Progressive angina pectoris – causes, symptoms, diagnosis and treatment

Angina pectoris is a form of coronary heart disease, characterized by paroxysmal pain in the heart, due to acute myocardial blood supply insufficiency. There are angina of exertion that occurs during physical or emotional stress, and angina of rest, arising outside of physical effort, more often at night. In addition to pain behind the sternum, it is manifested by a sensation of suffocation, pallor of the skin, fluctuations in the pulse rate, and sensations of interruptions in the work of the heart. May cause heart failure and myocardial infarction.

As a manifestation of ischemic disease, angina pectoris occurs in almost 50% of patients, being the most common form of coronary artery disease. The prevalence of angina pectoris is higher among men – 5-20% (versus 1-15% among women), its frequency increases sharply with age. Angina pectoris, due to specific symptoms, is also known as angina pectoris or coronary heart disease.

The development of angina pectoris is provoked by acute coronary blood flow insufficiency, as a result of which an imbalance develops between the need for cardiomyocytes in oxygen supply and its satisfaction. Violation of perfusion of the heart muscle leads to its ischemia. As a result of ischemia, oxidative processes in the myocardium are disrupted: there is an excessive accumulation of under-oxidized metabolites (lactic, carbonic, pyruvic, phosphoric and other acids), ionic equilibrium is disturbed, and ATP synthesis is reduced. First, these processes cause diastolic and then systolic myocardial dysfunction, electrophysiological disorders (changes in the ST segment and T wave on the ECG) and, ultimately, the development of a pain reaction. The sequence of changes occurring in the myocardium is called the “ischemic cascade”, which is based on impaired perfusion and a change in metabolism in the heart muscle, and the final stage is the development of angina pectoris.

Oxygen deficiency is particularly acute in the myocardium during emotional or physical stress: for this reason, angina attacks more often occur with increased heart function (during physical activity, stress). Unlike acute myocardial infarction, in which irreversible changes develop in the heart muscle, with angina pectoris, coronary circulation disorder is transient. However, if myocardial hypoxia exceeds the threshold of its survival, then angina can develop into myocardial infarction.

7b1cfbcbca7cc66461140415f4417298 - Progressive angina pectoris - causes, symptoms, diagnosis and treatment

Causes of Angina Pectoris

The main cause of angina attacks is atherosclerosis, the mechanism of development of which we partially examined at the beginning of the article. In short, the cause of angina pectoris is the defeat of coronary vessels with atherosclerotic plaques that reduce or completely cover the lumen of the bloodstream.

  • Spasms of coronary or coronary vessels;
  • Anomalies in the development of coronary vessels of the heart muscle;
  • Thrombosis and thromboembolism of coronary arteries;
  • Coronary heart disease (CHD).
  • Strengthened physical activity;
  • Strong emotional experience, stress;
  • Tachycardia;
  • Exit from a warm room to cold, cold and windy weather;
  • Genetic predisposition.
  • The use of unhealthy and junk food – soft drinks, fast food, non-natural foods with a large number of substitutes (food additives – E ***);
  • Bad habits – smoking, alcohol;
  • Hyperlipidemia (elevated blood lipids and lipoproteins);
  • Endothelial dysfunction (inner wall of blood vessels);
  • Hormonal imbalance (menopause, hypothyroidism, etc.);
  • Violation of metabolic processes in the body;
  • Increased blood coagulation;
  • Damage to blood vessels by infection – herpes virus, cytomegalovirus, chlamydia;
  • Drug abuse.
  • Males;
  • Overweight, obese;
  • Persons of advanced age;
  • Hypertensive;
  • Dependent on smoking, alcohol, drugs;
  • Fast food lovers;
  • People with a sedentary lifestyle;
  • People often exposed to stress;
  • Persons with diseases such as diabetes mellitus, arterial hypertension (hypertension).

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.

Sometimes angina pectoris develops only as a result of angiospasm without arteriosclerosis of the arteries. In a number of pathologies of the gastrointestinal tract (diaphragmatic hernia, gallstone disease, etc.), as well as infectious-allergic diseases, syphilitic and rheumatoid vascular lesions (aortitis, periarteritis, vasculitis, endarteritis), reflex cardiospasm caused by disturbance of the higher nerve can develop arteries of the heart – the so-called reflex angina pectoris.

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.

  • 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.

