Prinzmetal angina pectoris general information, causes of the disease, characteristic symptoms,

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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.

Of the variants of angina pectoris, the so-called angina of Prinzmetal is distinguished (Prinzmetal, 1959). It usually occurs during sleep or in the morning before rising. On the ECG, during an attack, changes characteristic of subepicardial damage (shift of the ST segment upward with a tendency to merge with the T wave) are recorded in one or another myocardial zone.

The author believes that this option is based on a spasm of a locally stenotic coronary artery, which has been confirmed in recent years in separate observations using coronarography (Dhurandhar et al., 1972). The appearance of angina attacks in the early morning hours may be related to the so-called paradoxical phase of sleep.

This phase is associated with dreams, it is recorded more often in the early morning, accompanied by a rapid movement of the eyeballs, and an increase in blood pressure. In the paradoxical phase of sleep, “ischemic changes” most often occur on the ECG (Murao et al., 1972).

For each patient suffering from angina pectoris, in general, one or another type of conditions for the onset of an attack is characteristic, especially the localization and irradiation of pain. It is assumed, for example, that the predominant occurrence of pain in response to emotional or physical stress is to some extent related to the personality characteristics of patients (Burch, Gills, 1973).

However, various options for angina can be combined. With the progression of the process, an increase in the degree of stenosis, anginal pain often occurs in any conditions that increase MV03, and their nature changes. Joining angina of rest angina pectoris is an unfavorable sign.

For patients with angina pectoris, which especially arises against the background of a nearby and not widespread process, a certain periodicity, undulating course of the disease is characteristic. Periods of deterioration, increased pain, are replaced by more favorable. According to B.V. Ilyinsky (1960), this is due to the nature of the atherosclerotic process, the progression of which occurs in waves.

Of great importance for the nature of the pain is the background on which angina pectoris occurs. Those conditions that themselves increase myocardial oxygen consumption contribute to angina pectoris. Hypertension, preventing the emptying of the left ventricle, increases its systolic tension.

With hypertension, in addition, oxygen access to individual muscle fibers deteriorates due to the relative decrease in the number of capillaries per unit of muscle mass. With tachycardia, thyrotoxicosis, obesity, attacks of paroxysmal tachycardia, myocardial oxygen consumption also increases.

Extrasystoles, especially those that occur during exercise, lead to useless oxygen consumption by the myocardium, especially with ineffective contractions. Severe bradycardia (transverse heart block, sinoauricular block, persistent sinus bradycardia), when the heart rate does not increase and with exercise, causes angina attacks due to heart distention, enlarged ventricles, increased stroke volume, decreased minute volume and increased, in part cases of blood pressure (Gabor, 1970).

Heart failure, aneurysms contribute to the appearance of angina pectoris, mainly due to an increase in heart volume and a tendency to tachycardia.

Causes of

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Prinzmetal angina occurs as a result of a sharp transient spasm of one of the coronary arteries. A critical or total obstruction (blockage) of an artery developing under the influence of a spasm causes a decrease in blood flow to the myocardium and leads to an attack of angina pectoris.

  • the presence of expressed to varying degrees of fixed stenosis (narrowing) of the proximal coronary artery as a result of the presence of atherosclerotic plaque-narrowing lumen;
  • the absence of severe stenosis of large coronary arteries (according to the CAG), since the spasm occurs at the level of small intramural coronary vessels, changes in which are difficult to detect with CAG.

Vascular spasm usually develops in the proximal part of the coronary vessel (at the site of atherosclerotic changes), but can also diffusely affect all branches of the artery in the area of ​​morphologically unchanged areas.

The main cause of Prinzmetal’s angina pectoris is atherosclerosis, which can provoke angina pectoris even at the initial stage of its development.

In addition, the reasons for the development of this form of angina include:

  • smoking (according to statistics, a significant portion of patients are malicious smokers);
  • cocaine use;
  • hypomagnesemia;
  • insulin resistance;
  • hypertension;
  • cholecystitis;
  • vitamin E deficiency;
  • peptic ulcer disease;
  • other diseases accompanied by unbalanced functioning of the autonomic nervous system and a tendency to spasm of blood vessels;
  • emotional stress;
  • general hypothermia;
  • hyperventilation, which causes respiratory alkalosis (alkaline blood reaction as a result of a decrease in carbon dioxide concentration).

Since Prinzmetal angina pectoris causes a spasm of blood vessels, the cause of the attack can also be:

  • increased activity of the parasympathetic and sympathetic nervous system;
  • taking histamine, sumatriptan, thromboxane, ergotamine and serotonin.

