Progressive angina pectoris causes, symptoms and treatment methods

From year to year, cardiovascular diseases are increasingly being diagnosed in fairly young people. This is due to poor ecology, poor-quality food, constant stress, a sedentary lifestyle, as well as factors of genetics. A pathology dangerous to humans is progressive angina pectoris.

Paroxysmal pains that occur in the chest at the first stage can appear with physical exertion, and in the future no longer depend on this. Unpleasant painful sensations – will intensify each time, so you should contact the clinic as soon as possible.

Since the disease is “getting younger” every year, from a young age you should accustom yourself to the right way of life. In this article, we will consider what progressive angina pectoris is, how it develops, characteristic symptoms, diagnostic methods, and treatment methods used.

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Progressive angina pectoris – a characteristic of the disease

Progressive angina pectoris is an exacerbation of angina pectoris, when during normal physical exertion there is a sudden increase in seizures, more severe and longer in time. Attacks can occur with much less stress or not associated with them at all, attacks are added at rest.

Progressive angina pectoris is characterized by the fact that the frequency and strength of seizures gradually (sometimes quite quickly) increase, seizures occur under conditions that have not been observed before, that is, a disease from functional classes I – II becomes III – IV. This form of the disease most often develops due to the formation of a crack or rupture of an atherosclerotic plaque and subsequent formation of a blood clot.

Sometimes there is spontaneous (variant, vasospastic) angina, or Prinzmetal angina, which is characterized by the spontaneous nature of the attacks, that is, attacks often occur at rest, and not under the influence of stress.

In patients suffering from this form of angina pectoris, as a rule, there are no pronounced atherosclerotic lesions, and the deterioration of the blood supply to the heart muscle occurs due to spasm of the coronary arteries. With spontaneous angina pectoris, the cause of ischemia – bleeding of a tissue site of the heart muscle – is not an increase in oxygen demand of the myocardium, which is manifested due to any circumstances (loads), but a significant decrease in its delivery.

A variation of angina pectoris is the so-called “X” syndrome (microvascular angina pectoris). In this disease, patients exhibit typical symptoms of angina pectoris, however, there is no marked narrowing of the lumens of the coronary arteries, which is detected by coronary angiography.

There are new symptoms:

Pain can change character, appear in new places. Medicines taken by a person earlier significantly reduce the effectiveness of the action, you have to take a much larger dose of the drug. This condition can last several months.

Attacks become more frequent, a person feels a sense of fear, a strong weakness appears, pressure surges are observed. Progressive angina pectoris, passing into rest angina, is characterized by seizures lasting more than 30 minutes. This is a very dangerous condition in which there is a high probability of myocardial infarction.

It is necessary to call an ambulance and urgently begin treatment, otherwise the outcome is unpredictable. Timely access to a doctor and immediately started treatment helps to stabilize progressive angina pectoris.

Causes of appearance

Many patients who have found progressive angina are at a loss. They cannot understand where they got this disease. The fact is that such a pathology for many years can be completely asymptomatic. This largely depends on the individual physiological characteristics of the body.

Sometimes the sick person does not pay attention to the primary signs, attributing them to fatigue, weather, and poor physical fitness. However, after a time when the symptoms manifest themselves brighter, the patient goes to the doctor, where he is diagnosed with ischemic heart disease (CHD).

Progressive angina pectoris is not a separate disease. She acts only one of the manifestations of coronary heart disease. This pathology develops due to a number of unfavorable factors. As a rule, the health of the heart muscle depends most of all on the person’s lifestyle, his habits.

In modern medicine, the following causes of coronary disease and its manifestations such as angina pectoris are distinguished:

  • the presence of atherosclerosis;
  • improper diet;
  • abuse of alcoholic and low alcohol drinks;
  • excessive consumption of sugar and light carbohydrates;
  • lack of physical activity;
  • climate change;
  • smoking;
  • a sharp change in sedentary lifestyle to active physical activity;
  • genetic predisposition;
  • exhausting workouts;
  • susceptibility to stress, depression, apathy;
  • congenital pathologies of the myocardium and the circulatory system as a whole.