Classification

According to the international classification adopted by WHO (1979) and the All-Union Cardiology Scientific Center (VKNC) of the Academy of Medical Sciences of the USSR (1984), the following types of angina are distinguished:

Angina pectoris – occurs in the form of transient episodes of sternal pain caused by emotional or physical stress that increases the metabolic needs of the myocardium (tachycardia, increased blood pressure). Usually the pain disappears at rest or is stopped by taking nitroglycerin. Angina pectoris includes:

The first arising angina pectoris lasting up to 1 month. from the first manifestation. It may have a different course and prognosis: to regress, go into stable or progressive angina pectoris.

Stable angina pectoris – lasting more than 1 month. According to the patient’s ability to tolerate physical activity, it is divided into functional classes:

  • Grade I – good tolerance of normal physical exertion; the development of angina attacks is caused by excessive loads, performed for a long time and intensively;
  • Grade II – normal physical activity is somewhat limited; the occurrence of angina attacks is provoked by walking on flat terrain for more than 500 m, climbing stairs more than 1 floor. The development of an attack of angina pectoris is influenced by cold weather, wind, emotional arousal, the first hours after sleep.
  • Grade III – normal physical activity is severely limited; angina attacks are caused by walking at the usual pace on flat terrain for 100-200 m, climbing stairs to the 1st floor.
  • Grade IV – angina pectoris develops with minimal physical exertion, walking less than 100 m, in the middle of sleep, at rest.

Progressive (unstable) angina pectoris – an increase in the severity, duration and frequency of seizures in response to the patient’s usual load.

Spontaneous (special, vasospastic) angina pectoris – caused by a sudden spasm of the coronary arteries. Angina attacks develop only at rest, at night or early in the morning. Spontaneous angina pectoris, accompanied by a rise in the ST segment, is called variant, or Prinzmetal angina.

Progressive, as well as some variants of spontaneous and first-occurring angina, are combined into the concept of “unstable angina.”

In medicine, a stable and unstable form of the disease is shared.

Functional Class (FC) Angina PectorisCharacterization of the functional class of angina pectoris
IStable angina pectoris of the first FC occurs with intense and prolonged physical or emotional stress.
IIThe second FC of stable angina is diagnosed if the patient develops an attack in cases of walking at a distance of 500 meters or more, walking at an accelerated pace in frosty weather, climbing stairs two or more floors.
IIIThe third FC is given to a patient whose attack occurs after a hundred meters of walking in a calm rhythm. This functional class of stable angina pectoris leads to severe limitations in physical activity.
IVPain occurs even at rest or during sleep. Any physical activity leads to angina pectoris.

An unstable form of the disease is a more complex diagnosis. The complexity of the diagnosis is that there is no relationship between the loads and manifestations of the disease. In the medical hierarchy, the unstable form takes an intermediate place between the stable form and acute myocardial infarction.

The unstable form requires constant monitoring by a doctor. The danger of an unstable form of angina pectoris is that seizures occur without obvious prerequisites and there is a risk of myocardial infarction or sudden death.

There are three classifications of unstable angina pectoris.

Unstable angina classCharacteristic class of unstable angina
IIt is characterized by the recent onset of angina pectoris in severe or progressive form. An exacerbation of coronary heart disease is observed, according to the patient, for two or less months.
IISubacute form of angina pectoris at rest and tension. The patient has a history of angina attacks in the last 30 days, but their absence over the past two days.
IIIThe acute form of angina pectoris. Over the past two days, several attacks of anginal pain at rest.
Unstable angina classSynonymous class name for unstable anginaCharacteristic class of unstable angina
АSecondary unstable anginaThe development of unstable angina pectoris occurs against a background of concomitant factors: anemia, respiratory failure, hypotension, uncontrolled hypertension.
ВPrimary unstable anginaUnstable angina is observed in the absence of factors that exacerbate the process of insufficient blood supply to the heart.
СEarly post-infarction unstable anginaUnstable angina pectoris develops in the period of two weeks after a general myocardial infarction.
Unstable angina classCharacteristic class of unstable angina
1Therapy was absent or was present minimally.
2Adequate protocol therapy was present.
3The treatment was carried out in three groups of antianginal drugs, including intravenous nitroglycerin.

Angina pectoris is divided into 2 main groups – stable and unstable angina pectoris.

Angina pectoris usually develops during physical exertion of a person, strong feelings, stress, i.e. in those cases when the heartbeat becomes more frequent, and the heart muscle needs an increased amount of blood, oxygen.

