease, angina pectoris FC 2. Coronary angiography was performed, on which 70% stenosis of the right coronary artery was detected. The defeat of the remaining vessels was uncritical, so it was decided to install a stent. Drug therapy (Acetylsalicylic acid, Rosuvastatin, Bisoprolol) was also prescribed. The patient noted a significant improvement in his condition in the form of cessation of pain attacks. At discharge, recommendations on lifestyle correction are given.

In conclusion, I want to note that exertional angina is a serious disease that requires proper attention, both from the doctor and from the patient. Ignoring bouts of pain can lead to poor prognosis of myocardial infarction, disability, and death. However, timely diagnosis and proper treatment can improve the quality and increase the life expectancy of a person.

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.

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.

What complications can occur with coronary heart disease?

The main complications of coronary heart disease are:

Cholesterol. About norms and interpretation of results

How to identify what to do when consult a doctor? What a .

  • myocardial infarction (including the so-called pre-infarction condition or acute coronary syndrome)
  • stroke
  • chronic heart failure
  • heart rhythm disturbances
  • sudden death

With adequate treatment and prevention, the risks of all complications can be minimized.

What is the basis for the prevention of coronary heart disease complications?

  • Monitoring the level of cholesterol and its fractions, supporting these indicators at the target level.
  • Monitoring blood pressure and maintaining it at the target level.
  • Compensation for diabetes.
  • Normalization of body weight.
  • Optimal exercise regimen.
  • To give up smoking.
  • A sharp restriction on alcohol consumption.

What concomitant diseases worsen coronary heart disease?

The main and most frequent diseases that seriously worsen the prognosis for coronary heart disease are arterial hypertension and diabetes mellitus. But diseases of the lungs, blood, endocrine system and urinary tract exacerbate the course of IHD directly or indirectly. Therefore, it is very important to treat or control all concomitant diseases.

There is a lot of talk now about operational and high-tech methods for treating coronary heart disease. Can an operation solve all my problems?

  • ineffectiveness of drug treatment, destabilization of the disease,
  • high risk of cardiovascular catastrophes.

Just surgery for surgery can make your long-term prognosis worse.

What are the main methods of surgical treatment in such a situation? Which method is the best?

The main surgical methods for treating stable angina are coronary artery bypass grafting and stenting. Like any treatment method, each of these options has its own indications and contraindications, and therefore there is no answer to the question “what is better and what is worse”.

No less talk now about coronarography as a method for the diagnosis of coronary heart disease, do I need it?

It is very important for you, as a patient, to understand that the logical continuation of coronary angiography (CAG) is surgery, and the indication for CAG is actually the indication for surgery. those. CAG is most often used not to make a diagnosis, but to determine the possibility and type of surgical intervention. Read more about coronarography

How can one support the heart? Can I drink vitamins or take a course of treatment?

To date, there is no evidence of the effectiveness of vitamins in the treatment of heart disease, moreover, some vitamins, affecting the blood coagulation system, can negatively affect the course of the disease. Also, with adequate treatment, there is no need for any additional treatment courses.

I was prescribed too many pills to drink at different times. This is very inconvenient and I constantly miss reception times. What do i do?

Talk with your doctor about using generics.

With adequate treatment and proper quality of life, there is no need for regular hospitalizations.

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I have confirmed the diagnosis of angina pectoris, how long do I need to be treated?

Treatment of angina pectoris does not imply a complete elimination of the problem. The goal of therapy:

  • reduce the risk of seizures in myocardial infarction or in sudden death;
  • reduce the frequency of symptoms;
  • eliminate the manifestations of the disease.
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The treatment can be divided into four groups:

  • symptom relief
  • drug therapy to reduce the risk of symptoms,
  • lifestyle change
  • surgical intervention.