Progressive angina pectoris is even more dangerous than the usual form of this pathology. She often causes sudden cardiac death. The above prerequisites for the development of coronary heart disease significantly increase the risk of blood clots and the development of atherosclerosis.

Coronary arteries are an incredibly important component of the circulatory system. Without them, blood circulation and heart nutrition with all necessary substances and, of course, oxygen are impossible.

People who are at risk are recommended to visit a cardiologist once a year, to undergo a preventive examination, which includes an electrocardiogram. The diagnosis of progressive angina pectoris is not a sentence. Unfortunately, it is almost impossible to completely cure CHD.

However, the patient’s condition can be alleviated with the help of special drugs that normalize blood pressure and reduce the load on the heart.
In addition, adherence to a therapeutic diet and regular morning exercises will also preserve the health of the most important organ, the heart, for a long time.

Development of the disease

The causes of coronary heart disease are known to many. Most often, myocardial malnutrition is associated with atherosclerosis, sometimes a spastic component is attached. At the same time, atherosclerotic plaque gradually grows and matures.

This usually happens when there is a high level of cholesterol in the blood, which is why it is so important for patients with coronary heart disease to follow medical recommendations regarding diet and medication.

The formation of atherosclerotic plaque in coronary heart disease has several successive stages:

  • In the initial stages of atherosclerosis, cholesterol is deposited in the walls of blood vessels in the form of fat bands and spots.
  • As the disease progresses, a fibrous plaque forms, which consists of foam cells and the tire.
  • Further, detritus begins to form in the center of the plaque, which is the result of the destruction of foam cells. The surface protruding into the lumen of the vessel gradually fibroses.
  • After the destruction of the tire occurs, internal detritus can enter the lumen of the arteries. This plaque is called unstable, and with coronary heart disease, blood clots can form on it, which leads to progressive angina pectoris or myocardial infarction.
  • At the last stage, calcifications are formed in the area of ​​the plaque, which increase the fragility of the arteries and are often the cause of complications in the surgical treatment of coronary artery disease.

The causes of progressive angina are similar to the etiological factors of coronary heart disease, however, as a rule, there is an unstable plaque on the surface of which blood clots form. The leading cause of angina pectoris, as well as coronary heart disease, is constriction of the coronary vessels caused by atherosclerosis.

Angina attacks develop with narrowing of the lumen of the coronary arteries by 50-70%. The more pronounced atherosclerotic stenosis, the more severe angina pectoris.

The severity of angina pectoris also depends on the extent and location of stenosis, on the number of affected arteries. The pathogenesis of angina pectoris is often mixed, and along with atherosclerotic obstruction, processes of thrombosis and spasm of the coronary arteries can occur.

As a rule, the development of the disease is preceded by a clinical history, a picture of the increase in symptoms and the progression of the disease.

  1. Progressive angina pectoris passes into the next stage, which is accompanied by an increase in seizures, their more severe course, lengthening the time of the attack.
  2. Attacks cause much less stress than before.
  3. New symptoms appear – patients complain of a state of suffocation, frequent perspiration, nausea, often accompanied by vomiting.
  4. Pain changes its character, and pain occurs in new areas, and the area of ​​irradiation also changes.
  5. The effectiveness of nitroglycerin is reduced (to stop the attack, the patient now needs to take more tablets), or he does not help at all anymore.
  6. The attack begins unexpectedly, and now it has nothing to do with stress, nervous shock and physical exertion.
  7. Attacks in tension are replaced by attacks at rest.
  8. ECG changes appear.

Further development of the disease causes a deterioration in the blood supply to the heart muscle and heart tissues, and the rhythm is disturbed. The area of ​​pain captures more and more zones, and attacks are very painful, without stress, most often at night. It is becoming increasingly difficult for patients to tolerate them, since the symptoms are more intense in comparison with seizures during exertion.

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A progressive pathology with tension sometimes lasts for several months. When going into a disease at rest, the pain intensifies significantly, the attack can last for half an hour. Patients often complain of a feeling of fear, unexpected weakness.