Angina pectoris FC 1 (FC I) – characterized by rare bouts of pain, mainly with significant or excessive physical exertion on the body;

Angina pectoris FC 2 (FC II) – characterized by frequent bouts of pain with minor physical exertion – climbing stairs to the 1st floor, brisk walking for about 300 meters or more. An attack can also begin in the first hours of a person’s wakefulness, when switching from a rest state to a normal mode, the rhythm of the heart increases, blood circulation increases, and the antifibrinolytic ability (circadian rhythm of angina pectoris) decreases.

Angina pectoris FC 3 (FC III) – characterized by frequent bouts of pain with minor physical exertion – climbing stairs to the 1st floor in the usual slow step, brisk walking for about 150 meters or more.

Angina pectoris FC 4 (FC IV) – characterized by frequent seizures with minimal physical activity of a person or a state of rest (rest).

2.1. The first angina pectoris (VVS) – the development of a second attack occurs 30-60 days after the first manifestation of the pain syndrome.

2.2 Progressive angina pectoris (PS) – development occurs more often against the background of a stable form of angina pectoris, with an increase in the functional class (FC).

2.3. Early post-infarction, postoperative angina pectoris – the development of pain occurs in the period from 3 to 28 days after myocardial infarction (according to the classification of domestic doctors), or from 1 to 14 days (NYHA classification).

2.4. Spontaneous angina pectoris (vasospastic, variant, Prinzmetal) – is characterized by sudden attacks of pain behind the sternum for no apparent reason, most often – at rest. Usually, vasospastic angina is not associated with atherosclerotic lesions of the coronary vessels. Its cause is mainly spasms of the coronary vessels.

Risk Factors

The development, progression and manifestation of angina pectoris is influenced by modifiable (disposable) and unmodifiable (unremovable) risk factors.

Non-modifiable risk factors for angina include gender, age, and heredity. It has already been noted that men are most at risk for angina pectoris. This trend prevails until the age of 50-55, that is, before the onset of menopausal changes in the female body, when the production of estrogen, the female sex hormones that “protect” the heart and coronary vessels, decreases. After 55 years, angina pectoris occurs in persons of both sexes with approximately equal frequency. Often, angina pectoris is observed in direct relatives of patients suffering from ischemic heart disease or who have suffered myocardial infarction.

Modifiable risk factors for angina pectoris a person has the opportunity to influence or exclude them from his life. Often, these factors are closely interrelated, and reducing the negative impact of one eliminates the other. Thus, a decrease in fat in food consumed leads to a decrease in cholesterol, body weight and blood pressure. Removable angina risk factors include:

  • Hyperlipidemia. In 96% of patients with angina pectoris, an increase in cholesterol and other lipid fractions with an atherogenic effect (triglycerides, low density lipoproteins) is detected, which leads to the deposition of cholesterol in the arteries that feed the myocardium. The increase in the lipid spectrum, in turn, enhances the processes of thrombosis in the vessels.
  • Obesity. Usually occurs in individuals who consume junk food with excessive amounts of animal fats, cholesterol and carbohydrates. Patients with angina pectoris need to limit cholesterol in their diet to 300 mg, table salt – up to 5 g, increase the intake of dietary fiber – more than 30 g.
  • Lack of exercise. Inadequate physical activity predisposes to the development of obesity and impaired lipid metabolism. The impact of several factors at once (hypercholesterolemia, obesity, physical inactivity) plays a decisive role in the occurrence of angina pectoris and its progression.
  • Smoking. Cigarette smoking increases the concentration of carboxyhemoglobin in the blood – a combination of carbon monoxide and hemoglobin, which causes oxygen starvation of cells, primarily cardiomyocytes, arterial spasm, and increased blood pressure. In the presence of atherosclerosis, smoking contributes to the early manifestation of angina pectoris and increases the risk of acute myocardial infarction.
  • Arterial hypertension. Often accompanies the course of coronary heart disease and contributes to the progression of angina pectoris. With arterial hypertension, due to an increase in systolic blood pressure, myocardial tension increases and its need for oxygen increases.
  • Anemia and intoxication. These conditions are accompanied by a decrease in oxygen delivery to the heart muscle and provoke angina attacks, both against the background of coronary atherosclerosis and in its absence.
  • Diabetes. In the presence of diabetes mellitus, the risk of coronary heart disease and angina pectoris increases by 2 times. Diabetics with a 10-year experience of the disease suffer from severe atherosclerosis and have a worse prognosis in the case of angina pectoris and myocardial infarction.
  • Increase in relative blood viscosity. It promotes the processes of thrombosis at the site of development of atherosclerotic plaque, increases the risk of coronary artery thrombosis and the development of dangerous complications of coronary artery disease and angina pectoris.
  • Psycho-emotional stress. Under stress, the heart works under conditions of increased stress: angiospasm develops, blood pressure rises, and the supply of myocardium with oxygen and nutrients worsens. Therefore, stress is a powerful factor provoking angina pectoris, myocardial infarction, sudden coronary death.
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Among the risk factors for angina pectoris also include immune reactions, endothelial dysfunction, increased heart rate, premature menopause and hormonal contraceptives in women, etc.

