Angina pectoris symptoms in women

Angina pectoris is an acute condition that occurs in cases of insufficient blood flow to the heart muscle. The heart works constantly and consumes a huge amount of energy in the form of oxygen, glucose and other nutrients. The cells of the heart muscle (myocardium) are fed with blood through the vessels that braid the heart in the form of a corona, and are called coronary arteries.

With their spasm and diseases, there is a sharp decrease in the amount of blood flowing through them per minute, which causes an attack. In addition, this condition occurs with a decrease in the total amount of blood in the bloodstream, or with a decrease in the amount of hemoglobin and red blood cells that carry oxygen.

Pectoral toad is an outdated name for an attack of angina pectoris. The term was coined by William Geberden in the 18th century. Over time, the cause of this condition was established, and the term was changed. The name “angina pectoris” accurately describes the patient’s feelings against the background of a classic attack, when there is pain behind the sternum, as if a stone were placed on the chest or a toad sat down. Recently, this term has been used less and less.

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Prinzmetal angina – characteristic

Prinzmetal angina pectoris is one of the unfavorable variants of resting angina pectoris, in which the epicardial layers of the myocardium are more affected. Its development is associated with severe stenosis of one of the large branches of the coronary arteries, although in some cases there is a widespread vascular lesion.

A typical picture of Prinzmetal angina is described with periodic obstruction of the lumen of the main coronary arteries with mobile polypous formations on the pedicle or with calcareous masses hanging from the lunar flap of the aortic valve.

This form of angina pectoris is characterized by severe pressing pain behind the sternum with radiation to the left half of the chest, back, left arm, accompanied by pronounced autonomic reactions – pallor, profuse sweat, increased blood pressure, sometimes fainting. An attack of pain most often occurs at night during sleep or in the morning before getting up, at about the same time.

Specific ECG changes occurring at the time of the attack and disappearing immediately after it is stopped: the RS-T segment rises above the isoelectric line (in the leads registering the ischemia zone) with the transition to a high T wave, in contrast to other angina pectoris, in which RS-T segment depression or pathological changes are absent.

For the diagnosis of Prinzmetal’s angina pectoris, a bicycle ergometry test is used (carefully, since potentially lethal arrhythmia can develop).

Symptoms

The main symptoms of angina pectoris are intense pressing, constricting pain, burning and a feeling of heaviness behind the sternum, which gives (radiates) to the left arm, under the left shoulder blade, to the neck and lower jaw. Pain occurs, as a rule, during physical or emotional stress, lasts up to 5 minutes, and passes either on its own after stopping the load, or after taking nitroglycerin (this drug acts immediately, expanding the coronary arteries).

Angina pectoris with coronary heart disease occurs due to narrowing of the lumen of the coronary arteries due to the growth of an atherosclerotic plaque in them. Atherosclerosis is a vascular disease in which fat is deposited in the vascular wall. In this case, the vessel wall thickens due to the formation of an atherosclerotic plaque, and the lumen of the artery narrows.

The disease develops at rest. This usually occurs in the early morning or at night. Pain can occur with little physical activity, at the same time, day or night.

An attack of the disease is characterized by sudden pain in the heart. It has the following parameters:

  1. Intense chest pressure.
  2. Burning.
  3. The cutting nature of the pain.
  4. Sudden sweating at the site of a spasm.
  5. Signs of tachycardia.
  6. Possible increase or decrease in blood pressure.
  7. The patient complains of a headache, he is sick, and pallor appears on his face.
  8. Sometimes spasm is accompanied by fainting.
  9. Often there is a violation of the rhythm of the heartbeat in various forms.

An attack of the disease can last from five to fifteen minutes. Sometimes it lasts ½ hours. Patients suffer such a blow much harder than ordinary angina pectoris. Cramping can be repeated as a series of seizures. The gap between them can be from two to twelve or more minutes. But most often they have a single character, that is, they can occur once a day (week, month).

The main clinical feature of this type of angina pectoris is severe cramping that appears at rest, which shows a disturbance in the patient’s body of a vegetative nature, a disturbance in the rhythm of the heart muscle, and symptoms that can lead to death. In this case, ventricular fibrillation, artioventricular block, ventricular extrasystole or tachycardia may be symptoms.

Some patients with whom I had to work believed that the symptoms were the same for everyone. That is why I had to explain to them that manifestations can vary depending on the individual characteristics of the body. Of course, at the same time, a number of general points can still be distinguished.

The clinical picture of variant angina, the cause of which is precisely a sharp decrease in the diameter of the coronary vessels, in many ways resembles the traditional angina of exertion. Most forms of coronary heart disease are similar to each other. My task, as a doctor, remains the differential diagnosis of pathological conditions.

Complaints addressed to me or another cardiologist for help:

  1. Pressive pain in the area of ​​the heart, which can spread to the left arm, neck, jaw. I often hear her being compared to a twisting sensation, a cramp in her chest. Sometimes patients indicate a burning sensation, which on its own can pass within 5-10 minutes.
  2. Heart rate acceleration. Against the background of pain, an increased heart rate. Recently, a woman said that, in addition to discomfort in her chest, her “heart wanted to pop out through her mouth.” Agree, this is a very eloquent description.
  3. Dyspnea. A sign that sometimes may be the only clinical manifestation of a pathology.
  4. Cold sweat. The symptom occurs in severe forms of the disease.
  5. Nausea, vomiting, confusion are rare but common satellites of variant angina pectoris.

Prinzmetal angina has severe symptoms. The attack is accompanied by prolonged anginal pain. With such episodes, the autonomic nervous system is disrupted, the rhythm and conduction of the heart are upset.

The main manifestation of the disease is considered strong and prolonged pain in the heart, when a person is in a calm state. Discomfort usually disturbs late at night or early in the morning. Habitual and moderate loads can also cause deterioration.

With the development of an attack:

  • sweating increases;
  • the skin turns pale;
  • increased heart rate;
  • headache;
  • nausea appears;
  • blood pressure in the arteries decreases or rises;
  • the patient loses consciousness.

Sometimes an attack contributes to a disturbance in the rhythm of the heart. A person has ventricular extrasystoles, paroxysmal ventricular tachycardia, atrial flutter, or atrioventricular blockade.

The main clinical difference between Prinzmetal’s angina pectoris and other forms of this ischemic state of the heart is more severe and prolonged attacks of religious pain. Such episodes of pain are always accompanied by severe disturbances in the functioning of the autonomic nervous system, dangerous disorders of the rhythm or conduction of the heart.

The main sign of this form of angina pectoris is the occurrence of strong and prolonged cardialgia at rest. Usually an attack develops early in the morning or at night. In addition, it can sometimes occur at the same time of the day against the background of quite familiar and moderate loads.

An attack of cardialgia with Prinzmetal angina occurs suddenly. Religious pain can be pressing, cutting or burning in nature, and always last for a long time – about 5-15 minutes (sometimes up to 30 minutes). Due to the intensity and duration of pain, such an attack is more difficult to tolerate than with other forms of angina pectoris, and pain is more difficult to stop with nitro-containing agents.