The apparent causes of variant angina are often absent.

Pathogenesis

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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. The vasodilating factor is nitric oxide, which is produced by the endothelium.

As a result of atherosclerosis and hypercholesterolemia, nitric oxide production decreases (or it undergoes a breakdown to a greater extent), and endothelial vasodilator function decreases. This causes an increase in the activity of vasoconstrictor factors and provokes the development of spasm.

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.

Symptoms

Prinzmetal angina in its clinical manifestations differs from the more common angina pectoris. A pain attack that usually occurs during nighttime sleep or early in the morning is not accompanied by obvious provoking factors (there is no increase in blood pressure and heart rate, which cause an increased need for myocardial oxygen).

Variant angina is characterized by:

  • A feeling of intense pain behind the sternum, which often radiates to the shoulder, shoulder blade or left arm. The attack lasts from 5-10 to 20-30 minutes and is characterized by a cyclical character (repeated at approximately the same time).
  • Bradycardia at the initial stage of an attack, which goes into tachycardia with reflex activation of the sympatho-adrenal system caused by pain, awakening or taking nitroglycerin.

With a decrease in contractility of the left ventricle, shortness of breath, a feeling of weakness, sweating, dizziness occur.

  • severe autonomic disorders;
  • transient intraventricular and atrioventricular block;
  • frequent ventricular extrasystoles of high gradations;
  • paroxysmal tachycardia (suddenly starting and ending seizures, which differ in frequency of about 140-240 beats per minute and the correct rhythm);
  • ventricular fibrillation (scattered and uncoordinated contractions of the muscle fibers of the heart muscle).

In some cases, an AV block of the II or III degree may develop, causing a stop of the sinus node and accompanied by syncopal conditions. Pain is not always eliminated with nitroglycerin.

Prinzmetal angina as a chronic variant of coronary heart disease may have 2 clinical options:

  1. in the presence of spasms of the coronary arteries, night attacks occur spontaneously, exercise tolerance is reduced, but angina pectoris is absent;
  2. in the presence of fixed stenosis of the coronary arteries, attacks of variant angina at night are combined with angina pectoris with increased myocardial oxygen demand in the daytime.

At a young age, with variant angina, physical activity is well tolerated.

Methods of diagnosis

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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.

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.

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Help with an attack

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With the initial occurrence of an attack at home, it is necessary 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.

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 the attack was calmly stopped, the patient needs to lie still for some time – preferably at least an hour. Any unusual development of the attack – pain in the wrong place, too much pain, unusual symptoms – an occasion to call doctors. Even if this is not a heart attack, then, most likely, the progress of angina pectoris.

Prinzmetal angina treatment

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As soon as there was a suspicion of such angina pectoris, the first thing that should be done is that the patient should be hospitalized. Postponing a problem can aggravate the situation and make it difficult to treat Prinzmetal’s angina pectoris. To begin with, treatment is carried out with the help of medications.

For example, nitroglycerin is taken to stop the painful attacks that occur during the course of this disease. In the future, it is gradually being replaced with nitrates of prolonged action. Potassium antagonists are also accepted, which allow you to expand collateral and coronary arteries.

If the patient has obstructive coronary artery disease, then you can also start taking beta-blockers. But there is an alternative opinion that beta-blockers only increase the attacks of such angina pectoris, because often they, on the contrary, are not prescribed. Alpha blockers can have a positive effect.

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.

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.
  • Please note that such treatment should be strictly according to the program. If you abruptly stop it, then negative consequences are possible. In particular, the number of seizures, instead of decreasing, can increase one and a half times, the symptoms only worsen – and there is also a risk of developing acute myocardial infarction, so it is necessary to take drugs exactly according to the schedule prescribed by the doctor.

    Often, such measures are enough, but if there is no proper effect, in particular in situations where a person has severe atherosclerosis of the coronary vessels, surgical intervention is acceptable.

    Medication Therapy

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    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.

    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.

    Surgical intervention

    If Prinzmetal’s angina pectoris is associated with atherosclerosis and drug therapy does not bring persistent therapeutic remission, then the treatment is carried out by surgical methods. Most often shown are aortic and coronary artery bypass grafting, angioplasty, and stent insertion into the coronary arteries.

    There are several options for surgical treatment:

    This operation is aimed at creating a workaround for blood flow in stenosis of the coronary arteries. Also, this type of intervention restores perfusion of the ischemic myocardium.

    In order to create such a path, arterial or venous shunts are used. At one end, they are fixed to the aorta, and at the other end below the site of stenosis, they are fixed to the artery that is affected.