The combination of 2 or more factors, even moderate, increases the total risk of developing angina pectoris. The presence of risk factors should be taken into account when determining treatment tactics and secondary prevention of angina pectoris.

Diagnosis of angina pectoris

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.

  • 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.

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.

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).

Confirmation of a diagnosis in a clinical setting is a complex and lengthy process that requires several instrumental tests:

  • electrocardiogram at rest,
  • electrocardiogram under physical exertion,
  • daily monitoring of electrocardiography,
  • resting echocardiography,
  • scintigraphy under physical or pharmacological loads,
  • echocardiography under physical or pharmacological loads.

In parallel with this complex of instrumental studies, laboratory tests are carried out to identify pathologies that can provoke coronary heart disease.

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. 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).

Angina treatment

It is aimed at stopping, as well as preventing attacks and complications of angina pectoris. Nitroglycerin serves as a first-aid drug for an attack of angina pectoris (keep on a piece of sugar in the mouth until completely resorbed). Pain relief usually occurs after 1-2 minutes. If the attack has not stopped, nitroglycerin can be reused at intervals of 3 minutes. and no more than 3 times (due to the danger of a sharp drop in blood pressure).

Routine drug therapy for angina pectoris includes the use of antianginal (anti-ischemic) drugs that reduce the oxygen demand of the heart muscle: nitrates of prolonged action (pentaerythritol tetranitrate, isosorbide dinitrate, etc.), b-adrenergic blockers (anaprilin, oxprenolol, etc.), calcidomin (verapamil, nifedipine), trimetazidine, etc.

In the treatment of angina pectoris, it is advisable to use antisclerotic drugs (a group of statins – lovastatin, simvastatin), antioxidants (tocopherol), antiplatelet agents (acetylsalicylic acid). According to indications, prophylaxis and treatment of conduction and rhythm disturbances are carried out; with angina pectoris of a high functional class, surgical myocardial revascularization is performed: balloon angioplasty, coronary artery bypass grafting.

When treating angina pectoris with folk methods, two rules must be followed:

  • any prescription of traditional medicine must be approved by the attending physician;
  • folk methods are helpers of traditional drug methods.

There are many alternative methods of treatment. They are based on the main points of the traditional treatment of the disease: a healthy diet and a healthy lifestyle.

Detonic – a unique medicine that helps fight hypertension at all stages of its development.

Detonic for pressure normalization

The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.

Detonic not addictive and withdrawal syndrome, since all components of the product are natural.

Detailed information about Detonic is located on the manufacturer’s page www.detonicnd.com.

Clove of garlic

A common clove of garlic is an alternative to nitroglycerin during an attack of angina pectoris. After chewing a clove of garlic, pain in the chest area will pass after 20 minutes. This recipe is found in many old collections of traditional medicine recipes. In principle, if an attack occurs unexpectedly, such a recipe is a good way to deal with pain.

The most popular stenocardia prophylaxis is a mixture of garlic, lemon and honey. To prepare it, you need to put one liter of honey in a three-liter jar, juice squeezed out of ten lemons and five medium heads of garlic, peeled on cloves.

Mixing the resulting mixture is not easy, but the contents need to be well mixed. Then close the jar with a lid and put for a week in a dark place with a cool temperature. The prepared infusion should be taken in two tablespoons before breakfast, dissolving it in your mouth. The course of admission is until the entire prepared infusion is over.

Aloe infusion on honey

It strengthens the heart and the infusion of aloe on honey. This prescription of traditional medicine is especially effective at the first manifestations of the disease.

Five large aloe leaves and three large lemons are passed together through a meat grinder. The resulting slurry is mixed with a half liter of honey, heated in a water bath. Next, the mixture is put in the refrigerator for several days and taken on a tablespoon on an empty stomach. As in the previous recipe, the course of taking aloe vera infusion on honey is until the infusion is over.