At the peak of religious pain with Prinzmetal angina, the patient has the following symptoms:

  • profuse sweat;
  • pallor of the skin;
  • increased heart rate;
  • headache;
  • nausea;
  • decrease (sometimes increase) in blood pressure;
  • fainting or fainting.

In some cases, an arrhythmia develops during an angina pectoris. Usually it occurs in the form of ventricular extrasystole, paroxysmal ventricular tachycardia, atrial flutter, blockade of the bundle of the bundle, or atrioventricular block. In more rare cases, ventricular flutter occurs.

With vasospastic angina pectoris, periods of prolonged remission sometimes occur spontaneously. They can last for years, but then characteristic angina attacks occur again.

The characteristic symptomatology of Prinzmetal angina can be considered pronounced, this makes it possible to distinguish it from other varieties of pathology. And although angina in any form is accompanied by soreness in the region of the heart and the sternum of the chest, however, Prinzmetal’s angina can be considered that type of cardiac pathology, which is characterized by the strength of the symptoms.

The most obvious manifestations of the pathology in question include the following symptoms:

  • pains in the region of the heart, in the sternum, which become more severe during the morning awakening, early in the morning;
  • vegetative disturbances;
  • periods of severe tachycardia with a violation in the usual rhythm of heart contractions;
  • changes in the cardiogram, on which the period of rise or depression in a certain segment is visible;
  • general manifestations of worsening general condition, which manifest as dizziness, weakness, especially in the morning, nausea, fainting. Short-term loss of consciousness is possible;
  • all manifestations are noted against the background of a protruding sweat, which can be quite plentiful depending on the strength of the manifestations of these symptoms.

However, even if there are some of the symptoms listed above, you should not make a diagnosis yourself, you need an accurate and detailed diagnosis, which will allow you to draw up the most effective treatment regimen. Only in this way can both eliminate the current manifestations of the disease, and prevent the likely negative consequences of the disease.

The methodology for the diagnosis of angina pectoris is also determined by the attending cardiologist, who will further draw up a treatment system and take into account the individual characteristics of the patient’s body, the presence of concomitant diseases and will prevent the likelihood of the likely consequences of Prinzmetal angina.

Disease Prevention

For any form of an unstable state, sudden closure of the coronary vessels is characteristic, in this case, spasm occurs in the large coronary artery and adjacent branches. Prinzmetal’s angina is not characterized by a violation of hemodynamics as a result of stenosis of the arteries, because it often covers the subepicardial (proximal) part of them, where the portion of the vessel is atherosclerotically altered.

Additional reasons provoking unstable angina of Prinzmetal are:

  • hypertension;
  • peptic ulcer disease;
  • cholecystitis;
  • allergy.

Therefore, an additional overlap of the coronary artery can be caused by:

  • hypothermia;
  • severe emotional stress;
  • hyperventilation of the lungs as a result of respiratory alkalosis.

Very often, a clinical condition develops for no apparent reason, when a person is at rest or performs normal physical activity, for example, walking, sitting. This pathology is also characterized by spasm of the vascular wall as a result of increased activity of the sympathetic and parasympathetic sections of the nervous system and the vasoconstrictor (vasoconstrictive) action of certain hormones: histamine, serotonin, thromboxane.

The spasm is more often localized on the part of the artery affected by atherosclerosis, but is able to affect the branches of blood vessels that do not have deformities. Accordingly, the main cause of Prinzmetal’s angina pectoris is an atherosclerotic disease that provokes the formation of cholesterol plaques on the walls of arteries. Atherosclerosis can cause an attack at an early stage of the development of the disease.

In addition to the main reason, the following are distinguished:

  • smoking (common cause);
  • taking drugs;
  • lack of magnesium;
  • the absence of cell reactions to the action of insulin;
  • hypertension;
  • inflammation of the gallbladder;
  • lack of vitamin E;
  • peptic ulcer disease;
  • diseases characterized by an imbalance of the autonomic nervous system, a predisposition to spasm of blood vessels;
  • psychoemotional disorder;
  • extensive hypothermia;
  • hyperventilation, provoking respiratory alkalosis.

Prinzmetal’s angina pectoris can provoke the use of certain medications, high activity of the nervous system. Visual causes of the disease may be absent.

The complication of Prinzmetal’s angina pectoris is due to the frequency of seizures, their severity and duration. Against the background of the absence of coronary artery damage, the risk of coronary death is low and approximately 0,5%. In the case when the attacks are long, regularly recurring in nature, the death is up to 25% per year.

For the prevention of the disease, it is necessary to stop smoking and begin to maintain a healthy lifestyle. It is important for the prevention and development of the disease to give preference to natural dietary food, so as not to increase the level of cholesterol in the body. People who have any abnormalities in the work of the heart, experience periodic pains and attacks, must definitely stand at the dispensary control of a specialist.

Prevention of the development of the disease consists of a regular visit to a cardiologist, giving up bad habits, normalizing the state of the nervous system. A patient with a diagnosis of Prinzmetal’s angina pectoris should be put on a mandatory record with a cardiologist. Patients are advised to:

  • observe proper regular nutrition;
  • get rid of bad habits;
  • normalize the emotional state of a person;
  • get rid of physical overvoltage;
  • sleep – at least eight hours a day;
  • avoid stress whenever possible.

Preventive measures are taken to delay a second anginal attack. It is necessary to take full responsibility for the treatment of the disease and prevention, because non-compliance with the doctor’s prescriptions can lead to death.

The degree of complications of this disease depends on the level of coronary obstruction, the frequency of spasms, their severity and duration. If there is no damage to the coronary vessels by atherosclerosis, then the probability of sudden cardiac arrest is very small and amounts to half a percent per year. With often recurring and prolonged cramps, which the patient suffers hard, the likelihood of death in this type of angina pectoris can increase up to 22%.

Since this disease is considered one of the variants of coronary insufficiency, which is of a progressive nature, all patients should be registered with a cardiologist. Preventive measures to combat the disease include:

  1. Full refusal from smoking.
  2. Normalization of the tone of the ANS.
  3. The fight against hyperlipidemia.

All these measures are carried out under the supervision of the attending physician. The patient must be on time for admission to the clinic in order to timely detect signs of the disease.

Severe smokers must give up smoking to maintain their health and life.

Diagnostics

A correctly diagnosed diagnosis is a very important stage in the treatment of any ailment. The main method that will help confirm a disease such as Prinzmetal’s angina pectoris is an ECG. Used during an attack. If the ST segment on the cardiogram is raised, then this is the disease that you suspected.

If this method does not completely refute or confirm the suspicion of a specialist, it is used:

  • provocative test with hyperventilation;
  • the introduction of injections of “Acetylcholine” or “Ergometrine”;
  • cold and ischemic test.

Studies are being carried out with a load. In this way, tolerance to stress is checked. Coronary angiography is mandatory. Using this method, it is possible to determine and evaluate the degree of damage to blood vessels by plaques.

