Features of the occurrence and manifestation of Prinzmetal angina

The heart is the main muscle organ of our circulatory system. It begins its work on the 26th day from fertilization, being still single-chamber. And he finishes beating his rhythm only at the time of death. The heart constantly pumps blood through the whole body, supplying every cell of our body with oxygen and nutrients. And two coronary arteries branching from the aorta supply blood to the organ itself. These are small vessels, but their importance is difficult to overestimate.

  • Prinzmetal’s angina pectoris was first described in medical literature in the XNUMXth century and named after the author.
  • It is a rare type of coronary heart disease caused by a spasm of the vessels that feed the heart and is accompanied by changes in the electrocardiogram in the form of a rise or depression of the ST segment.
  • Other names for this pathology are also known – variant or spontaneous, vasospastic angina pectoris.

According to statistics, about 1% of patients hospitalized with chest pain have variant angina pectoris. More often this disease is detected in men. Among Europeans, its prevalence is about 2% (in the structure of the total incidence of angina pectoris). Higher rates are available in Japan, which is probably due to genetics.

Development mechanisms

  1. The cause of Prinzmetal angina is a sudden spasm of one of the coronary arteries, as a result of which the blood flow to a certain part of the myocardium is sharply disrupted.
  2. According to the results of pathophysiological studies, it was proved that spasm of coronary arteries is the cornerstone of spontaneous angina attacks, which causes a decrease in oxygen delivery to the myocardium and causes characteristic pathological symptoms.
  3. The mechanisms of this phenomenon remain unclear to the end. Let us dwell on the main ones:
  1. Endothelial dysfunction.
  2. Hypersensitivity of coronary arteries to vasoconstrictors.
  3. Increased tone of the autonomic nervous system.
  4. Smoking.
  5. Increased Rho kinase activity.
  6. High activity of Na-H channels.
  7. Deficiency in the body of vitamin E.

Vascular endothelium is a highly active cell layer with multiple metabolic functions. It has a modulating effect on the function of smooth muscle cells, providing their response to the influence of various types of stimuli.

With the normal functioning of the endothelium and adequate production by it of the most significant vasodilating factor – nitric oxide – the effect of acetylcholine on the vascular wall leads to the expansion of their lumen.

With endothelial dysfunction due to insufficient enzyme activity necessary for the synthesis of nitric oxide, a deficiency is observed, while acetylcholine causes vasoconstriction or spasm.

Coronary artery spasm is associated not only with humoral imbalance, but also with increased sensitivity of their receptors to the action of catecholamines. This may be due to autonomic influences, as evidenced by the development of seizures at night and during psycho-emotional overload, the effectiveness of plexectomy, which eliminates the constant effect of the sympathetic nervous system.

Recently, an elevated level of the Rho kinase enzyme, which in turn reduces the level of another enzyme, myosin phosphatase, has been considered as a trigger, which leads to an increase in contractility of smooth muscle cells and their sensitivity to calcium.

Of particular importance in the development of vasospasm is the increased activity of Na-H channels, which are regulators of intracellular pH. With alkalization of the intracellular medium, the concentration of calcium ions increases, which contributes to the narrowing of blood vessels.

The role of vitamin E in the development of the disease continues to be studied. It is known that the level of this substance in patients with variant angina is lower than in healthy individuals.

Spasm can occur both in completely intact vessels and in arteries affected by atherosclerosis.

In some patients, Prinzmetal angina is combined with atherosclerotic stenosis of the coronary arteries and attacks of stable angina. Therefore, a special mixed form of this pathology is highlighted.

There is an assumption that patients with variant angina have a general predisposition to vascular spasms. After all, they often reveal other diseases with a similar tendency, such as Raynaud’s disease, migraine, etc.

Features of the course

The clinical picture of Prinzmetal’s angina pectoris is somewhat different from the manifestations of classical angina pectoris. However, when combined, it is quite difficult to make a correct diagnosis.