Vegetable juice

This recipe is suitable for the prevention of many heart problems. It helps with both arrhythmia and coronary heart disease.

To prepare vegetable juice, you need to mix a liter of carrot juice, 600 grams of celery juice, 500 grams of spinach juice and 250 grams of parsley juice. Such a vegetable mix should be drunk in two glasses daily. There are no time limits on the course of admission. If possible, this juice should be made a permanent part of your daily diet.

With coronary heart disease, progressive angina is usually treated in a hospital. This is due to the fact that in an unfavorable combination of circumstances, the patient may die from life-threatening arrhythmia or myocardial infarction. Therefore, with a similar course of the disease, it is desirable to conduct monitor observations until the condition improves.

  • nitrates;
  • disaggregants;
  • beta-blockers;
  • Veroshpiron;
  • antihypertensives;
  • statins.

Intravenous administration of heparin and nitroglycerin is sometimes prescribed. If the medical history of a patient with progressive angina is accompanied by a serious change in the coronary bed, which is revealed by coronary angiography, then the optimal treatment strategy is stenting or bypass surgery.

With a local lesion of 1-2 vessels, minimally invasive treatment can be performed and stenting performed. Preliminarily, balloon plastic surgery is performed, which is necessary to expand the lumen of the vessels. Sometimes complications associated with the formation of calcifications occur in the area of ​​the operation. Such a plaque becomes very stiff and difficult to crush.

In addition, its sharp edges can damage the integrity of the vascular wall, which will cause bleeding. Therefore, in some cases, open surgery (coronary artery bypass grafting) is used to treat progressive angina pectoris. This operation is accompanied by circulatory arrest, therefore, it is contraindicated in patients in serious condition or in the presence of serious concomitant pathologies.

How to treat angina pectoris? The treatment of angina pectoris is aimed at stopping the pain syndrome, preventing the development of myocardial infarction, as well as stopping the development of atherosclerosis and cleansing the blood vessels of atherosclerotic plaques.

1. Restriction of human physical activity; 2. Drug treatment (drugs for angina pectoris): 2.1. Relief of pain; 2.2. Maintenance therapy; 2.3. Atherosclerotic therapy; 3. Diet; 4. Surgical treatment; 5. Compliance with preventive measures.

As we have repeatedly mentioned in this article, any physical activity of a person, including strong emotional experiences, makes the heart work faster, the pulse increases and the heart begins to pump blood faster for normal functioning, and therefore needs more blood.

- Progressive angina pectoris - causes, symptoms, diagnosis and treatment

To prevent such situations, the patient needs rest, and the higher the functional class (FC) of angina pectoris, the more you need to protect yourself from physical activity and stressful situations.

Physical activity is needed and is prescribed by the attending physician at the rehabilitation stage, after an additional examination of the patient.

Important! Before using any means and drugs for the treatment of angina pector, be sure to consult your doctor!

Important! Before using folk remedies for angina, be sure to consult your doctor!

Lemon. Following the diet, which we talked about a little higher in the article, before each meal, use a carefully washed lemon peel.

Garlic, lemon and honey. Put in a 3 liter jar 1 liter of honey, juice of 10 lemons and 5 heads of garlic (not cloves) squeezed through a garlic grinder, mix everything thoroughly, cover the jar with a lid and put in a dark, cool place for 7 days to insist. You need to take the drug for 2 tbsp. tablespoons in the morning, 1 time per day, on an empty stomach, slowly absorbing the product for a couple of minutes. The course of treatment is until the cooked remedy is over.

Hawthorn. Pour in a thermos 4 tbsp. tablespoons of hawthorn and pour it with 1 liter of boiling water, put the product overnight for insisting. Drink the infusion throughout the day as tea.

Mint and Valerian. 4 tbsp. tablespoons peppermint and 1 tbsp. add a spoonful of valerian to a thermos, fill the plants with 1 liter of boiling water and set aside for insisting for a couple of hours. Infusion should be drunk during the day.

To increase the effectiveness of the remedy, you can also add a couple of teaspoons of rose hips here, which will add a portion of vitamin C to the drink, directly counteracting the formation of atherosclerotic plaques.

Fir oil. To stop pain in the heart, it is necessary to rub 6-7 drops of fir oil in this place.