The patient should keep a diary of sensations. In it, he notes all changes from the side of the heart. As well as pain that may occur when performing a particular job.

Diagnosis of angina pectoris is uncomplicated if the attack is classic. Additional studies will help confirm the diagnosis: electrocardiography (ECG), daily Holter monitoring, ultrasound of the heart, coronary angiography. An ECG is the easiest and fastest method for examining heart function. But with the disease, changes on the cardiogram will be displayed only during the attack, which is not always possible to fix.

In order to obtain more accurate results, use the method of daily monitoring, when ECG registration occurs during the day. This will establish not only the diagnosis, but also a number of arrhythmias. In this case, the subject must keep a detailed diary of his actions and feelings. This will allow you to say what the seizures are associated with, and will reveal hidden forms of the disease.

Angina pectoris is dangerous because sharp oxygen starvation of myocardial cells develops against the background of a spasm of the coronary vessels. Frequent seizures lead to the gradual replacement of myocardial cells with connective tissue. As a result, the contractility of the heart decreases and heart failure develops. In this case, connective tissue is scarring, which can cause the development of cardiac arrhythmias.

With an attack duration of more than 30 minutes, the death of cells lacking oxygen occurs. This condition is called myocardial infarction. Moreover, the myocardial region around the dead cells is in a state of ischemia (acute oxygen deficiency), which can also lead to their death. Therefore, if the attack lasts longer than 10-15 minutes, occurs in a state of calm, is not removed by conventional drugs, then this is an occasion for an urgent call for an ambulance. Independent movement in this case should be limited.

For the diagnosis of variant angina pectoris, I, according to modern recommendations and protocols, use an integrated approach to assessing the patient’s condition. Much in the process of identifying the underlying disease depends on the quality of the first conversation with the patient.

The key features that allow me to diagnose precisely a spasm of the coronary arteries are:

  • Episodicity of symptoms, which is not associated with physical activity. Patients in the morning may suffer from chest pain, but after lunch go to the gym and perform a full range of exercises.
  • The appearance of uncomfortable sensations at about the same time of the day.
  • The short duration of the attack, which passes on its own with further normalization of the human condition.

To confirm the appropriate diagnosis, I always additionally prescribe a number of instrumental and laboratory studies.

Traditionally, the first thing to do is register the ECG. This method allows you to evaluate the electrical function of the heart, which changes against the background of various forms of coronary heart disease. It is important to note that there may not be any abnormalities on the ECG outside the attack. This speaks in favor of a spasm of the coronary arteries. However, for the reliability of the study, it is necessary to “catch” the patient during the period of pain, which is sometimes extremely difficult, given nightly attacks. The ST segment elevation will be recorded on the film, which is typical for decreasing myocardial blood supply.

For a full assessment of the patient’s condition, the following procedures are also used:

  1. Angiography of the vessels of the heart. The essence of the method is to visualize the patient’s coronary arteries on the monitor after the contrast medium is injected into the bloodstream. This allows me to pinpoint the location of the spasm. However, again, you need to “catch” the patient at the time of the attack.
  2. Echocardiography. The technique is based on ultrasound examination of the heart. On the screen you can see the cavity of the organ, and I evaluate its functional activity. With Prinzmetal angina pectoris, no special pathological changes occur.
  3. Sample with dosed load. You are offered in a controlled environment to perform exercises on an exercise bike or treadmill. At this time, the ECG is recorded, the pressure is measured and the general condition is evaluated. If there is pain in the heart, the procedure stops. However, with variant angina pectoris, patients traditionally tolerate the load well.
Helpful information   Classification of angina pectoris types and forms

Based on the results of diagnostic procedures, individual treatment is selected.

The main method for diagnosing variant angina is an ECG during an attack. The fact is that this disease is diagnosed by the ST-segment, which should be raised on the electrocardiogram.

The main difference between variant angina and myocardial infarction is that in the first case, the ST segment rises for a short time, about 20 minutes, and with a heart attack this indicator will not drop for about a month. When identifying variant angina, the following diagnostic methods are also used:

  • Holter ECG. The patient is monitored for an electrocardiogram throughout the day. This diagnostic method allows you to />
  • Echocardiography. This method of ultrasound examination of the heart muscle allows you to identify various pathologies of the heart. Using it, it is possible to consider the dimensions of the cavities of the heart muscle, evaluate the function of the ventricles, and also exclude or confirm the presence of valvular heart defects.
  • Coronary Angiography This method is invasive, a special catheter is inserted into the vessels of the heart, and then the degree of their damage, the presence of atherosclerotic stenosis and other changes in the walls of the arteries that could cause angina pectoris are determined.

Based on the results of the above studies, a diagnosis is usually made. Also, the doctor should interview the patient, listen to his complaints and the nature of the pain. An important role is played by the hereditary factor, therefore, usually doctors will find out if any of the close relatives had heart diseases, whether there were cases of sudden death.

In addition, a blood and urine test may be needed, they are necessary to identify concomitant diseases that could affect the course of angina pectoris. A biochemical blood test is always done, it allows you to determine the level of cholesterol in the blood, which contributes to the formation of cholesterol plaques in the arteries, they narrow the lumen and can lead to a heart attack.

The main diagnostic sign of Prinzmetal’s angina pectoris is ECG indicators, which are recorded during a religious attack. A classic sign in such cases is the rise of the ST segment, which occurs against the background of transmural ischemia of the heart muscle.

With myocardial infarction, such a clinical ECG sign is observed for a month after the attack, and with Prinzmetal angina, such a violation is recorded sporadically and lasts only during the attack (about 5-20 minutes).

When performing an ECG according to Holter, transient episodes of ischemia are determined, not accompanied by significant changes in the heart rate. They indicate the presence of episodes of coronary artery spasm.

In addition to these studies, the following examination methods are prescribed to confirm the diagnosis of Prinzmetal angina pectoris:

  • provocative tests with hyperventilation, causing angiospasm;
  • cold and ischemic tests;
  • coronarography (detects coronary stenosis in 50% of patients).

When performing a treadmill test and bicycle ergometry in patients with this form of angina, good tolerance of physical activity is revealed. The diagnosis of angina pectoris is based on:

  1. Anamnesis and analysis of patient complaints.
  2. ECG data. The study is carried out at the time of the attack, since severe transmural myocardial ischemia is characterized by a rise above the isoline of the RS-T segment (due to transient dynamic occlusion of the coronary arteries).

In some cases, the ST segment falls below the contour line – this is due to the presence of subendocardial ischemia, which occurs when the large coronary artery is incompletely blocked or during spasm of small intramural coronary vessels. When stopping the attack, the RS-T segment returns to the isoelectric line.

Data of Holter long-term ECG monitoring, which allow to detect an abrupt shift of the RS-T segment at the initial stage of the attack and its rapid disappearance at the end of the attack.

Holter ECG monitoring allows you to detect the absence of an increase in heart rate at the time of the attack (heart rate increases by no more than 5 beats per minute), which makes it possible to distinguish variant angina pectoris from angina pectoris, as well as the disappearance of the attack with increasing heart rate as a result of a reflex reaction to pain.