The symptoms of the disease can be relieved by using short-acting nitrate drugs. The therapeutic effect of nitrates is based on the expansion of:

This improves nutrition of ischemic sections of the myocardium, reduces peripheral resistance, improves coronary blood flow. Reduction of compressive pain in the chest area is achieved due to hemodynamic unloading of the myocardium and a decrease in the amount of stress on the heart. The latter fact reduces the heart’s oxygen demand.

That is, the supply of oxygen to the heart after taking nitrates does not increase. The need for them decreases. Among short-acting nitrates, the only drug is common: nitroglycerin. It is released in the form of tablets or a hyoid spray and costs at pharmacies from 66 rubles.

To relieve symptoms, a nitroglycerin tablet is placed under the tongue and held there until completely resorbed. To accelerate the effect of taking the medicine, a nitroglycerin tablet can be pre-bitten into several parts and also put under the tongue.

To reduce the risk of angina pectoris, drugs of seven groups are prescribed in various combinations. Antiplatelet drugs inhibit platelet aggregation. This reduces the risk of blood clots.

Among antiplatelet drugs, aspirin is used, which is effective in both stable and unstable angina. Reducing the risk of coronary thrombosis reduces the risk of developing myocardial infarction.

Hypolipidemics – drugs to prevent the formation of lipids in the blood, which provoke atherosclerosis.

Preparation Price Description
Simvastatin from 54 rubles. In each tablet, depending on the dosage, 10 or 20 mg of simvastatin. In the package from ten to one hundred tablets.
Atorvastatin from 52 rubles. The drug is available in the form of tablets. Each contains 10, 20, or 40 mg of atorvastatin. A package may contain from ten to one hundred tablets.
Rosuvastatin from 154 rubles. Tablets with the active substance rosuvastatin. In each 5, 10, 20 or 40 mg of active substance. In a package of 30 or 60 tablets.

β-blockers – a group of drugs whose action is aimed at normalizing the heart rate and reducing the frequency of contractions of the heart muscle.

Preparation Price Description
Bisoprolol from 79 rubles. The drug is in the form of tablets, each of which can contain 2,5, 5 or 10 mg of bisoprolol. Available in packs of 30, 50 or 60 tablets.
Nebivolol from 187 rubles. Tablets with five milligrams of nebivolol hydrochloride in each. In the package, depending on the packaging, from 14 to 60 tablets.
Carvedilol from 69 rubles. Available in tablet form. Depending on the dosage, each may contain 6,25, 12,5 or 25 mg of carvedilol. In a package of 30 tablets.
Preparation Price Description
Nifedipine from 28 rubles. Available in the form of dragees and tablets. Regardless of the form of release, one unit of the drug contains 10 mg of the active substance nifedipine. In the package of 50 tablets or dragees.
Diltiazem from 95 rubles. Tablets containing 60 or 90 mg of diltiazem each, in a package of 30 pieces.
Verapamil from 17 rubles. Available in tablet form. The active substance of verapamil hydrochloride is contained, depending on the dosage, in a volume of 40, 80 or 240 mg per tablet. Available in packs of 50 tablets.
Preparation Price Description
Coraxan from 1100 rubles. Film-coated tablets containing 5,39 mg of ivabradine hydrochloride each. The package contains 56 tablets.
Bravadin from 392 rubles. Tablets with 5 or 7,5 mg of the active substance ivabradine. The package contains 28 or 56 tablets.
Preparation Price Description
Candesartan from 160 rubles. Tablets of 28 pieces in a package, each of which contains 8, 16 or 32 mg of candesartan cilexetil.
Perindopril from 66 rubles. 30 tablets per pack. Each, depending on the dosage, contains 4 or 8 mg of perindopril erbumin.
Ramipril from 87 rubles. Available in the form of tablets of 5 or 10 mg of the active substance, 30 tablets per pack.
Valsartan from 309 rubles. Valsartan is available in tablet form, in packs of 28,30 or 84 pieces. Each film-coated tablet contains 80 or 160 mg of valsartan.