The clinical manifestation of coronary artery spasm is the sudden onset of pain in the heart at rest or during sleep. This usually happens at night, early in the morning, less often during the day, often at the same time. In this case, there is no connection between the pain syndrome and physical activity.

For him, a typical long-term increase in discomfort with a faster resolution. The nature of pain can be different, sometimes even unbearable.

The patient is covered with cold sweat, tachycardia and hypotension may be observed. Sometimes an attack occurs in the form of separate series with a total duration of up to 1 hour. As a rule, taking nitrates relieves pain.

However, any such attack can go into acute myocardial infarction.

In the case of a combination of this pathology with stable angina pectoris during the day, such patients are worried about angina attacks provoked by physical exertion, emotional stress, inhalation of cold air, while at night there are attacks of chest pain without provoking factors and a previous increased myocardial oxygen demand.

Diagnostics

Prinzmetal suspects angina pectoris with Holter ECG monitoring.

The doctor can suspect the presence of a variant angina pectoris in a patient by the combination of clinical signs and medical history. Physical (external) methods are uninformative.

In the absence of a combined pathology, they do not reveal abnormalities. During an attack, systolic murmur and a fourth heart tone can be heard.

The most characteristic signs of the disease are detected on the electrocardiogram when registering it during an attack, which is not always possible. In this case, changes in the ST segment are revealed – its rise above or below the contour.

It should be noted that such changes are reversible and disappear after stopping the attack.

A more informative diagnostic method is Holter monitoring, which allows continuous recording of an electrocardiogram for 24-72 hours.

The gold standard for diagnosing variant angina is coronary angiography. It makes it possible to exclude or confirm atherosclerotic lesion of the coronary arteries and detect vasospasm.

In the absence of changes in the arteries that feed the heart, provocative tests can be used to detect coronary spasm.

The international recommendations highlight several ways to implement them:

  • pharmacological (with the introduction of ergonovin or acetylcholine);
  • hyperventilation;
  • cold.

The latter two are safer in terms of the development of complications, but are inferior to medications in terms of information.

The test with ergonovine has the highest sensitivity, but its carrying out carries certain risks. It may be complicated:

  • refractory vascular spasm with the development of myocardial infarction;
  • severe arrhythmias.

It can not be used in individuals with the following pathology:

  • common atherosclerosis;
  • left ventricular dysfunction;
  • stenosis of the aortic orifice;
  • recent myocardial infarction;
  • rhythm and conduction disturbances.

The attitude to such tests is ambiguous. In some countries they are prohibited, in others they are used in extreme cases when it is not possible to make a diagnosis using other methods. In Russia, cardiologists often use safe samples with hyperventilation and cold.

Principles of treatment

The basis for the treatment of Prinzmetal angina pectoris is drug therapy. The most effective drugs used to treat this pathology are considered calcium antagonists and prolonged action nitrates. For relief of night attacks, nitrates of short action are usually used.

Such treatment is effective in most patients. However, in some cases, an adequate response to the ongoing therapy cannot be obtained. Therefore, at present, the search for new methods of treatment continues.

Studies have been conducted that prove the effectiveness of magnesium sulfate for the relief of pain attacks. Also, with success in the treatment of this pathology, the Rho kinase inhibitor, fasudil, was tested.

Another area of ​​treatment for forms of the disease resistant to conservative therapy is surgery using stents, coronary grafting, etc.

With a mixed form of angina pectoris, treatment is carried out according to the standard principles of the treatment of coronary heart disease. Such patients are recommended to take statins, antiplatelet agents and ACE inhibitors (if necessary).

Particular attention should be paid to treatment with β-blockers, which are usually prescribed to patients with other forms of coronary heart disease. With variant angina, their use is undesirable, since they can increase the frequency of seizures and their duration.

  • If you experience sudden shortness of breath, chest pain, an attack of cold sweat in the early morning hours (from 3 to 6 in the morning), you must first consult a physician who, after an initial examination, will refer the patient to a cardiologist.
  • If seizures become more frequent, occur every night, cause a significant deterioration in well-being, you need to call an ambulance.
  • After examination and confirmation of the form of the disease, a consultation with a cardiac surgeon is additionally prescribed.