If, during an attack, all the symptoms are joined by pressure drops and increased heart rate, then a pre-infarction condition is possible. Due to the fact that this form of pathology often provokes the occurrence of myocardial infarction, emergency care is required immediately, otherwise the prognosis of the course of the disease is unfavorable.

Timely medical assistance and proper treatment stabilize the patient’s condition, and can slow down the course of the disease. There are cases when an unstable pathology returns to the stage of a stable disease, but with more severe manifestations.

Under certain conditions, remission is possible, and the cessation of attacks. Doctors must be sure to trace the history of the disease and the types of manifestations of the pathology, since the disease must be distinguished from myocardial infarction (symptoms are quite similar in nature). With a heart attack, the attack lasts in excess of half an hour, it is impossible to remove it with nitroglycerin.

Classification of the disease

Pathology has several clinical forms, which depends on what was the history of development, and what combined manifestations were noted:

  • attacks become more frequent, but the type of their course does not change;
  • attacks are characterized by intensity and duration, but the amount does not change;
  • seizures in a state of tension alternate with seizures at rest;
  • attacks are characterized by intensity and duration, and also become more frequent.

Depending on the severity of the course of the attack, the pathology is divided into classes:

  • A recent disease in a state of stress.
  • Subacute form combining tension and peace.
  • The acute form is at rest.

There is also such a thing as unstable progressive angina pectoris (NPS). This pathology is characterized by a pre-infarction condition, in which prolonged seizures are observed, having a duration of about thirty minutes. However, they are not affected by drugs such as nitroglycerin.

NPS is also characterized by a significant increase in the severity and frequency of seizures that cause severe pain in the sternum. Pain occurs even with the most minor loads, which previously had a less intense character.

symptomatology

Symptoms of coronary heart disease with progressive angina are distinguished by a number of characteristic features:

  • the appearance of seizures in the patient is increased, compared with the previous medical history;
  • the seizures themselves become longer and more intense;
  • reduced exercise tolerance;
  • often vegetative symptoms join (cold sweat, nausea, choking, etc.);
  • pain can change the nature and area of ​​distribution;
  • sometimes attacks appear not only during exercise, but also at rest;
  • pain can occur suddenly, without a clear connection with the load or emotional experiences.

In addition to pain during progressive angina, as with other forms of coronary heart disease, rhythm disturbances can occur. These symptoms of the disease are associated with electrical myocardial destabilization against the background of an extensive area of ​​ischemia. At the same time, the general well-being of patients worsens.

The course of progressive angina pectoris in coronary heart disease can continue for several months. In this case, the medical history develops in two ways:

  • the transition of pathology to a stable form;
  • the development of myocardial infarction.

In the second case, the precursors of a fatal event are:

  • feeling of fear;
  • fluctuations in system pressure;
  • tachycardia;
  • general weakness;
  • the duration of the attack is more than 20 minutes;
  • the appearance of changes on the ECG;
  • the development of seizures of the disease at rest.

With this course of unstable angina, the risk of developing myocardial infarction is quite high, so the patient should be hospitalized in a hospital in the near future.

The stabilization of the process is possible against the background of complex treatment with the use of anticoagulants, antiplatelet agents and a number of other drugs. At the same time, the surface of the atherosclerotic plaque becomes more stable, and thrombotic masses are no longer deposited on it.

In addition, progressive angina pectoris (CHD) is also characterized by noticeable changes to the electrocardiogram. Therefore, it is not surprising that such surveys are carried out as often as possible in order to constantly monitor vital indicators.

In the presence of this stage of the disease, the patient may appear so-called immunity to various kinds of drugs. So, for example, nitroglycerin, often used to stop attacks, can stop providing the necessary effect, which will lead to the fact that it will be extremely difficult to provide rehabilitation assistance.

Another feature of this situation of the patient is an increase in the volume of drugs necessary for taking at one time. This is a significant issue. Since the human body, which has been struggling with coronary heart diseases for many months or years, is already weakened.

Strong pills that need to be taken in large quantities can improve heart function, but at the same time significantly “plant”, for example, the liver or stomach. In some cases, vision is seriously affected.