  • Coronary angiography data to detect arterial stenosis.
  • Data of functional stress tests, which in most patients give negative results (an attack may in some cases occur at the height of physical activity). Tolerance to physical activity fluctuates due to the changing tone of the coronary arteries.
  • Functional test data. A hyperventilation test and a cold test are usually performed, for which the patient’s hand is placed in water for 3 to 5 minutes (water temperature is 4 ° C). With vasospastic angina, ischemic changes in the RS-T segment are observed in 15-20% of patients.
  • Pathogenesis

    The pathogenetic mechanism of variant angina is based on spasm of the coronary artery. An important link in the development of the disease are also:

    • Erosion of the endothelium lining the inner surface of the vessels (a single-layer layer of flat cells). Damage to the endothelium affects the development of atherosclerosis.
    • Fibromuscular dysplasia. Due to this non-inflammatory lesion of the vascular wall (due to genetic mutation), smooth muscle cells of the middle membrane of arterial vessels are transformed into fibroblasts, bundles of elastic fibers accumulate at the border with the outer membrane of the vessels and typical “constrictions” form.

    As a result, the lumen of the vessel narrows, and the elastic inner membrane is fragmented or thinned.

  • Increased concentration of cells in adventitia (outer membrane of blood vessels).
  • Prinzmetal angina occurs with a temporary increase in the tone of large coronary vessels. The vasodilating (vasodilating) and vasoconstrictive factors influence the tone of the coronary vessels.

    A negative effect is exerted by both a lack of nitric oxide (NO) and an excess of endothelin (a vasoconstrictive peptide of endothelial origin). A mutation of the endothelial NO synthase gene may also be observed.

    Severe spasm provokes transmural ischemia, which is characterized by dyskinesia of the left ventricular wall, and an ST segment elevation is detected on the ECG. The cause of the resulting ischemia is not an increased myocardial oxygen demand, but a significant transient decrease in its delivery.

    Variant angina (Prinzmetal, vasospastic): treatment, folk remedies, causes

    The treatment of heart disease should be approached with all responsibility, since they carry a danger to human life. For example, there is a separate form of angina pectoris – Prinzmetal, which can lead not only to a heart attack, but also sudden cardiac death. You can prevent the condition only if you prepare yourself for the possible consequences.

    Features of the disease

    Prinzmetal angina pectoris is one of the forms of angina pectoris that occurs against the background of coronary angiospasm. Pathology got its name in honor of the cardiologist M. Prinzmetal, who first described this form in 1959. In the international classification of diseases 10, a disease revision is assigned the code I20.

    Prinzmetal angina is also called unstable vasospatic, variant and spontaneous. Pathology is rare, as it occurs in about 3% of patients. Most often met men aged 30-50 years. Sometimes variant angina is combined with angina pectoris.

    The main feature of Prinzmetal’s angina is a severe and long pain attack that can occur at rest.

    We will tell you more about what is the cause of variant angina pectoris such as Prinzmetal.

    Prinzmetal angina pectoris manifests amid spasm of the coronary artery. The spasm lasts until critical form obstruction, which leads to a deterioration in blood flow to the myocardium. The most common cause of spasm is atherosclerosis, plaques of which narrow the lumen of the vessels.

    It can also lead to spasm:

    1. hypothermia;
    2. severe emotional stress;
    3. hyperventilation;
    4. excessive activity of the sympathetic and parasympathetic nervous system;
    5. stenosis;

    According to statistics, the majority of cases (over 50%) are smokers with a long history, moreover, they suffer from concomitant diseases, for example, hypertension, cholecystitis, ulcers, etc.

    Folk remedies for angina pectoris can also relieve an attack and prevent its occurrence. Distracting measures in the form of applying mustard plasters or pepper plasters on the legs will expand the heart vessel and reduce pain. Menthol is also a good distraction. Menthol lozenges reduce the duration and intensity of pain.

    Fir oil, which should be rubbed into the heart area, helps to relieve the attack. It is also effective to massage the little finger of the left hand against the background of an attack, since in this place the heart meridian passes, which is responsible for its work. From herbal preparations, tinctures of hawthorn and valerian are effectively used.

    The diet should be observed constantly, and contain a large amount of protein, carbohydrates, and polyunsaturated fats. With coronary heart disease, cholesterol is deposited in the vascular wall. Polyunsaturated fatty acids found in marine fish, olive, sunflower and other types of vegetable oils contribute to the removal of cholesterol from the body.

    Therefore, nutrition should include fat-containing foods. Red wine, citruses, garlic and fish oil contain a large amount of antioxidants, which increases the resistance of body cells to oxygen starvation. Wine, in addition, dilates blood vessels, so in countries where it is customary to regularly consume a small amount of wine, there are fewer cases of heart attacks.

    The use of a patch for hypertension in angina pectoris is effective for several reasons. The patch during an attack has a distracting effect, reducing pain. In addition, the plants contained in it contribute to the expansion of the blood vessels of the heart and lower blood pressure, which prevents the development of the disease again.

    General recommendations for the treatment of angina pectoris: Due to spasmodic narrowing of the lumen of the cardiac artery, insufficient blood supply to the heart muscle occurs, causing severe pressing pain. The attacks are sudden, do not last long, but everyone can be fatal. This condition is relieved by nitroglycerin, but there is no radical remedy for treatment.

    In Russia, angina pectoris is successfully treated with the help of hawthorn berries and motherwort herb, mixed equally (by weight), and complete recovery is noted. Dry rose hips are often added to a medicine to improve palatability and increase vitamin C content.

    Tincture of hawthorn berries against angina pectoris: 7 tablespoons with top of hawthorn berries (whole or chopped) and 7 glasses of boiling water are placed in a jar. Then the jar is closed and wrapped in a warm cloth, put in a warm place for 20-24 hours. After insisting, strain the medicine, place in the refrigerator and take 3 cups a day with meals.

    Herbs and fees that can be applied:

    • If you feel heavy in the heart, take 3-4 tablespoons of pumpkin seeds daily.
    • Take 7 tablespoons (with top) of a mixture of hawthorn berries and rose hips, pour 2 liters of boiling water, put on a heat-insulating stand, wrap heat and insist for 1 hours. Strain, squeeze the swollen berries and put the infusion in the refrigerator. Drink 2 glass a day with meals instead of tea for 3-XNUMX weeks with angina pectoris.
    • Squeeze juice from fresh motherwort herb. Take 30-40 drops in 2 tablespoons of water 30 minutes before eating with angina pectoris.
    • Squeeze the juice from the green pods of the seed bean. Take 2 tablespoons 2-3 times a day before meals as an alternative treatment for angina pectoris. Especially indicated for patients with impaired sugar metabolism.
    • Pour 1 tablespoon of chopped rhizome with valerian roots with 1 glass of boiling water, insist overnight in a thermos. Drink 0,3 cups 3 times a day 30 minutes before meals for 2-3 weeks with angina pectoris.
    • Take 3 parts grass root and thyme herbs, 4 parts lemon balm leaf. Pour 1 tablespoon of the mixture with 1 glass of cold water and let it brew for 3 hours, then boil for 5 minutes and cool for 15 minutes. Drink a folk remedy for 1-2 glasses per day in sips.
    • Take 1 part grass of rue, peppermint leaf and rhizome with valerian roots, 2 parts of adonis grass. 2 teaspoons of the mixture, insist 30 minutes in 1 cup boiling water and drink in sips for 1 day with angina pectoris.
    • Take in equal parts the grass of the root, the grass of the sunflower, lavender flowers, a leaf of rosemary. 1 teaspoon of the mixture pour 1 cup of water and insist. Take 1 glass in the morning and evening with angina pectoris.
    • Take 2 parts of caraway seeds, periwinkle leaves, 3 parts of rhizome with valerian roots, lemon balm leaf, 4 parts of hawthorn flowers, 6 parts of mistletoe leaf. 1 tablespoon of the mixture pour 1 cup boiling water, leave for 2 hours and strain. Take 2 cups a day with angina pectoris.
    • Take 3 parts of bean leaves, birch buds, stigmas of corn, bearberry leaf, 2 parts of hernia grass, grass of horsetail, flowers of blue cornflower. 4 tablespoons of the mixture pour 1 liter of water, leave for 12 hours, boil for 10 minutes, strain. Drink 0,5 cups 4 times a day 1 hour after a meal in a warm form with angina pectoris.
    • Take in equal parts the root leaf, arnica flowers, hawthorn flowers, celandine grass, yarrow grass. 1 tablespoon of the mixture pour 1 cup boiling water, leave to cool and strain. Take for 1 day in 3 divided doses for angina pectoris.
    • Take 30 g of peeled cloves of garlic, hawthorn flowers, hawthorn fruit, mistletoe leaf, field horsetail fruit, 10 g of arnica flowers. Brew 1 tablespoon of the mixture in 1 cup boiling water, strain after cooling and drink 0,25 cup 3-4 times a day with angina pectoris.
    • Take 2 parts of a leaf of wild strawberry, 1 part of a sheet of lingonberry, yarrow grass and dog violet grass. 1 tablespoon of the collection pour 1 cup boiling water, insist 1 hour, drain. Drink 0,5 cup 3 times a day with angina pectoris.
    • Take 2 parts of dog violet grass and 1 part of rhizome with valerian roots. 1 tablespoon of the collection pour 1 cup boiling water, insist 1 hour, drain. Take a folk remedy of 0,5 cup 3 times a day with angina pectoris.
    • Take 2 parts of a sheet of lemon balm medicinal and fruits of hawthorn blood red, 1 part of a rhizome with the roots of Valerian officinalis and grass of horsetail. 1 tablespoon of the collection pour 1 cup boiling water, insist, strain. Take a folk remedy of 0,3 cup 3 times a day 30 minutes before meals. Soothes the heartbeat and reduces pain in the heart.
    • If angina passes without pain, but only with a feeling of tightness in the chest, then to prevent a night attack, it is recommended to take grated horseradish with honey in the evening.

    The modern option: mix grated horseradish with honey in a ratio of 1: 4, take a teaspoon of the mixture 2 times a day before meals for a month.

  • It is recommended, along with other means, to take at least once a year the infusion of medicinal sweet clover herb: for 0,3 l of water 2 teaspoons of grass, drink half a glass 3 times a day 40 minutes before meals, the course of treatment is 1 month.
  • Take 6-7 stems of a medium-sized shake (Briza media L.), pour 1,5 liters of boiling water, insist in a warm place or in a thermos for 20-30 minutes; drink throughout the day without restriction. Wagtail will help with other heart diseases, as well as with urolithiasis.
  • For 100 g of alcohol, take a tablespoon of Avrana grass, insist 10 days, take 15 drops 3 times a day before meals; strictly observe the dose, since exceeding it causes the eyes to be immune to green.
  • Mix the ready-made pharmacy tinctures of hawthorn, mistletoe and valerian equally, take 20-30 drops 3 times a day as an alternative treatment for angina pectoris.
  • How to identify ischemic heart disease in humans

    • analysis for the presence of intracellular protein enzymes in the blood (troponin, aminotransferase, lactate dehydrogenase, myoglobin);
    • biochemical research;
    • electrocardiography;
    • Ultrasound of the heart;
    • study of the lipid spectrum;
    • coronary angiography;
    • daily monitoring;
    • physical examination;
    • general clinical tests.

    Be sure to assess the level of blood pressure, respiratory rate and heart rate. The attending physician should collect a detailed history of life and disease. If there is a suspicion of angina pectoris, stress tests are performed (treadmill test and bicycle ergometry). Electrocardiography is a diagnostic method for coronary heart disease. With a heart attack on an ECG, a negative T wave and an abnormal QRS complex are detected. With extensive damage, a pathological Q wave is determined. It may not be.

    Deciphering the results allows you to evaluate the work of the body. Each tooth and complex reflect the state of individual chambers in systole and diastole. With the help of ultrasound it is possible to evaluate the function of the ventricles and atria, myocardial contractility, and the valve apparatus. To determine the patency of coronary arteries and the degree of obstruction, coronary angiography is performed.

    Possible complications

    Prinzmetal angina can lead to a heart attack. True, the probability of this is small. The cramps that occur during an attack are not very long. There is another danger – a violation of the electrical function of the heart. This leads to a violation of the heart rhythm, which leads to the manifestation of ventricular tachycardia, and this is one step to death.

    Another consequence of the disease is obstructive damage to the coronary arteries.

    If we go to the numbers, then we can say the following. In the first six months after the development of the disease takes about ten percent of the sick. Twenty percent of patients are in remission. True, they will have to follow some rules for the rest of their lives, because the symptoms can return in a few years.

    To put the correct forecast for the development of the disease in the future is not an easy task. It depends on the severity of the disease and the frequency of seizures. And of course, coronary atherosclerosis cannot be ignored.

    Prinzmetal angina can be complicated by the following conditions:

    • extensive myocardial infarction;
    • heart aneurysm;
    • chronic heart failure;
    • life-threatening arrhythmias;
    • sudden coronary death.

    The likelihood of complications is not always predictable. Usually it depends on the duration and frequency of angina attacks. Predictions may also depend on the degree of obstructive lesions of the coronary arteries:

    • in their absence, the probability of death is unlikely and is 0,5% per year;
    • if they exist, the probability of death increases sharply and is about 25%.

    Therapeutic tactics for coronary heart disease

    In acute forms of coronary disease, emergency care is required. If you suspect a heart attack, do the following:

    • call an ambulance;
    • to lay a person;
    • raise the head end of the bed or place a roller under the neck;
    • give a tablet of nitroglycerin under the tongue;
    • remove clothing that restricts movement;
    • prov >

    Emergency care includes the use of aspirin. It is an antiplatelet agent. It prevents the formation of blood clots. In the absence of breathing and cardiac arrest, resuscitation is performed. Treatment of coronary heart disease after diagnosis is determined by the form of ischemia. If angina is detected, then antianginal drugs of long action are prescribed.