The prognosis for spontaneous angina pectoris, provided adequate treatment is considered favorable. However, when vascular spasm is combined with atherosclerotic lesions of the coronary arteries, it becomes heavier, increasing the likelihood of developing acute myocardial infarction and sudden death.

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Causes and risk factors

This type of angina pectoris, unlike others, develops against the background of a sharp transient spasm that occurs in the coronary artery, in its large branch. Such a spasm develops to total or critical obstruction, due to which the blood flow to the myocardium is significantly reduced.

The main reason for this condition is atherosclerosis, which can contribute to the development of an attack at the initial stage of its formation. It is noted that angina pectoris often develops in those people who smoke actively and have a history of concomitant diseases. They can be:

  • arterial hypertension;
  • peptic ulcer;
  • cholecystitis;
  • allergic reactions and so on.

These and other diseases are characterized by an imbalance that occurs in the autonomic nervous system, as well as a tendency to spasms in the vessels. In addition, variant angina pectoris can be caused by:

  • emotional stress;
  • general cooling;
  • hyperventilation, which is accompanied by respiratory alkalosis.

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.

But with this pathology, a spasm of the unchanged site or the smallest branch of the coronary artery can also occur. Critical or total artery obstruction leads to a sharp decrease in the blood supply to the heart muscle. The main reason is vascular damage atherosclerosis, often its initial stage can provoke pathology.

Additional reasons provoking unstable angina of Prinzmetal are:

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

Unlike typical angina pectoris – which is often caused by physical exertion or emotional stress – Prinzmetal’s angina almost always occurs when a person is resting, usually between midnight and early morning. These attacks can be very painful.

Causes of variant angina pectoris: spasm in the coronary arteries (which supply blood to the heart muscle).

Coronary arteries can cramp as a result of:

  • exposure to cold weather;
  • arterial hypertension ;
  • stress;
  • high cholesterol;
  • medicines that tighten or constrict blood vessels;
  • smoking;
  • the use of alcohol, cocaine.

Prinzmetal angina pectoris accounts for about 2,0% of hospitalizations with a clinical picture of unstable angina pectoris. Most often, this manifests itself in adulthood (from 50 to 60 years) and shows a 5: 1 ratio among men and women. Smoking is the only recognized risk factor; however, the use of certain other harmful substances (e.g. alcohol, cocaine, 5-fluorouracil, sumatriptan) may also contribute to variant angina pectoris.

In rare cases, variant angina is associated with systemic vasomotor disorders, such as migraine and Raynaud’s phenomenon, which indicates the presence of a general vascular disorder.

A widespread type of disease related to coronary heart disease is angina pectoris. A special type of this disease, which differs from its other types, is Prinzmetal angina.

Other signs of this disease are vasospastic, variant, or spontaneous. This type of disease is named for the United States cardiologist M. Prinzmetal, who first described the symptoms of the disease in 1959.

Evidence

The main symptoms of Prinzmetal angina:

  • severe severe pain in the sternum, which appear at night or in the morning;
  • increase in heart rate (tachycardia);
  • drop in blood pressure (hypotension);
  • the appearance of sweat;
  • the occurrence of fainting.

Pain usually occurs without any physical exertion. The duration of pain usually lasts from five to fifteen minutes, sometimes half an hour. Attacks can be single or serial with a break from two to fifteen minutes.

Causes

The main cause of the disease is vascular spasm, which leads to a sharp reduction in blood flow that feeds the myocardium. Attacks occur in patients who have vascular atherosclerosis. Usually, for the onset of this disease, it is enough to have the initial stage of atherosclerosis.

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In this case, seizures can be initiated by hypothermia, emotional stress, but most often they appear without any apparent reason. The attack begins at a time when a person is in a calm state or does the usual work, which until then was well tolerated.