Nitrates, which were already mentioned in the section on symptomatic therapy of angina pectoris. Drugs in this group vary in time of action:

  • short action (up to one hour),
  • moderate prolonged action (up to six hours),
  • significant prolonged action (from six to 24 hours).

Short-acting nitrates Nitrogliticerin, Isacardine, Nitrosorbide are taken immediately before exercise to prevent an attack of angina pectoris. The lack of effect is an occasion to reflect on the correct diagnosis.

Function class Nitrate group Main drugs Reception Features
II Short and moderate prolonged nitrates Cardiket 20, Monosan, Corvaton The application is similar to the first FC with the difference that the temporary coating with nitrates is longer, depending on the expected loads.
III Significant Long-acting Nitrates Pectrol, Olicard Retard, Nitrong Fort Angina pectoris of the third functional class is stopped by drugs of significant prolonged action. At the same time, it is imperative to maintain a certain nitrate-free period in order to avoid the development of resistance to nitrates.
IV Significant Long-acting Nitrates Pectrol, Olicard Retard, Nitrong Fort The nitrate intake schedule is designed in such a way that their action is covered all the time.

The main role in stopping the manifestations of the disease belongs to the patient’s lifestyle. Let’s start with physical activity.

Even with angina pectoris of the fourth functional class, when a person is practically incapacitated, physical activity is necessary. The main enemy of the patient is inactivity. For those who spend most of their time in an armchair or in bed, it is more difficult to stop the disease. Physical exercises for the patient are selected by the doctor. Even if it is only a couple of steps every few hours, they are important.

At the same time, amateur activity in the form of an independent increase in loads with an imaginary improvement in condition is prohibited. An attack is almost impossible to predict. Therefore, any adjustments in the system of physical activity are possible only with the permission of the doctor.

More on smoking. This bad habit is a strong risk factor for angina pectoris. The connection between cigarettes and the disease in question is direct: smoking narrows and damages blood vessels, causing blood flow to deteriorate. Therefore, with angina pectoris, smoking cessation is mandatory. There are no alternatives for angina pectoris. Stop smoking

Now about nutrition. There are no alternatives in this matter either. Only a fairly strict diet, which, however, fits into the concept of a healthy diet. The patient does not need to eat only vegetables and drink water. Food can be varied.

The main ban is cholesterol-containing foods. We are talking about animal fats. From meat it is better to choose poultry and fish. Otherwise, the diet for angina pectoris is simple: more unprocessed grain in any form, more fruits and vegetables.

And about emotions! Stress is the enemy in the fight against angina pectoris. Negative emotions must be avoided. Respiratory exercises and oriental practices help to cope with this task: yoga, meditation. The patient’s task is to adjust his life so that unpleasant situations are less common. It is difficult but necessary.

Surgical intervention for angina pectoris is prescribed when drug therapy did not give the desired result. The methods of surgical treatment of the disease are quite effective and lead to a result in which the attacks completely stop. With angina pectoris, one of two types of surgical intervention is used:

  • coronary artery bypass grafting,
  • balloon angioplasty.

Coronary artery bypass grafting is the laying of a bypass area between the aorta and the coronary artery. Arteries or veins taken directly from the patient are used as a bypass shunt.

For such a transplant, a part of the internal mammary artery is taken, if there are no contraindications to this. Bypassing the bloodstream with a narrowed lumen eliminates the lack of oxygen under stress and prevents the development of ischemia and heart attack.

Balloon angioplasty is a less traumatic surgical solution to the problem. Based on coronarography, the site of the greatest narrowing of the blood vessel is revealed. During the operation, a balloon is inserted into this place. It is pumped into the vessel, expanding the lumen. The cylinder then descends and is removed. Earlier on this balloon angioplasty was completed. But now this procedure in its pure form is not effective enough.

Balloon angioplasty combined with stenting. A metal stent is inserted in place of the balloon, which remains there forever. It keeps the lumen of the blood vessel at the required level.

Balloon angioplasty followed by stenting is the most effective option for surgical treatment of angina pectoris.

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.