The study of this type of coronary heart disease as progressive angina pectoris provides evidence that an attack can occur regardless of human activity. The patient may be in a calm state, but at the same time he may be overtaken by a heavy blow, which will be extremely difficult to cope with.

It is worth noting that most often such situations occur in the morning. It is at this time that the body is in the most weakened state, which is the reason for such frequent attacks in this period of the day.

Diagnostics

Diagnosis of angina pectoris includes the following examination methods:

  • Anamnesis;
  • General blood analysis;
  • Blood chemistry;
  • Measurement of blood glucose (determination of glycemia);
  • Electrocardiography (ECG) at rest and during exercise;
  • Daily monitoring of the heart with an ECG;
  • Echocardiography (EchoECG) at rest and during physical exertion;
  • Scintigraphy during physical or pharmacological stress;
  • Coronarography (in some cases, at the discretion of the doctor).

In coronary artery disease, progressive angina can be diagnosed by carefully collecting an anamnesis, that is, after reading the medical history. As a rule, a patient with coronary artery disease notes a sudden increase in angina attacks or a change in their nature. Sometimes the pain becomes much more pronounced than at the beginning of the medical history.

Among instrumental diagnostic methods, the most informative is coronarography, which allows you to accurately determine the cause of IHD.

In this study, the doctor can notice not only the atherosclerotic plaque itself, which narrows the lumen of the coronary artery, but also the formation of blood clots on its surface. This is a sign of instability and is considered a direct indication for surgical treatment by stenting.

Among other diagnostic methods for progressive angina pectoris are informative:

  • ECG, on which at the time of the attack you can identify a number of changes;
  • Ultrasound of the heart will help to detect areas of the so-called sleeping myocardium, which does not fulfill its function, but is not structurally changed;
  • biochemical blood test;
  • myocardial scintigraphy.

Quite often, it is necessary to distinguish progressive angina pectoris from myocardial infarction. Along with instrumental examination methods, it is necessary to know the results of blood biochemistry. First of all, attention is paid to the level of cardiospecific proteins (CPK-MV, troponin).

With their significant increase, massive necrosis of the heart muscle is usually not in doubt. In the case of a slight increase, the diagnosis remains doubtful, and patients receive treatment as in a heart attack. When recognizing angina pectoris, patient complaints, nature, localization, irradiation, duration of pain, conditions of their occurrence and attack relief factors are taken into account.

Laboratory diagnosis includes a study in the blood of total cholesterol, AST and ALT, high and low density lipoproteins, triglycerides, lactate dehydrogenase, creatine kinase, glucose, coagulogram and blood electrolytes. Of particular diagnostic significance is the definition of cardiac troponins I and T – markers indicating myocardial damage.

Identification of these myocardial proteins indicates a microinfarction or myocardial infarction and prevents the development of post-infarction angina pectoris. An ECG taken at the height of an attack of angina pectoris reveals a decrease in the ST interval, the presence of a negative T wave in the chest leads, impaired conduction and rhythm.

Daily ECG monitoring allows you to record ischemic changes or their absence with each attack of angina pectoris, heart rate, arrhythmia. Increasing heart rate before an attack allows you to think about angina pectoris, normal heart rate – about spontaneous angina pectoris. Echocardiography with angina reveals local ischemic changes and impaired myocardial contractility.

Velgoergometry (VEM) is a breakdown that shows what maximum load a patient can tolerate without the risk of developing ischemia. The load is set using an exercise bike until the submaximal heart rate is reached with simultaneous recording of the ECG.

With a negative test, submaximal heart rate is achieved in 10-12 minutes. in the absence of clinical and ECG manifestations of ischemia. A sample is considered positive, accompanied at the time of loading by an attack of angina pectoris or a shift of the ST segment by 1 or more millimeters.

Detection of angina pectoris is also possible by inducing controlled transient myocardial ischemia using functional (transesophageal atrial stimulation) or pharmacological (isoproterenol tests with dipyridamole) stress tests.

Myocardial scintigraphy is performed to visualize perfusion of the heart muscle and identify focal changes in it. The radioactive drug thallium is actively absorbed by viable cardiomyocytes, and with angina pectoris accompanied by coronary sclerosis, focal zones of myocardial perfusion are detected.