The spasm of the vessel wall that occurs during an attack can be associated with an increase in the excitation of the human nervous system, as well as the poor functional state of the inner layer (endothelium) of this vessel. Usually patients with spontaneous angina are many and often smoke.

In this case, spasm often covers the area of ​​the vessel in which there is atherosclerotic thickening, but spasm and the entire artery can be covered.

Diagnosing variant angina is much more difficult than other types of this disease. In this case, there is no direct relationship between exacerbation and physical activity. At the initial stage, the type of disease must be recognized by the nature, location, duration of the attack, as well as other manifestations of the disease.

An important step in the diagnosis of the disease is the removal of an electrocardiogram (ECG). If the patient develops variant angina, then on the ECG, which is removed at the time of the attack, the ST segment should be raised. In contrast to the state of this segment in case of myocardial infarction, its rise continues only during the attack, whereas in the first case it remains for a month.

In the case when the diagnosis using the electrocardiogram is not reliable enough, additional examinations can be carried out to clarify it:

  • Holter ECG monitoring;
  • bicycle ergometry;
  • treadmill test;
  • coronary angiography;
  • provocative tests using ergonovin.

At the same time, daily monitoring of Holter allows you to determine the characteristic ECG changes in the morning hours. Stress tests allow you to assess the body’s tolerance to various loads. With the help of coronarography, the sizes of coronary artery stenosis are determined. This procedure also allows you to visualize the process of occurrence and development of spasm.

The ergonovine test is designed to check for spasm of the coronary arteries. In this case, ergonovine is administered intravenously and is controlled by an ECG. With a positive test, spasm and an increase in the ST interval by 1 mm occur compared with the ECG before ergonovine is administered. Such a test is very sensitive and can cause unwanted effects.

With the positive results of these additional studies, Prinzmetal’s angina is finally diagnosed.

Variant angina usually appears in people aged 30-50 years. Moreover, males are more susceptible to this disease (70-90%).

In its pure form, this disease is quite rare, and more often it is combined with angina pectoris. Such symbiosis occurs in 50-70% of cases.

Since the duration of an attack with variant angina is quite a short time, the likelihood of myocardial infarction during such attacks is rather small.

The ventricular tachycardia that occurs in this case is very dangerous and can cause death.

The average five-year survival of patients with spontaneous angina is 90-97%. However, in the presence of two types of disease (spontaneous and tension) or in the presence of atherosclerotic artery obstruction, this survival is significantly less.

The prognosis of complications of the disease is directly related to the presence of obstruction of the arterial vessels, as well as the severity of the attacks of the disease. If the arteries are not affected by atherosclerosis, then the probability of a patient’s death is quite low and amounts to only half a year. In the presence of severe and frequent seizures, this probability can increase to twenty-five percent.

Treatment

After diagnosing the disease, the most correct decision is to place the patient in a hospital. In the future, Prinzmetal’s angina can be treated both with drugs and with the help of surgical intervention.

The following drugs are used as medicines:

  • nitroglycerin (to interrupt an attack). In the future, other nitrates can be used that act for a long time;
  • potassium antagonists for vasodilatation;
  • beta-andrenoblockers (to compensate for obstructive lesions of arteries);
  • antiplatelet agents (acetylsalicylic acid preparations) necessary to reduce blood coagulation.

In some cases, beta-andrenoblockers are not effective enough. In these cases, alpha-blockers can be used.

The medication should be carried out strictly according to the proposed scheme. It should also be borne in mind that in the event of a sharp cessation of medication, withdrawal syndrome may appear. This syndrome causes undesirable consequences, up to the occurrence of myocardial infarction and death.

If drug treatment of the disease does not help, then surgical methods of treatment are used. These include:

  • vascular bypass;
  • stent placement in arteries;
  • angioplasty.

conclusions

  1. Prinzmetal angina pectoris, the symptoms of which are chest pain, pressure drop, tachycardia, is one of the dangerous diseases associated with coronary artery disease.
  2. The main cause of this disease is a spasm of blood vessels that feed the heart muscle that occurs against the background of atherosclerosis.
  3. The diagnosis of this disease can be made according to the characteristics of the ECG, and treatment can be carried out both with drugs and surgically.