    This operation can be performed using an apparatus that provides cardiopulmonary bypass and extracorporeal gas exchange. That is, the heart does not work at this moment, but the drug works, called the “heart-lungs”.

    Coronary artery stenting.

    This is a minimally invasive surgical method that allows you to restore the internal lumen of the arteries of the heart that have undergone stenosis. Endovascular devices such as stents and balloon catheters help in this. The essence of this method is that through a puncture puncture under X-ray control, the catheter is guided to the area where the coronary vessel is narrowed.

    A stent and balloon are attached to the catheter. When the balloon inflates, the intravascular lumen expands. At the same time, a stent is installed in the walls of the artery, that is, a metal tube consisting of wire cells. The deflated balloon and catheter are removed, and the stent remains there, in the artery, so that the lumen is maintained in the position of the balloon.

    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.

    ethnoscience

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    Along with traditional methods, angina pectoris is treated with folk remedies. The main objective of the treatment with this nosology is to reduce the oxygen demand of the heart muscle and prevent blood clots. Traditional medicine offers a number of recipes for this purpose:

    • dried and chopped hawthorn flowers, in the amount of two tablespoons, are brewed in 300 ml of boiling water, kept on low heat for ten minutes, then allowed to cool, filter and drink a tablespoon before main meals;
    • 100 g of the floral part of the hawthorn is poured with a liter of good vodka, a month they insist in the dark, squeezed, sieved through a sieve and drink thirty drops three times before meals;
    • a mixture of rosehip and hawthorn berries in the amount of seven tablespoons brew two liters of boiling water, put in a warm place for a day (you can wrap), then strain, keep the cooked infusion in the refrigerator and drink a glass before main meals for two to three weeks, repeat 3-4 times a year;
    • squeeze the juice from two lemons, from two leaves of large aloe, mix with a pound of honey, put in a cold place for a week in a sealed container, then use according to Art. spoon three times a day an hour before meals;
    • prepare a mixture of dried apricots, raisins, prunes and walnuts, taken in equal amounts, add chopped lemon and peel per 1 kg of the mixture – 1 lemon and three hundred grams of honey in liquid form. Accept under Art. spoon three times a day with any heart disease an hour before eating, well strengthens the myocardium;
    • drink tinctures of tricolor violets as tea for a long time;
    • make a mixture of honey and garlic gruel in a ratio of 1: 1, keep it in a closed container for a week in a cold, dark room, use a tablespoon three times a day;
    • pour the alcohol tinctures of motherwort and lily of the valley (from the pharmacy) in one dish, store in the refrigerator, drink thirty drops twice or thrice a day;
    • make a collection of equal parts of yarrow, St. John’s wort and shredded valerian root, then take one tablespoon of raw material and pour 250 ml of cool water, leave for four hours, then boil for five minutes, leave for two hours, strain, drink a third cup three times in day before meals.

    Many healers recommend, before treating angina pectoris with folk remedies, to conduct a 3-week weekly fasting, it is allowed to eat only raw fruits, vegetable salads, honey, nuts. Between fasting take weekly breaks.

    Used for the treatment of angina pectoris folk recipes, proven by generations. At the heart of many of them is garlic.

      Recipe. Garlic as a means to stop an attack of angina pectoris.

    A whole slice of garlic as a folk remedy for the appearance of pain in the heart is consumed in the absence of nitroglycerin.

    Recipe. Garlic, honey and lemons for the treatment of angina pectoris.

    Using a meat grinder, grind 5 heads of garlic and lemons (10 pieces) of medium size. It is good to mix the resulting mixture with a liter of any honey and put in a tightly closed container, put it for a week in a cool dark place. During this time, the mixture must be mixed periodically.

    The use of 4 teaspoons of the mixture (with a break of one minute before taking each next spoon) once a day, half an hour before eating, provides assistance with angina pectoris.

    Juice squeezed from 24 lemons, mix with mashed garlic (350 g) and pour into a regular jar, the neck of which is tied with gauze. The mixture should be maintained for at least 1 hours. Take overnight, shaking, a spoonful of the mixture in half a glass of pre-prepared infusion (10 to ) of birch leaves.

    Recipe. Garlic boiled in vegetable broth as a remedy for angina pectoris.

    Pour half a liter of the broth prepared from vegetables (carrots, onions, cabbage, celery and table beets) into the saucepan, put the peeled cloves of a large head of garlic there.

    Cover the saucepan with a lid, bring its contents to a boil and boil for 15 minutes over low heat. At the end, add parsley (2 bunches), put off the heat and let the broth cool slightly, then use a mixer to turn it into mashed potatoes. Add to it the sprouted wheat ground into powder.