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Diagnostic coronarography is performed to assess the localization, degree and prevalence of damage to the arteries of the heart, which allows you to decide on the choice of treatment method (conservative or surgical). The very first diagnostic method for identifying this pathology is a detailed, attentive questioning of the patient about his feelings during the attack, the nature of the pain, its duration, drugs that the patient is trying to relieve the pain syndrome.

Doctors also use instrumental methods of research, including listening, tapping and palpating the region of the heart, to determine the nature of heart sounds, the regularity of the heart, the presence of pathological noises in different phases of the cardiac activity cycle, the shape of the heart and its configuration features.

The next most common method for detecting angina pectoris is electrocardiography (ECG), which shows the shift of the ST segment and the decrease in the amplitude of the T wave. Use stress tests (test on an exercise bike), but they are dangerous for patients, especially with a pronounced degree of disease.

Echocardiography is informative: it provides information about some constant or periodic increase in the size of the left ventricle. Coronary angiography allows you to assess the localization and severity of stenosis of the coronary vessels, and an X-ray examination of the chest organs gives a potentially altered overview of the shadow of the heart, lungs and mediastinum.

Laboratory research methods have an auxiliary value: a general blood test and a biochemical blood test. They make it possible to identify signs of a beginning or existing atherosclerotic process by increasing indicators such as low and very low density lipoproteins and lowering high density lipoproteins along with triglycerides.

Differential diagnosis of angina pectoris

A diagnosis of angina pectoris due to coronary sclerosis should be made in all cases where the patient may have atherosclerosis, in particular coronary sclerosis, and there is at least an erased picture of a typical pain syndrome, even without severe severe pains with typical irradiation.

The most evidence for the diagnosis of angina pectoris is not the strength of pain and not the classical fear of death (angor), but the appearance of sensations, although they are not very characteristic when walking, physical work and their disappearance in complete rest or after taking nitroglycerin.

The power of pain is said to be of lesser importance; it can range from a feeling of great heaviness in the region of the heart, squeezing with ticks, to unclear constriction, numbness behind the sternum or left towards the neck or shoulder joint. The seizure is often limited to numbness, an unpleasant sensation of stiffness in the left hand in the branch area of ​​the median nerve.

Recently, they have been trying to bring an objective basis for the diagnosis of angina attacks by conducting a physical dosage load in patients and noting at that time the S-T interval shift absent during the workload of a healthy heart on the electrocardiogram recorded (the method, however, is indisputable).

Having diagnosed the stenocardial nature of the pain, it should further be determined whether the patient really has coronary sclerosis or if the pain syndrome of a similar origin is not associated with coronarosclerosis.

    Reflex pectoral toad of vagal origin in case of damage to the abdominal organs, especially with diaphragmatic hernia in the area of ​​hiatus oesophageus, when the cardial part of the stomach protrudes into the chest hernially, irritating the vagus passing nearby, the beginning of the reflex.

Highly located peptic ulcers of the stomach or cancer of the cardia can also be accompanied by reflex angina pectoris, which is eliminated after removal or mobilization of the cardiac part of the stomach.

Inflammation of the gallbladder, hepatic colic can also be accompanied by angina pectoris, and the operation of cholecystectomy can lead to the cessation of these reflected pains for years. Apparently, any other hollow organ of the abdominal cavity, especially the stomach and intestines, can become, with its excessive stretching, a source of the vagal reflex to the coronary circulation of the heart.

So, Botkin describes a case of sudden death, apparently of such an origin, which came from excessive stretching of the stomach by pancakes. True, it is usually in patients of this kind, such as, for example, in case of gallstone disease in obese elderly people, it is more correct to suspect the presence of coronary sclerosis with the leading value of the violation of neurovascular regulation.