Prinzmetal angina pectoris – symptoms, diagnosis and treatment

Prinzmetal angina pectoris should be suspected in each patient with bouts of chest pain occurring exclusively or mainly at rest. Although the majority of patients with rest angina pectoris have the most common form of unstable angina, characterized by coronary thrombosis, individualization in a subgroup of patients with variant angina pectoris is crucial among these patients, since the possibility of preventing coronary spasm by introducing a vasodilator (e.g. calcium) is an antagonist and nitrates) will avoid life-threatening complications of coronary spasm, including cardiac arrest and acute myocardial infarction.

Angina attacks are usually short in duration (2-5 minutes, but sometimes only 30 seconds) and can be repeated in groups of more episodes within 20-30 minutes. Angina pectoris usually responds quickly to sublingual nitrates and may be circadian in nature with a predominance in the early morning or night hours.

Tolerance to effort is usually well maintained, but exercise can cause cramping in about a quarter of patients. Variant angina pectoris can represent “hot phases” with frequent relapses of angina pectoris, alternating with “cold phases”, with remission of symptoms for weeks or months.

In several cases, provocative pharmacological tests are needed to confirm the diagnosis of vasospastic (variant) angina pectoris. The intracoronary or intravenous administration of ergonovine or the intracoronary infusion of acetylcholine can be used to induce and directly demonstrate coronary spasm during coronary angiography.

Intravenous ergon testing, on the other hand, can also be safely performed non-invasively, with careful clinical monitoring of the 12-lead ECG, with coronary spasm confirmed by the induction of angina pectoris and ST segment elevation.

Attacks of vasospastic angina pectoris can be effectively prevented with the help of medium or high doses of calcium antagonists (non-dihydropyridine and dihydropyridine preparations, alone or in combination) in about 90% of patients. In some cases (e.g., persistence of episodes, side effects of calcium antagonists), the addition of long-term nitrates is useful for controlling symptoms.

In approximately 10% of cases, coronary artery spasm may be immune to optimal vasodilator therapy and require very high doses of calcium antagonists / nitrates. In the case of persistent attacks of Prinzmetal’s angina pectoris, anti-alpha-adrenergic drugs such as guanethidine (Octadine) or clonidine (Catapresan, Gemiton, Chlofazolin, Atenzina, Kapressin, Clonilon, Hyposin) can help.

It is also assumed that the use of antioxidant vitamins (C and E) improves endothelial function and reduces vascular reactivity in prinzmetal angina and, therefore, can improve the effect of vasodilator drugs, but data on this possible approach are not available. Where possible, a K-channel opener nicorandil may be added.

Recent evidence that coronary angioplasty with stenting can also help prevent coronary spasm in the refractory variant of angina pectoris.

Complete denervation of the heart with plexectomy, with or without coronary artery bypass surgery, has previously been proposed for the most persistent cases; however, procedural risks are high and the results are contradictory.

Due to the possibility of long-term remission of symptoms, in patients who become asymptomatic, you can try to gradually abandon drug therapy, in case of recurrence of angina pectoris, a vasodilator can be administered quickly. However, long-term treatment with vasodilators is recommended for those patients with signs of angina attacks who are at risk of life-threatening tachy or brady arrhythmias. In these patients, it is necessary to consider the need for implantation of an automatic cardiac defibrillator or pacemaker, respectively.

The diagnosis of “vasospastic angina” is formulated according to the results of a comprehensive examination of the patient. At the first call to a cardiologist, the exact cause of the symptoms is established, a list of tests and studies is assigned.

Diagnostics includes the following methods:

  1. Survey of the patient with the collection of information necessary for the diagnosis.
  2. Inspection, including palpation, auscultation (listening) and percussion.
  3. Electrocardiography (ECG).
  4. Echocardiography
  5. Coronarography
  6. Holter ECG monitoring.
  7. Functional tests.