Signs of angina pectoris

Angina pectoris, regardless of type, is clearly visualized. A person feels severe pain in the chest area of ​​a cutting or oppressive nature. A characteristic sign is the pressing of a fist to the heart by the patient, which he tries to show in place of the concentration of pain. Such a gesture is instinctive. Pain during an attack of the disease does not appear pointwise in the chest.

The following symptoms indicate an attack:

  • physical or emotional stress prior to the attack,
  • blanching
  • lack of sensitivity in the fingers,
  • expression of suffering on the face
  • sweat on the forehead
  • intermittent rare breathing
  • rapid pulse.
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In most cases, with a stable form of the disease, an attack occurs immediately after the cessation of physical activity.

Prognosis and prevention

Prevention of angina pectoris is important because the prognosis of the treatment of the disease is unfavorable. It is impossible to cure the disease with conservative methods. And the risk of it developing into myocardial infarction or sudden death is quite high.

Therefore, you need to start thinking about heart health when it is healthy. It is recommended that you make the few rules below a part of your lifestyle. Prevention of angina pectoris can fit into four simple truths:

  • constant physical activity
  • lack of emotional overstrain,
  • to give up smoking,
  • health monitoring.

Let us examine these truths in more detail.

The human heart is a muscle. Maintaining her tone requires regular exercise.

The loads can be different: walking, running, physical work, gym classes. And all of them will positively affect the state of the heart and strengthen it.

If you are not a professional athlete, do not exhaust the body with exhausting loads. But sitting all day in an office chair is not worth it. You need a middle ground. It is enough to walk a few kilometers daily or to run several circles around your block in the mornings. The main thing is constancy, and then the heart will be ready for exertion.

Stress is your enemy in preventing heart problems. Constant hassle and anxiety negatively affect the resource of the heart muscle. Everyone understands that you can’t put yourself in the sideboard and not worry about anything. But, thinking about your body, you need to properly prioritize.

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Do not spray emotions on problems that do not deserve it. It has long been noted that non-conflict people are much less likely to encounter heart problems. This also applies to angina pectoris.

Therefore, we take it as a rule: to reduce the risk of developing angina pectoris, it is necessary to reduce the amount of stress in life.

To give up smoking

Smoking and prevention of angina pectoris are incompatible concepts. Oxygen, which must be delivered to the heart by blood vessels, is replaced by harmful compounds from tobacco smoke when smoked. Automatically, we get an aggravation of one of the factors in the development of the disease – a poor supply of oxygen to the heart.

This fact applies to the fight against the disease, and its prevention. With each cigarette, we worsen the nutrition of the heart and bring closer the moment when the first attack of chest pain occurs. Angina pectoris is much closer to those who smoke.

With regard to alcohol, there is an interesting opinion: alcohol perfectly breaks down fatty compounds that clog vessels and lead to atherosclerosis. Based on this fact, a number of experts believe that moderate-dose alcohol is useful as a prophylaxis for angina pectoris and other heart problems.

This statement is also supported by the fact that many old-timers regularly drank a glass of wine or a glass of cognac. But this fact cannot be taken as a guide to action.

If a person leads a healthy lifestyle, experiences regular physical exertion, avoids stress, then the best solution would be a complete rejection of alcohol.

ateroskleroz razvitie bolezni 1 - Progressive angina pectoris - causes, symptoms, diagnosis and treatment

It must be kept in mind that the likelihood of angina pectoris increases with concomitant diseases. Diseases of the lungs, liver, diabetes mellitus, problems with the gastrointestinal tract are all factors that increase the risk of developing angina pectoris.

Regular preventive examinations by a therapist will allow you to diagnose any health problems in the early stages. Early diagnosis is the easiest way to get rid of problems.

Remember that the heart is the motor of the body. But any problems with other organs increase the load on the heart and significantly reduce its resource.

Angina pectoris is a chronic, disabling heart disease. With the progression of angina pectoris, there is a high risk of developing myocardial infarction or death. Systematic treatment and secondary prevention help control the course of angina pectoris, improve prognosis and maintain working capacity while limiting physical and emotional stress.

Effective prophylaxis of angina pectoris requires the exclusion of risk factors: reducing excess weight, controlling blood pressure, optimizing diet and lifestyle, etc. As a secondary prophylaxis with an already established diagnosis of angina pectoris, it is necessary to avoid worries and physical effort, prophylactically take nitroglycerin before exercise, and prevention of atherosclerosis, conduct therapy of concomitant pathologies (diabetes mellitus, gastrointestinal tract diseases). Exactly following the recommendations for the treatment of angina pectoris, taking prolonged nitrates and dispensary monitoring by a cardiologist can achieve a state of prolonged remission.