Hemodynamic-ischemic angina pectoris due to insufficient oxygen delivery to the heart with unchanged coronary vessels due to small systolic volume, insufficient pressure in the initial part of the aorta, oxygen poverty with severe anemia, poisoning with light gas, etc. So, even in young patients with severe rheumatic stenosis of the aortic orifice, severe anginal attacks are possible due to insufficient blood pressure in the Valsalva sinuses, and hence insufficient irrigation of the blood even of the unchanged coronary arteries, especially since the heart that is sharply hypertrophied with aortic defect requires more oxygen.

Aortic valve insufficiency also, although less commonly, leads to angina pectoris due to too rapid pressure fluctuations in the arterial system, which do not provide a constant supply of blood to the heart muscle. Excessive tachycardia, for example, paroxysmal tachycardia, tachycardia in case of crises of a base disease, can also disrupt the blood supply to the myocardium and cause ischemic pain.

In severe anemia, such as, for example, malignant anemia with very low hemoglobin numbers (about 20% and lower), pain attacks can equally be associated with insufficient oxygen supply to the myocardium, and attacks stop improving blood composition.

Acute blood loss can also cause angina pain. Collapse with insufficient delivery of blood to the heart, for example, in a person recovering from a severe infection during the first steps in the ward or in a patient with hypoglycemic shock, can also be accompanied by ischemic pain in the heart.

Of course, one should also think more often about sclerosis of coronary arteries. So, in patients with malignant anemia, especially in older men with symptoms of, apparently, anemic angina pectoris, as in patients with diabetes mellitus in the presence of, it would seem, only hypoglycemic angina pectoris, often severe coronary sclerosis. With rheumatism and valvular defect of the aorta, rheumatic coronaritis can occur simultaneously, etc.

Angina pectoris pain can also occur as a result of rapidly developing hypertension in acute nephritis, when the heart muscle does not cope with a sudden obstacle with a often reduced blood flow through the coronary arteries, as well as with an overdose of adrenaline when administered intravenously.

Excessive physical activity with a healthy heart rarely causes angina pectoris, as increasing shortness of breath makes you stop working before the lack of blood affects the myocardium; significant expansion of the heart under these conditions can cause pain in the region of the heart, apparently due to the extension of the pericardium.

Occurring with chronic nephritis, and even more so with hypertension, angina pectoris is neurogenic, but is usually combined with coronarosclerosis. The so-called tobacco angina pectoris is also functional in nature, but is often combined with coronarosclerosis or leads to it.

Angina pectoris has, further, to differentiate from pains of a different origin in the region of the heart, in the chest, not depending on myocardial ischemia. Aortalgia in syphilitic aortitis is characterized by constant mild pains mainly behind the sternum handle, not associated with walking, not relieved by nitroglycerin and at rest, and is explained by the involvement in the inflammatory process of the nerve elements of the outer aortic membrane and neighboring tissues.

With particular evidence, this nature of pain in the upper chest is detected clinically with significant saccular aneurysms with periaortitis. In practice, aortalgia is difficult to distinguish from angina pain caused by syphilitic aortitis with a specific lesion of the coronary orifice or a complication of conventional coronary sclerosis.

Pain in acute sweaty pericarditis is associated with excessive stretching of the pericardium when its support function is exceeded. With the accumulation of fluid in the pericardium under high pressure, coronary arteries with a violation of blood circulation in them may also be squeezed.

The pathogenesis of pain in the region of the heart in acute myocarditis is unclear. Perhaps they arise due to overextension of the heart or the formation in the sharply affected myocardium of metabolic products similar to those occurring in the ischemic muscle tissue of the heart.

Pain in the heart can be a manifestation of diseases of neighboring organs. Such are chest pains with paramediastinal pleurisy, sometimes occurring with dysphagia, different size of the pupils, etc.:

  • pain with recoil in the shoulder, violating the respiratory act, with diaphragmatitis,
  • pain in the left nipple with intercostal neuralgia, fibrositis, myositis, gouty deposits, fractures of the ribs, osteomyelitis,
  • periostitis, with painful seizures of the diaphragm in neuropaths, the so-called phrenocardia, or with a high standing of the diaphragm, especially in women during menopause.

In this group of diseases, the localization of pain in the nipple and soreness of the skin in the same area often comes to the fore, although such soreness can also be with typical angina pectoris of varying severity.