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 identify ECG changes that occur during an attack.
  • Load test. In this case, a special treadmill or exercise bike is used. Patients perform physical activity under the supervision of an ECG. Using this diagnostic method, it is possible to detect changes that occur in the heart muscle during exercise.
  • Cold test. It is usually done in the morning. A person should immerse the hand and forearm of his right hand in water with pieces of ice for about 5 minutes. If such a procedure provokes an attack, then the diagnosis is confirmed.
  • Ergometrine test. Ergometrine is a substance that can cause spasm of the coronary arteries, it is a derivative of lysergic acid. If an arterial spasm was recorded with an ECG during the administration of this substance, the diagnosis of variant angina pectoris is confirmed.
  • 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.

Any kind of disturbance in the functioning of the cardiac system is a serious danger to human health, since changes in the functioning process can lead to a deterioration in the state of many other internal organs and systems in the body.

In the absence or insufficiency of treatment, a high probability of developing a number of complications that already negatively affect the health and even the life of the patient; however, some lesions of the cardiac system, being rarer and difficult to treat, are more difficult to detect and correct.

Complications after them are especially dangerous due to the more extensive effects on the body.

And Prinzmetal’s angina pectoris, which is a rather rarely diagnosed type of damage to the heart muscle, has a number of specific features of the onset and course, and can also lead to a number of consequences, the knowledge of which will help to avoid a sharp negative impact on health and take a number of necessary therapeutic measures in time.

There are several synonymous names for this type of pathology of the heart muscle, and they all mean the same kind. This is spontaneous, variant, vasospastic angina pectoris.

This type of cardiac pathology is, according to medical statistics, considered one of the most dangerous due to the very extensive damage to the myocardial tissue, the possibility of a significant number of irreversible complications.

Symptoms of the disease are quite characteristic, which allows you to identify it at an early stage of development and minimize the negative impact on the health of the patient.

Representing a clinical manifestation of resting angina pectoris, Prinzmetal angina is noted when spasms of the blood vessels of the myocardium occur, due to which the nutrition process of heart tissues is carried out.

The frequency of manifestation of this phenomenon depends on a number of subjective and objective factors, and the cause of spasm of the coronary vessels is considered to be the lack of increased metabolic needs of heart tissue before the onset of the attack.

Variant angina was named after the famous cardiac surgeon M. Prinzmetal (America), who accurately described the manifestations of this pathology, the features of its occurrence and the characteristic symptoms that separate it from other varieties of the disease.

The same data can be obtained by analyzing the age category of patients with this type of cardiac pathology, comparing the frequency of the noted cases of the disease of other varieties.

Prinzmetal angina pectoris is considered one of the most dangerous varieties of this lesion for the patient’s health, since it is detected somewhat less frequently than other types of this pathology, the initial stage conceived is asymptomatic, which does not allow timely detection of the disease at its beginning. Later stages, to a more complex degree, can be completely cured. The frequency of negative consequences for the patient’s health in this type of disease is high.

Disposable factors and prevention

Although variant angina is considered a rare form of the disease, it is also quite dangerous, because it brings with it unpleasant consequences, up to death, especially if its treatment is irresponsible.

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Therefore, it is necessary to call an ambulance at the first symptoms of the onset of an attack, and even better to lead a lifestyle that will minimize the chances of developing angina pectoris.

The risk of complications is associated with spasm of the coronary vessels, the frequency and duration of seizures. To maintain health, prevention is important. Maintaining the right lifestyle, nutrition and sports strengthen the body, train it in front of negative environmental factors.

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.

There are two main directions for the prevention of angina pectoris:

  • primary prevention, which is designed to prevent the development of the disease in an initially healthy person;
  • secondary prevention, which is designed to prevent the progress of the disease in the patient.