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    Recipe. Cahors with garlic from angina pectoris.

    Prepare a mixture of 250ml Cahors, half a teaspoon of salt and juice, obtained from one large head of garlic. Need to take before bedtime. The duration of treatment with this drink is one month, and it must be carried out twice a year.

    Recipe. Treatment with a honey mixture of aloe juice and angina lemon.

    Before you cut 2 leaves with aloe, do not water the plant for two weeks. The juice obtained from cut aloe leaves should be mixed with juice squeezed from two medium-sized lemons and honey (0,5kg) added.

    Keep refrigerated. Shake the mixture well before taking. Reception: a tablespoon three times a day 60 minutes before a meal. Up to 4 such treatment courses are needed per year. The break between them is about one month.

    Effectively treats angina pectoris with folk remedies, such as decoctions or tinctures from herbs, herbal preparations, fruits of medicinal plants.

    In the evening, brew in a thermos 6 full tablespoons of motherwort and as many dried fruits of hawthorn and a half liters of boiling water. In the morning, drink 150 ml of strained infusion, and then drink 100-50 ml of infusion during the day (another two to three times).

    Recipe. Treatment of angina attacks with astragalus.

    Infusion of astragalus as a treatment for folk angina pectoris contributes to venous filling, removal of tachycardia and normalization of pressure. Also relieves swelling in kidney disease.

    Regular intake of infusion will help reduce pain behind the sternum and the frequency of attacks. Brew 200ml of boiling water with a dessert spoon of astragalus. Heat in a water bath for 15 minutes. Reception of infusion (1 – 2 tbsp.spoons) is carried out from three to four times a day.

  • Recipe. Tincture of adonis and a three-leaf watch as a medicine for angina pectoris.
    Pour 100 g of a mixture of equal parts of adonis and a three-leaf watch with a liter of vodka and put to infuse in a dark place (for 20 days). Admission: thrice a day, 25 drops of tincture.
  • Buteyko breathing exercises

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    Alternative medicine has its own secrets to treating angina pectoris. One of them is breathing exercises according to the Buteyko method. The author of the gymnastics is a physiologist, who in 1952 developed his own method of combating bronchial asthma, angina pectoris and hypertension.

    The principle of therapy is based on the assertion that the cause of all these diseases lies in pulmonary hyperventilation. Having them, a person begins to breathe deeper. This leads to a reduction in the bronchi and spasm of the blood vessels. There is a spasm, and as a result of it – oxygen starvation of the body.

    It turns out that carbon dioxide is retained in the body, because the vessels are narrowed. He has nowhere else to go, except to accumulate in the blood. This becomes a serious obstacle to the medical treatment of the disease. Buteyko breathing exercises help relieve angina attack. The essence of this method is that during gymnastics lessons a person begins to breathe correctly.

    The main goal of such exercises is to correct chronic pulmonary hyperventilation. You need to learn how to relax the respiratory muscles, hold your breath until you feel a barely noticeable lack of air. Thus, the depth of inspiration is gradually reduced. This leads to relaxation of the nervous system and the expansion of blood vessels. Thus, for example, angina pectoris can be treated.

    Therapeutic diet

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    One of the main principles of the diet prescribed for patients with angina pectoris is the exclusion of animal fats from the diet. It is in them that there is a lot of cholesterol, which gradually accumulates in the body. Eating fatty foods daily, you expose yourself to the risk of atherosclerosis, and it is this ailment that is the basis for the development of angina pectoris.

    Under animal fats is meant a whole list of products. These include:

    • fatty meat of any kind;
    • any type of fat (salted, smoked);
    • any smoked meats and sausage;
    • the liver and other organs of animals that are eaten;
    • fatty dairy products, be it cow’s milk with a high percentage of fat or cream;
    • butter.

    The diet recommended for angina pectoris is aimed not only at stopping the course of the disease, but also at losing weight if the patient is overweight. The fact is that extra pounds are not only problems regarding the appearance of a person, but also a factor that provokes the active progression of the disease.

    That is why adhering to a special diet, it is also necessary to reduce the daily calorie intake of foods consumed.

    Low calorie foods include:

    1. bakery products and easily digestible carbohydrates;
    2. any pastries and confectionery;
    3. sweets, including chocolate;
    4. ice cream;
    5. high sucrose and fructose fruits;
    6. any carbonated drinks.

    Cardiologists also recommend another diet called Table 10, which consists in eating foods that improve blood circulation and strengthen the cardiovascular system. Such a diet is shown to patients with angina pectoris, coronary heart disease, post-infarction conditions, heart defects and hypertension.