Finally, angina pectoris is often mixed with cardiac asthma, although in the classical manifestation of these syndromes there is almost nothing in common: however, they are united to a large extent by the common pathogenesis and, in some cases, in the same patient can either combine or alternate at the same time.

Features of the treatment of the disease

Symptoms indicating the development of progressive angina pectoris are an occasion for urgent medical attention to prescribe a different treatment regimen, as well as for reviewing the dosage of drugs used. The main task of specialists at this stage is to prevent the development of a heart attack and death.

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Treatment of patients with this disease is carried out in a hospital and requires close monitoring by doctors. Treatment of progressive angina pectoris is complex and includes the following activities:

    medical treatment prescribed by a cardiologist on the basis of the symptoms of the disease and general well-being of the patient.

Taking medications is aimed at maintaining the work of the heart, increasing the elasticity of blood vessels, as well as increasing their lumen, which will improve the process of providing the heart with blood and oxygen;

Progressive angina pectoris is a rather dangerous disease, however, modern methods of treatment give quick positive results and allow you to forget about existing problems for a long time.

Medication Therapy

It is prescribed using several drugs of various groups that affect various links of pathogenesis. Effects of the applied means:

  1. Anti-ischemic.
  2. Antiaggregant.
  3. Cardioprotective.
  4. Hypolipidemic.

The anti-ischemic effect is characteristic of nitrates, beta-blockers, calcium antagonists. Each group has a different mechanism of action. Nitrates create a depot in the venous bed, and beta blockers prevent the effect of catecholamines on the myocardium. Which reduces its need for oxygen. Calcium antagonists lead to dilatation of arteries, which improves coronary circulation.

Affordable and popular anti-thrombotic agents are aspirin-based drugs. Their effectiveness in the prevention of vascular accidents has been proven.

For cardioprotective purposes, it is appropriate to use Trimetazidine, which restores the energy balance of damaged cells. The hypolipidemic effect is characteristic of statins, which lower blood cholesterol, which protects blood vessels from plaque formation and subsequent narrowing.

Drug therapy is prescribed individually, depending on how severe the patient’s condition is. Treatment with medications is aimed at nourishing the myocardium, strengthening vessels, expanding the lumen of the vessels.

Surgery

Surgery is performed only in serious situations when large-scale damage to the heart muscle is observed. Most often, the patient is prescribed:

  • Coronary artery bypass grafting – bypasses create paths past the affected artery to promote blood flow.
  • Coronary angioplasty, when a special balloon catheter is inserted into the coronary artery, with the help of which the lumen of the vessel expands and blood flow is stabilized.
  • Stenting – the introduction of a special stent into the vessel, which remains inside, forcibly expanding the lumen.
  • Heart transplant – a similar treatment for progressive angina is prescribed to patients with severe heart damage, since the risk of death in this case is very high.

The prognosis directly depends on the treatment, the patient’s standard of living and the degree of vascular damage, but in any case it is rather unfavorable, since the disease develops and causes significant damage to the body.

Disease breathing exercises

The respiratory system supplies air to the body to enrich them with oxygen and consists of a number of important organs, one after the other: the nasal and oral cavities. They are followed by the pharynx and larynx, and then the trachea and lungs. In the latter, the respiratory system is completed by the bronchi and bronchioles.

Each of these bodies is not only directly interconnected with neighboring bodies in the system, but also has a separate role. Breathing exercises help to clean the channels of oxygen supply to the blood.

Thanks to the world-famous physiologist Buteyko, medicine in 1952 became known for his method of treating asthma, angina pectoris, and also hypertension. Moreover, the method was very effective. The method was based on the fact that the cause of the above diseases is excessive ventilation of the lungs (otherwise, hyperventilation).

In simple terms, the respiratory system is simply not functioning properly in people. During the course of the disease, the patient experiences difficulty in breathing, and begins to breathe more often and more intensely, thereby exerting a certain effort during breathing, and spending extra energy on this.

Such breathing is not the norm for the human body, and the current rhythm leads to frequent contractions of the lungs and vascular stenosis. As a result, the malfunctioning of the respiratory system leads to the occurrence of oxygen starvation of the organs of the whole organism.