Despite different goals, both directions are very similar and require virtually the same approach:

  1. Rationalization of nutrition. Angina pectoris in most cases develops due to atherosclerosis, and that, in turn, due to an excess of “bad” cholesterol in the body. To prevent its accumulation, you should:
    • eat less animal fats – fatty dairy products, fatty meat;
    • refuse stimulants – alcohol, drinks containing caffeine;
    • use less salt and try to limit the intake of foods rich in fast carbohydrates – sweets, pastries;
    • eat more vegetables, fruits, citrus fruits, garlic, onions and ginger.
  2. Tracking physical activity. It does not have to be exhausting (it also affects the heart badly), but it must be regular. Daily walks in the park, cycling or swimming will be perfect.
  3. Rejection of bad habits. Alcohol should be eliminated almost completely, smoking should be completely abandoned.
  4. Track your own health.

Even absolutely healthy people are useful from time to time to measure blood pressure and visit a doctor once a year. Do an ECG, give him a heart listen and make sure that everything is in order. At the first sign of pain, you should not wait until it passes, and consult a doctor.

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.

It is possible to exclude only those influences that are subject to man, they are called disposable. The rest – unrecoverable – are not subject to our influence. Unrecoverable risk factors include gender, race, heredity and age. For example, men are more prone to angina. This trend was noticed until the age of 50-55 years, when the female body approaches menopause.

During this period, women stop producing estrogen, which is the protector of the heart. After 55 years, the likelihood of illness in men and women equalizes. The race affects as follows: residents of the Scandinavian countries suffer from angina pectoris much more often than a representative of the black race. And heredity is manifested only in direct relationship with a person who has had myocardial infarction.

  • plentiful meal;
  • any amount of alcohol;
  • emotional and mental stress;
  • strong physical activity;
  • smoking;
  • general cooling;
  • lung hyperventilation;
  • stress.

All these risks can be reduced by changing your lifestyle. This applies not only to reducing the likelihood of repeated attacks, but also to prevention. Even if you have never had cramps, you should think about their possible occurrence and change your habits.

Medication Therapy

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;
  • Minor 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.

Variant angina of Prinzmetal – how is it different from the rest

This kind of disease is characterized by single seizures that occur most often during moments of physical rest, when negative effects are completely absent. It develops due to a spasm of the vessel wall, the cause of which is an increase in the level of work of the sympathetic and parasympathetic nervous system.

Distribution

  • in the UK, the likelihood of this kind of disease is small, as local doctors widely use calcium channel blockers to treat other diseases (these drugs relax the walls of blood vessels);
  • in Japan and South Korea, 40% of patients with complaints of angina are diagnosed with vasospastic.

It is impossible to predict the appearance of a particular form of the disease. But it cannot be said that there is no likelihood of predisposition.

Manifestations

  • low pressure;
  • tachycardia;
  • increased sweating.

For each person with angina pectoris, a number of conditions is compiled necessary for the onset of an attack. Even the strength and localization of pain is individual. The attacks of Prinzmetal’s angina pectoris are much more difficult than the manifestations of ordinary heart disease. Cramps can be not single, but pass in series, observing an interval of several minutes.

During an attack, the patient feels a burning sensation, compression of the chest and heaviness behind the sternum. And the pain can diverge under the left shoulder blade or “shoot” into the left hand, neck. Much less often, pain passes into the lower jaw and on the right side of the body. In general, the symptoms and treatment of Prinzmetal angina pectoris are not much different from the manifestations of the usual form of the disease. But first of all, a diagnosis should be made.

  • hemoglobin;
  • glucose;
  • high and low density lipoprotein cholesterol;
  • triglycerides;
  • total cholesterol;
  • AST and ALT.

These indicators will not be able to accurately indicate the presence (or absence) of the disease, but will help to see the full picture of the state of health. In particular, to determine the presence of risk factors, for example, diabetes. Using an ECG for diagnosis is also fraught with some difficulties. First, a normal electrocardiogram does not yet deny a positive diagnosis.