Prevention of angina pectoris includes compliance with the following rules and recommendations:

  • Complete cessation of smoking and alcohol;
  • Minimizing the use of unhealthy and junk food, including fatty, fried, spicy, salty, smoked meats, as well as foods that increase the level of “bad” cholesterol in the blood;
  • Eating foods enriched with vitamins and macro-microelements (minerals);
  • Move more so that blood circulation always “plays”. Exercise, if necessary, consult a physical therapy doctor so that he appoints a group of exercises to strengthen the cardiovascular system;
  • Watch your weight, do not obesity;
  • Avoid stressful situations, if necessary, change jobs;
  • Do not leave to chance its various diseases, especially the cardiovascular system, so that they do not become chronic.

How to treat angina pectoris

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

  • reduce the risk of seizures in myocardial infarction or in sudden death;
  • reduce the frequency of symptoms;
  • eliminate the manifestations of the disease.

ateroskleroz razvitie bolezni - Progressive angina pectoris - causes, symptoms, diagnosis and treatment

The treatment can be divided into four groups:

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

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

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

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

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

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

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

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

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

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

PreparationPriceDescription
Bisoprololfrom 79 rubles.The drug is in the form of tablets, each of which can contain 2,5, 5 or 10 mg of bisoprolol. Available in packs of 30, 50 or 60 tablets.
Nebivololfrom 187 rubles.Tablets with five milligrams of nebivolol hydrochloride in each. In the package, depending on the packaging, from 14 to 60 tablets.
Carvedilolfrom 69 rubles.Available in tablet form. Depending on the dosage, each may contain 6,25, 12,5 or 25 mg of carvedilol. In a package of 30 tablets.
PreparationPriceDescription
Nifedipinefrom 28 rubles.Available in the form of dragees and tablets. Regardless of the form of release, one unit of the drug contains 10 mg of the active substance nifedipine. In the package of 50 tablets or dragees.
Diltiazemfrom 95 rubles.Tablets containing 60 or 90 mg of diltiazem each, in a package of 30 pieces.
Verapamilfrom 17 rubles.Available in tablet form. The active substance of verapamil hydrochloride is contained, depending on the dosage, in a volume of 40, 80 or 240 mg per tablet. Available in packs of 50 tablets.
PreparationPriceDescription
Coraxanfrom 1100 rubles.Film-coated tablets containing 5,39 mg of ivabradine hydrochloride each. The package contains 56 tablets.
Bravadinfrom 392 rubles.Tablets with 5 or 7,5 mg of the active substance ivabradine. The package contains 28 or 56 tablets.
PreparationPriceDescription
Candesartanfrom 160 rubles.Tablets of 28 pieces in a package, each of which contains 8, 16 or 32 mg of candesartan cilexetil.
Perindoprilfrom 66 rubles.30 tablets per pack. Each, depending on the dosage, contains 4 or 8 mg of perindopril erbumin.
Ramiprilfrom 87 rubles.Available in the form of tablets of 5 or 10 mg of the active substance, 30 tablets per pack.
Valsartanfrom 309 rubles.Valsartan is available in tablet form, in packs of 28,30 or 84 pieces. Each film-coated tablet contains 80 or 160 mg of valsartan.

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

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

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

Function classNitrate groupMain drugsReception Features
I
IIShort and moderate prolonged nitratesCardiket 20, Monosan, CorvatonThe application is similar to the first FC with the difference that the temporary coating with nitrates is longer, depending on the expected loads.
IIISignificant Long-acting NitratesPectrol, Olicard Retard, Nitrong FortAngina pectoris of the third functional class is stopped by drugs of significant prolonged action. At the same time, it is imperative to maintain a certain nitrate-free period in order to avoid the development of resistance to nitrates.
IVSignificant Long-acting NitratesPectrol, Olicard Retard, Nitrong FortThe nitrate intake schedule is designed in such a way that their action is covered all the time.

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

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

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

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

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

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

stenokardiya grudnaya zhaba lokalizaciya - Progressive angina pectoris - causes, symptoms, diagnosis and treatment

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

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

  • coronary artery bypass grafting,
  • balloon angioplasty.

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

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

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

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

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

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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