Carbon dioxide in the blood is not able to leave it quickly due to vascular stenosis. Consequently, it accumulates in the blood stream and lingers there. This all leads to abnormal functioning of all organs, and the disease progresses much faster.

Respiratory gymnastics with angina pectoris according to the Buteyko method is very effective, since it is aimed at normalizing the functioning of the respiratory system, and, therefore, the normal provision of all organs of the body with oxygen. The methodology is based on the person’s ability to control and control his respiratory muscles in order to be able to reduce the respiratory rate so as to feel discomfort (lack of air).

Breathing lungs should be rare, but at the same time deep, as they say, in the whole chest. Such measured and calm breathing leads to a decrease in vascular stenosis, as well as a decrease in the frequency of contractions. In this case, the nervous system relaxes, and the blood vessels expand.

When performing exercises, the patient fills in a diary, where he notes the date and time of classes, control pauses (before, after training and every 5 minutes), heart rate, well-being. Exercises are performed on an empty stomach, breathing is done only through the nose and silently.
Exercises:

  1. Breathing “tops of the lungs”: 5 seconds – inhale, 5 seconds – exhale, 5 seconds pause – maximum relaxation. Repeat 10 times.
  2. Breathing by the stomach and chest: 7,5 seconds – inhale, 7,5 seconds – exhale, 5 seconds – pause. Repeat 10 times.
  3. Acupressure of the nose at the time of maximum breath holding. 1 time.
  4. The breath of the right, then the left half of the nose. 10 times.
  5. Retraction of the abdomen – 7,5 seconds, on a full breath. Then the maximum exhalation is 7,5 seconds, the pause is 5 seconds. Repeat 10 times.
  6. Maximum ventilation of the lungs – 12 maximally deep breaths and exhalations for 1 minute (5 seconds per breath and exhale). Immediately after this, you need to perform the maximum breath hold on the limit of expiration (1 time).
  7. Rare breath (breathing by level).

All this leads to the enrichment of all organs with the necessary oxygen content. During the performance of respiratory gymnastics, a number of rules must be observed:

    The most important rule that must be observed when performing breathing exercises is to produce all respiratory movements with all the lungs, and not use only their upper zone.

To boil the correct execution of your breathing, you need to take an upright position, straighten your back and put one hand on your chest and the other on your stomach. Taking a deep breath, notice that you first rose. If the stomach first rose, and then the chest, then you breathe correctly.

Possible complications and predictions

Forecasts for patients with a diagnosis of coronary heart disease, angina pectoris with timely treatment are quite optimistic. Less than 40% of patients suffer from a heart attack or die. However, the prognosis in each case depends on the presence of concomitant diseases and the stage of the disease.

Subacute angina pectoris of tension and rest and acute angina pectoris require hospitalization of the patient. At earlier stages, regular observation and implementation of all recommendations of a cardiologist is sufficient.

With incorrect or untimely treatment, progressive angina can lead to dangerous complications, including chronic heart failure (CHF), arrhythmia, ischemic stroke, cardiac asthma, coronary thrombosis and pulmonary edema.

Prevention of attacks and giving up bad habits is necessary not only for those who have learned from experience what progressive angina is, but also for healthy people who are at risk for age or concomitant diseases.

For pain in the sternum, it is necessary to undergo a comprehensive diagnosis and receive the appointment of drugs that will reduce the risk of heart attack and dangerous complications of ischemia. Timely treatment is the key to a positive prognosis of treatment.

Prevention

To avoid the progression of pathology, the following preventive measures should be taken:

  1. Smoking cessation and alcohol abuse.
  2. Prevention of stressful situations and excessive psycho-emotional stress.
  3. Control of body weight and a balanced diet.
  4. Regular physical education.
  5. Measurement of blood pressure and systematic monitoring of its level.

Angina pectoris along with other diseases of the cardiovascular system is currently one of the most common human diseases. But the system of effective treatment and a set of preventive measures allows you to effectively deal with all the symptoms and causes of the formation of an imbalance of processes in the myocardium.
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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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