    These include nitrates (Sustak, Nitrong), calcium channel blockers (Verapamil), peripheral vasodilator drugs (Corvaton), beta-blockers (Anaprilin). Therapy of angina pectoris involves the use of statins, antiplatelet agents and antioxidants. In severe cases, angioplasty or coronary artery bypass grafting is required. These are radical treatments.

    Standards for the treatment of coronary heart disease are known to any cardiologist. Patients with myocardial infarction are hospitalized on an emergency basis. Therapy includes the use of antiplatelet agents (Aspirin, Clopidogrel), anticoagulants (Fraxiparin), thrombolytics (Urokinase, Streptokinase). Stenting and angioplasty are often required. It is completely impossible to cure patients with a heart attack.

    In the event of a heart rhythm disturbance, therapy involves the use of medications such as Amiodarone, Lidocaine and Atropine. If necessary, a pacemaker is installed. How to treat heart failure, not everyone knows. Therapy is aimed at the main cause of its occurrence.

    In acute failure, rest is required. Liquid intake is reduced to 500 ml. Symptoms and treatment are interconnected. If there are signs of thrombosis, anticoagulants and antiplatelet agents are prescribed. In heart failure, glycosides (Digoxin, Strofantin, Korglikon), nitrates, ACE inhibitors (with high blood pressure), beta-blockers, and diuretics are indicated.

    Prevention

    Despite the fact that Prinzmetal angina can affect a person at any age, do not panic. In order for your heart to be in order, follow these rules:

    • Eat low-calorie foods.
    • Exclude foods rich in animal fats.
    • Do not abuse alcohol, and give up smoking.
    • Sleep – at least eight hours a day.
    • Sports or at least evening walks.
    • Avoid stress whenever possible.

    To avoid the development of angina pectoris, it is necessary to apply measures for the prevention of coronary heart disease. First of all, a person should give up smoking and even try not to be in places where you can inhale cigarette smoke. More physical activity is recommended, but without exceeding their capabilities. In the presence of excess body weight, this problem should be solved.

    Thanks to the observance of these recommendations, a person of any gender and age may well avoid the development of Prinzmetal angina and its other types.

    You need to know not only what coronary heart disease is, but also what its prevention should be. To reduce the risk of developing coronary heart disease, you need:

    • get rid of bad habits (smoking, drinking alcohol and drugs);
    • move more;
    • do sport;
    • timely treat arterial hypertension;
    • limit the intake of foods rich in animal fats;
    • treat endocrine diseases;
    • eliminate stress;
    • boost immunity.

    There is no specific prophylaxis. There are risk factors for the development of coronary heart disease that cannot be eliminated (male gender, old age). Prevention of myocardial infarction comes down to the controlled treatment of hypertension. People who regularly take ACE inhibitors have a much lower risk of developing a heart attack.

    If various clinical syndromes (pain, edema) appear, then you must immediately consult a doctor.

    Prevention of coronary disease includes normalization of nutrition.

    Almost always, the cause of angina pectoris and heart attack is atherosclerosis. To prevent it, you need to eat more fruits and vegetables. In addition, it is recommended that products with anti-atherosclerotic action be included in the diet. These include sunflower and olive oils, fish, nuts. Very useful seafood.

    Thus, the presence of symptoms of coronary heart disease is a reason for contacting a cardiologist and a comprehensive examination. When detecting coronary heart disease, one medication is not enough. Drug therapy without fail is combined with diet and maintaining a healthy lifestyle. In the case of the development of extensive heart attack and acute heart failure, the prognosis is relatively unfavorable.

    Urgent care

    • Causes
    • Symptoms
    • Diagnosis and treatment
    • Help with an attack

    Prinzmetal angina, or, as it is also called, spontaneous, vasospastic or variant, is diagnosed with a spasm of the vessels that feed the heart. This is a rare form of angina pectoris, which manifests itself in a person at rest. The disease was first described by an American scientist in the late 50s, and it was from that time that they began to isolate it as a separate type of angina pectoris.

    Prinzmetal angina is found in people whose age is 30-50 years. The treatment of the disease is non-standard in comparison with other types of therapy used to treat angina pectoris. An attack in the presence of an illness can occur at night when a person is sleeping; it is also often preceded by vasospasm due to low air temperature.

    Prinzmetal’s vasomotor angina occurs due to a sharply passing spasm of the coronary artery to an obstructive condition, against which there is a lack of blood supply to the myocardium.

    Prinzmetal angina pectoris, developed against the background of prolonged smoking, is often combined with diseases such as arterial hypertension, peptic ulcer, cholecystitis, allergic reactions, etc.

    Prinzmetal’s angina attack can occur against the background of hypothermia, as a result of emotional stress or neurosis, hyperventilation or for no reason, spontaneously.

    One of the main signs of the disease is the occurrence of an attack absolutely unexpectedly when a person is resting or doing household, physically uncomplicated work. Pain in this case rolls up and increases behind the sternum.

    It can be confused with pain arising from diseases of the digestive tract.

    Smoking, especially in people with long experience, leads to various vascular pathologies. Cardiovascular disease is the inevitable outcome of people who poison their body with nicotine for a long time. Angina pectoris in this case develops quite often, including Prinzmetal’s angina pectoris.

    Diagnosis of the disease is often carried out using an electrocardiogram, where a distinctive feature will be a change in segment. With myocardial infarction, this segment is also elevated, but, unlike Prinzmetal’s angina, it has been in this condition for a rather long time.

    In addition to this procedure and collection of symptoms, there are other research methods: acetylcholine or ergometrine is administered, ischemic and other tests are performed, etc.

    Prinzmetal’s angina pectoris is treated only in stationary conditions where the patient will be under the constant supervision of specialists. Initially, with this form of angina pectoris, drug therapy is used. Prinzmetal angina is treated:

    1. A budget and affordable drug called Nitroglycerin. The drug helps to stop painful attacks. It must be in the house of all the cores. Nitroglycerin is used for all types of angina pectoris and is included in the standard content of a first-aid kit.
    2. Sustained-release nitrates. They are prescribed after using nitroglycerin for a long time.
    3. Potassium antagonists. They contribute to the expansion of the coronary and collateral arteries.
    4. Beta-blockers for obstructive diseases of the arteries.
    5. Acetylsalicylic acid. It prevents blood clotting and reduces the risk of heart attack.

    All funds must be taken under the supervision of doctors, strictly following the prescribed scheme. Otherwise, the disease can only worsen. It is especially important to go through the entire course of therapy from beginning to end, without stopping when improving health.

    With timely access to a doctor, drug therapy gives positive results.

    If after the course of treatment there is no improvement, then an operation is prescribed: stenting of the coronary arteries, coronary artery bypass grafting, etc.

    The main indication for surgery is the presence of severe coronary atherosclerosis.

    In addition to the main treatment, lifestyle changes will be required, in particular, the patient must get rid of all bad habits, including overeating.