    In addition, it is necessary to limit salt intake. It is best to completely exclude it, but if it’s hard for you to refuse it, then you can simply add salads. Instead of ordinary table salt, it is recommended to use dietary salt with the lowest sodium content, as well as add various greens to the dishes (dill, parsley, green onion, lettuce, spinach, etc.).

    This will give the dishes a special flavor and improve the taste of fresh food. For angina pectoris, as well as for myocardial ischemia, it is recommended to include in the diet products such as unpolished cereals, seafood, low-fat fish, seaweed, beans and soy, low-fat poultry (especially chicken without skin), brown bread and low-fat dairy.

    The diet for angina pectoris is slightly different, patients with this diagnosis are recommended to include any leafy vegetables (cabbage, spinach, parsley, vegetable fennel, arugula, chard, etc.) and unsweetened fruits in their diet. It is especially useful to eat cereals from various cereals (buckwheat, wheat, rice, oat and barley).

    Fruits are best eaten fresh, as well as some vegetables. You can make various salads, stew or steam vegetables with the addition of greens. This processing method allows you to save all the useful vitamins and minerals in vegetables. Effective removal of cholesterol from the body contributes to the daily consumption of complex carbohydrates, fiber and food with coarse fibers.

    Optimum 35 g per day. Any seafood, especially seaweed, is rich in trace elements that our body needs so much. Such a diet will help speed up the metabolism. Vegetable oils reduce the amount of cholesterol in the blood, whether it is olive, corn, soy or ordinary sunflower.

    You need to try not to fry in vegetable oil, but add it in its natural form to various dishes, dress them with salads. To replenish protein reserves in the body, it is enough to consume white varieties of fish and chicken, they contain a small amount of saturated fat, and in general these products are considered very dietary, but only if they are cooked correctly.

    It is better to bake chicken in the oven without using oil and mayonnaise or boil it. Rich in potassium, a substance that patients with angina pectoris need, raisins, dried apricots, prunes, honey, walnuts and other types of nuts. It is enough to consume a handful of such components per day. It is also necessary to include foods rich in Omega-3 in food for ischemia and angina pectoris.

    They are found in sufficient quantities in marine varieties of fish. As shown by numerous studies, the daily use of such products will reduce the risk of heart attack with angina pectoris by 30%, and deaths by 50%. Thanks to polyunsaturated fatty acids, many processes are normalized in the body, overall health improves, blood pressure normalizes, the likelihood of thrombosis decreases, and the process of clogging of blood vessels with cholesterol plaques slows down.

    Another anti-atherosclerotic diet can be considered Mediterranean. It is often recommended for patients with heart problems who have had myocardial infarction, including people suffering from symptoms of angina pectoris. At the heart of such a diet are the dietary preferences of the inhabitants of the Mediterranean.

    The French diet was especially fond of the French, and their rates of cardiovascular disease were an order of magnitude lower than that of residents of the United States. As numerous studies have shown, there are much fewer cases of sudden death from heart ailments in those countries where people are accustomed to consume foods that are on the diet menu of the Mediterranean diet on a daily basis.

    Among these products, the following can be distinguished:

    1. Fresh vegetables, parsley, chives, spinach, fruits, nuts, beans, pasta, potatoes. All this is included in the daily diet.
    2. Seafood, especially sea fish, kefir, yogurt, olive oil. Used at least 3-4 times a week.
    3. Low-fat poultry (chicken), chicken eggs, sweets. Not more than twice a week.
    4. Low-fat meats (beef, veal, rabbit, turkey). Not more than once a week.

    The most important rule in the Mediterranean diet is the correct ratio of the proportions of carbohydrates, fats, proteins and minerals. The largest amount in the daily diet should be products containing polyunsaturated fatty acids, then vegetables, fruits, and vegetable oils go to decrease.

    The most important rule in the Mediterranean diet is the correct ratio of the proportions of carbohydrates, fats, proteins and minerals. The largest amount in the daily diet should be products containing polyunsaturated fatty acids, then vegetables, fruits, and vegetable oils go to decrease.

    preventive measures

    %D0%9F%D1%80%D0%BE%D1%84%D0%B8%D0%BB%D0%B0%D0%BA%D1%82%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D0%B5 %D0%BC%D0%B5%D1%80%D1%8B 2 - Prinzmetal angina pectoris general information, causes of the disease, characteristic symptoms,

    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.

    Prevention is the best way to protect yourself from developing the disease. Attention to your health, caution and a clear knowledge of the symptoms will help you live a long and happy life, even with angina pectoris.
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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.
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