And secondly, this form of the disease manifests itself only in the resting stage, and the ECG is performed outside of attacks, therefore, it may not show changes in the heart rhythm pattern. Stress tests allow you to understand how well the heart copes with the increased pace of work. To conduct such a study, the patient is placed on a treadmill, or seated on an exercise bike. An ECG is recorded during all exercise. It allows you to identify the relationship between pain and blood flow in the coronary arteries.

Since the main cause of the disease is vasoconstriction due to atherosclerotic plaques, coronary angiography should be performed. This procedure allows you to identify violations in the structure of arteries that feed the heart. It shows the lumen of the vessels, whether there are plaques in it. It is carried out under the influence of a local anesthetic, it is short-lived and safe.

A contrast agent is injected into the blood, which will be clearly visible on x-rays. Such images will reliably show the specialist whether there are changes in the structure of the arteries. Holdin monitoring can be very effective. During the day, the patient keeps hourly records of his condition, sensations and pains. At the same time, the doctor makes an ECG, and then compares the data with the patient’s records. Thus, you can see a more complete picture of the state of the heart.

Treatment

  • nitroglycerin in the form of any tablets or spray produces a short-term effect, but its use alleviates the symptoms at the time of the attack;
  • antiplatelet agents (eg, aspirin) are prescribed to prevent the formation of new blood clots;
  • slow calcium channel blockers relax the muscle tissue of the coronary arteries;
  • in very rare cases, treatment with standard methods does not help, then you have to use alpha-blockers, such as prazosin.

Principles of treatment

Angina pectoris occurs due to increased oxygen demand of the myocardium (“secondary angina pectoris”). In this case, the affected coronary arteries are not able to provide an adequate increase in coronary blood flow.

Spontaneous angina pectoris occurs at rest, without increasing heart rate and blood pressure. The cause of spontaneous angina is a primary decrease in coronary blood flow due to spasm of the coronary artery. Therefore, it is often called “vasospastic” angina pectoris.

Other synonyms for spontaneous angina are: “variant angina,” “a special form of angina.”

The diagnosis of spontaneous angina is much more difficult to establish than the diagnosis of angina pectoris. The most important sign is missing – a connection with physical activity.

All that remains is to take into account the nature, location and duration of the attacks, the presence of other clinical manifestations or risk factors for coronary heart disease.

The stopping and preventive effect of calcium nitrates and antagonists is of great diagnostic value.

For the diagnosis of spontaneous angina pectoris, ECG recording during an attack is very important. A classic sign of spontaneous angina is a transient ST segment elevation on the ECG.

In the absence of ECG changes during seizures, the diagnosis of spontaneous angina pectoris remains presumptive or even doubtful.

A classic variant of spontaneous angina is type Prinzmetal angina (variant angina). In patients with angina pectoris described by Prinzmetal (1959), angina attacks occurred at rest, they did not have angina pectoris.

They had “isolated” spontaneous angina pectoris. Attacks with Prinzmetal angina usually occur at night or early in the morning, at the same time (from 1 a.m. to 8 a.m.), usually attacks are longer than with angina (often from 5 to 15 minutes).

On the ECG during seizures, an ST segment elevation is recorded.

During an attack of angina pectoris, a marked increase in the ST segment is observed in leads II, III, aVF. In assignments I, aVL, V1-V4, reciprocal depression of the ST segment is noted.

According to strict criteria, only cases of angina at rest, accompanied by an increase in the ST segment, belong to variant angina. In addition to raising the ST segment, in some patients at the time of the attack, pronounced rhythm disturbances, an increase in the R waves, and the appearance of transient Q waves are noted.

Variant angina pectoris – angina pectoris arising from arterial spasm (Prinzmetal angina).

Aftermath

It is clear that the consequences and prognosis for this form of the disease are very disappointing, it is good that this form of the disease is quite rare compared to other types.

The disease can lead to serious and life-threatening consequences. As a result of Prinzmetal’s angina pectoris, there is a development:

  • acute attack of myocardial infarction;
  • heart aneurysms;
  • chronic heart failure;
  • life-threatening forms of heart rhythm disturbances;
  • sudden coronary death.

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%.

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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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