    Food should be balanced, with the exception of animal fats, salt, spices, smoked and spicy foods. The menu should be abundantly present berries, vegetables, fruits, honey, nuts, multivitamin preparations.

    Prinzmetal angina is not treated with folk remedies. They can be used as an addition to the main therapy, after consulting with a specialist. Such therapy is based on the use of mustard plasters, pepper plasters, which are applied to the lower part of the limbs to reduce pain during attacks. Menthol plates, pinky massage, etc. can be used.

    Help with an attack

    With the initial occurrence of an attack at home, you need to call an ambulance. Before the doctors arrive, you need to sit on a chair or sofa and hang your legs down.

    Any motor activity, including walking, performing simple work during seizures is prohibited. To provide oxygen access, you need to unbutton the collar of your shirt, remove your sweater, scarf or tie – all that fetters the throat.

    Windows or windows in them must be opened, if possible, turn on a fan or air conditioning.

    Being in a sitting position and waiting for an attack, you can take acetylsalicylic acid and put a nitroglycerin tablet under your tongue, which should always be at hand. Basically, an attack lasts no more than 15 minutes, this time you need to wait in a calm sitting position. To alleviate pain, nitroglycerin can be drunk repeatedly, but no more than 3 tablets for the entire attack.

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    If the patient becomes sharply worse, despite taking first-aid drugs, it is difficult for him to breathe, vomiting appears, then the patient must be urgently taken to the hospital. After all, such symptoms can manifest not only angina, but also a heart attack.

    Prevention of angina pectoris is a healthy and proper lifestyle, smoking cessation, the implementation of normalized physical activity, quality nutrition.

    If in the family of close relatives there are cases of angina pectoris, it is necessary to undergo regular examination by a cardiologist so as not to miss dangerous disorders in the body.

    It is especially important to do this if a person notices the occurrence of pain behind the sternum, shortness of breath, the inability to perform physical exertion, etc.

    If there is an attack of angina of Prinzmetal, accompanied by intense and prolonged pain, it is necessary to call an ambulance. Otherwise, the principle of first aid is almost the same as with a regular angina attack:

    1. Provide the patient peace, optimal temperature and fresh air.
    2. Give a nitro-containing preparation under the tongue: Nitroglycerin, Nitrominate, Nitrolingval, Isoket, etc.
    3. To eliminate angiospasm, give a tablet (10 mg) of Nifedipine under the tongue.
    4. For severe headaches, take a pill of Baralgin, Spazmalgon, Sedalgon or Analgin.
    5. To improve blood flow and reduce the load on the myocardium, give an aspirin, powdered tablet, to be taken.
    6. To relieve tension and relaxation, perform a light massage of the face, neck, neck, shoulders, left half of the chest and knee joints.

    Causes of Prinzmetal angina

    The disease is provoked by a sudden spasm of one of the branches of venous blood flow. This action lasts until complete obstruction, which partially or completely blocks the flow of blood that goes to the myocardium. One of the main factors for the appearance of these signs is atherosclerosis, which is often in this period at the initial stage of its development.

    Variant angina pectoris (another name for this disease) occurs in malicious smoking enthusiasts, and it is often accompanied by various diseases of the bronchi, arterial hypertension, ulcerative lesions, cholecystitis, allergies of various kinds and others, which can be described as an imbalance in the nervous and autonomic system of the body. This usually leads to cramping. Spontaneous angina pectoris manifests itself in the form of seizures when exposed to factors such as:

    1. Hypothermia of the body (general or local).
    2. The development of emotional stress in the patient.
    3. Respiratory alkalosis with hyperventilation.
    4. Increased activity of the human nervous system (sympathetic and parasympathetic).
    5. Exposure to histamine, thromboxane or serotonin.
    6. Venous artery dysfunction and blood coagulation in coronary insufficiency.

    But the disease can occur without apparent reasons – this is the most significant sign of this disease. Attacks can begin and at rest, without the influence of any factors, or when performing a little physical work. Cramps occur in arteries that are already partially affected by atherosclerosis of individual sites.

    The main symptoms of Prinzmetal disease

    1. Pain occurs for no apparent reason or when exposed to a provoking factor. Typical seizure times are night and early morning. It is also possible that Prinzmetal’s angina manifests itself regularly, at the same time of the day, during regular daily activities.
    2. The duration of a pain attack varies from 2-3 to 15 minutes, less often – up to 30 minutes. Attacks can be repeated at short intervals (from 2 to 15 minutes).
    3. The frequency of seizures also varies. A disease such as vasospastic angina can occur daily, once a week, once a month, and even less often.
    4. Pain sensations are localized in the projection of the heart, however, patients can also describe them as pain behind the sternum.
    5. The intensity of the pain syndrome with Prinzmetal angina is significant. Such pain is tolerated by patients much worse than pain with other forms of coronary heart disease.
    6. Patients usually describe the nature of the pain as burning, cutting, or pressing.
    7. At the peak of the attack, vegetative symptoms develop. There is profuse sweating, pronounced pallor, jumps in blood pressure (Blood pressure can either decrease or increase, depending on individual propensity), headache, a feeling of nausea. The development of fainting conditions is also possible.

    It is characteristic that outside the attack, patients diagnosed with Prinzmetal angina feel completely healthy. However, the attacks themselves are quite difficult, poorly tolerated by patients and can be complicated by the development of life-threatening conditions.

    In order for the treatment of Prinzmetal’s angina pectoris to achieve the expected results, modern specialists use an integrated approach. To do this, it is necessary to divide the entire treatment course into such stages as:

      Elimination of spasm, which consists in the effective elimination of acute pain.

    For this, drugs that contain nitrates are used. Most often, nitroglycerin tablets are used for this purpose. They must be given to the patient every five minutes until the symptoms disappear.

    It should be remembered that giving more than five tablets at a time is dangerous and not recommended.

    The use of vasodilator type. Their task is to relieve spasm from coronary arteries.

    In this case, blood flow throughout the body should also improve, which also plays a significant role in achieving stabilization of the state of the human body. The indicated medications include any antispasmodics, as well as beta-blockers.

  • It is necessary to include in the treatment course such drugs as: anticoagulants and antiplatelet agents. The purpose of their use is to prevent such a process as gluing shaped blood elements.
  • Work with the diet. The nutrition of a person who has acute problems with heart function should be filled with a lot of vitamins and beneficial elements. It is imperative to exclude all kinds of fatty and harmful dishes from the daily menu.
  • The first thing that worries patients with this pathology and their relatives is the question of what medicines to take to stop attacks? Everything is simple. To relieve pain, it is necessary to use Nitroglycerin tablets. These are inexpensive small sublingual (i.e., those placed under the tongue) tablets.

    Inpatient treatment will help eliminate vascular spasm, a lack of blood supply to the myocardium, a decrease in the frequency and “strength” of arrhythmias. In addition, it is timely therapy that ensures the prevention of myocardial infarction and even possible sudden coronary death. Under stationary conditions, Nitroglycerin is also prescribed, after which they switch to long-acting nitrates.

    At the same time (or instead of the above drugs), patients are recommended to take calcium antagonists (such drugs as Verapamil, Nifedipine). They expand the arteries that feed the heart, eliminating the negative effect of vascular atherosclerosis. Patients with spontaneous angina pectoris often take small doses of acetylsalicylic acid preparations.

    In the case when spontaneous angina is accompanied by a severe form of atherosclerosis of the heart vessels, patients are recommended surgical treatment – angioplasty, coronary artery bypass grafting and stenting.

    Variant angina occurs due to spasm of arteries that feed the heart muscle. An attack occurs spontaneously; sometimes it is difficult to determine the causes of its occurrence. Most often, this form of angina pectoris is caused by local endothelial dysfunction or its increased sensitivity to vasoconstrictor substances.

    As a result of a spasm, there is a sharp violation of the blood flow to the heart muscle, if the attack is not stopped and treatment is not started in time, then myocardial infarction may occur.

    There is another reason that can provoke variant angina pectoris – atherosclerosis. Even at the initial stage of this disease, Prinzmetal angina can occur. Consider other factors that can trigger this disease:

    • smoking;
    • hyperventilation;
    • peptic ulcer;
    • allergy;
    • cholecystitis;
    • arterial hypertension:
    • hypothermia;
    • frequent stress.

    The above factors can lead to an imbalance in the autonomic nervous system and trigger an attack of this kind of angina pectoris. Sometimes the cause of the disease can be a violation of blood coagulation or endothelial dysfunction and the vasoconstrictive effect of serotonin, thromboxane and histamine.

    Medication

    If a person has suspicions that he has Prinzmetal angina, then you must immediately go to the hospital. In a hospital, he will be examined, diagnosed and prescribed the necessary treatment, it can be either medication or surgical.

    Basically, medication is prescribed, which boils down to taking the following drugs:

    • Nitrate-containing medicines. They are used during an attack of angina pectoris and for prevention, reduce the tone of blood vessels and contribute to their expansion. Nitroglycerin belongs to this category of drugs, it is used under the tongue to stop the pain syndrome and stop the attack.
    • Vasodilator drugs. They improve blood circulation and relieve coronary spasm. Antispasmodics, beta-blockers, calcium channel blockers – all these drugs belong to this category. A doctor should prescribe medications, self-medication can be dangerous.
    • Drugs that prevent blood clotting. This group includes acetylsalicylic ac >

    Medicines for the treatment of vasospastic angina pectoris:

    • aspirin, clopidogrel – are used to reduce blood clots;
    • simvastatin – reduces the concentration of cholesterol in the blood;
    • bisoprolol, metoprolol – under the influence of these drugs, the heart muscle needs much less oxygen;
    • enalapril, lisinopril – eliminate spasmodic contractions of muscle fibers in the vessel wall.

    Drug treatment begins with nitroglycerin under the tongue. If the symptoms have not decreased, then after 30 minutes you can repeat taking this drug. A further therapeutic regimen may include:

    • prolonged nitrates: Isosorbite mononitrate, Nitrogranulong, Trinitrolong;
    • calcium antagonists: nifedipine, verapamil. They expand the coronary arteries of the heart;
    • B-blockers: Betalok, Nebilet, Concor. These medicines are sometimes prescribed as a substitute for sustained release nitrates;
    • small doses of acetylsalicylic acid;
    • alpha blockers: Prazosin, Tamsulosin, Dalfaz.

    With this type of angina, replacement therapy may be needed. Then selectively appoint:

    • hypoglycemic agents, if the main ailment is associated with diabetes;
    • enzyme preparations: Panzinorm, Festal;
    • hormonal substances: trireodine, etc .;
    • vitamins. For example, vitamin D if there are signs of rickets.

    We must not forget about the implementation of preventive therapy, which includes the use of antiviral agents. They are indicated for seasonal influenza epidemics, then Remantadine is indicated. In some cases, disinfectants are needed. A good effect in preventive treatment is given by timely vaccination.

    Diagnostic methods for determining Prinzmetal’s disease

    To accurately determine the disease, an electrocardiogram is used, which is removed with the next spasm in the patient. As a determinant of the disease, a visible elevation of the ST segment is used, which manifests itself in myocardial ischemia (transmural). With a typical heart attack, this segment is in an elevated state for more than one month, and with spontaneous angina pectoris this is fixed in a short period of time (from five to twenty minutes), while the patient has a spasm.

    If the clinical picture is not entirely clear, then use the method of Holter electrocardiogram with monitoring. This method allows you to identify quick-flowing episodes of the development of the disease, which can occur without noticeable changes in the frequency of beating of the heart muscle.

    If doctors suspect this type of angina pectoris in a patient, they can send him for testing (provocative hyperventilation) or make various tests (ischemic or cold). The administration of acetylcholine or ergometrine or stress testing with a bicycle ergometer can be used. The patient is sent for coronarography, which allows you to determine the level of stenosis of the arteries.

    Surgical treatment method

    If variant angina pectoris is combined with atherosclerosis in an advanced stage, then, most likely, surgical intervention is needed, it can be of two types:

    • Coronary artery bypass grafting. In this case, an additional pathway for blood flow is created, venous or arterial shunts are used. They are attached to the aorta and to the artery, which is affected, but only below the site of stenosis. This operation is performed using a special apparatus that provides extracorporeal gas exchange and cardiopulmonary bypass.
    • Coronary artery stenting. This treatment method is minimally invasive. With the help of a special balloon catheter, a stent is installed – this is a metal tube made of special wire cells. Thanks to it, the narrowed artery expands and does not interfere with blood flow.

    If the disease is complicated by atherosclerosis, then the prognosis is disappointing. Surgery may help, but sometimes the disease returns years later. About 10% of people diagnosed with variant angina pectoris die.

    Variant angina is a rare and very dangerous disease that can result in death. That is why it is important to consult a doctor with the first symptoms of this disease. He will prescribe a treatment that will reduce the risks of sudden cardiac arrest and prevent the development of a heart attack.

    Treatment of angina pectoris with various methods

    If an accurate diagnosis is made, patients are hospitalized. To eliminate the disease, spasms and myocardial ischemia must be removed. In this case, it is necessary to significantly reduce the possibility of the appearance of various arrhythmias, the occurrence of acute myocardium or sudden cardiac arrest.

    At the initial stage, nitroglycerin is prescribed. Then they switch to nitrates of a longer action. Together with these drugs, calcium antagonists should be taken, such as:

    They dilate collateral and coronary vessels. If the disease is started, then beta-blockers may be used. Prinzmetal patients with angina can also use acetylsalicylic acid. If you suddenly stop taking drugs (nitrates and calcium antagonists), then the so-called withdrawal syndrome may occur. It manifests itself in an increase in the number of spasms and the development of myocardial infarction.

    If the disease is accompanied by a severe form of coronary atherosclerosis, then the patient undergoes an operation – coronary artery bypass grafting, artery stenting and angioplasty.

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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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