Angina pectoris – what are these, signs, symptoms,treatment and emergency care in an attack of angina

Angina pectoris is a pain syndrome in the region of the heart,
due to insufficient blood supply to the heart muscle. Other
words, angina is not an independent disease, but
set of symptoms related to pain
syndrome. Angina Pectoris is a manifestation of
coronary heart disease (CHD).

What is this disease, why does it occur in humans, and also what
The main signs and treatments are effective for angina, we
consider further in the article.

Angina: what is it?

Стенокардия

Стенокардия — это клинический синдром, характеризующийся
discomfort or severe pain behind the sternum, the main cause
which is a violation of the coronary blood supply to the heart
muscle.

The name is associated with symptoms of the disease, which manifest themselves in
feeling of pressure or compression (narrow – stenos from Greek), feelings
burning in the region of the heart (kardia), behind the sternum, turning into
pain.

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

Symptoms of angina occur due to coronary atherosclerosis
артерий —  заболевания, при котором на их стенках
cholesterol is deposited and atheromatous plaques are formed. With
over time, the lumen narrows, often a complete blockage occurs.

Classification

Currently, on the basis of the clinical course
There are three main options for angina:

Stable angina pectoris

Stable angina pectoris — означает, что в течение предыдущего
months or longer the patient had bouts of chest pain about
same intensity. Stable also called
angina, as the development of seizures is associated with
overstretched work of the heart muscle forced
pump blood through the vessels, the lumen of which is narrowed to 50 –
75%.

Angina is divided into 4 functional classes (FC):

  1. Attacks of chest pain are rare, only at maximum
    physical and emotional overload. ECG changes
    rarely found. Coronary artery lumen may be narrowed.
    by 50%. Perhaps atherosclerosis affects only one of them.
  2. The second functional class causes seizures and pain when
    climbing stairs, walking in quick steps, after a hearty meal.
    The provoking factors here are often frosty weather and
    wind.
  3. When FC 3 diagnosed severe physical limitation
    activity. Angina makes itself felt with the smooth movement of
    level road to a distance of one hundred two hundred meters, when climbing on
    ground floor. Attacks become frequent if the patient smokes. Have
    such patients can have angina at rest in the prone position after
    Nervous shocks.
  4. With FC 4, any slightest load causes pain and discomfort.
    Often in the history of a person with such a variant of angina can
    find a heart attack or heart failure in the chronic stage.
    Often the angiotic syndrome occurs in complete rest or even
    at night.

Unstable Angina of the Heart

What it is? Unstable angina is characterized by pain.
attacks of varying intensity, duration,
unpredictable appearance, for example – at rest. Painful
the syndrome is more difficult to stop, when taking nitrates
(nitroglycerin). The risk of myocardial infarction is higher, in contrast
from the stable form of this pathology.

Unstable angina is divided into:

  • For the first time arising angina – the first attack was no later than
    30 days.
  • Progressive – increases severity, duration, or
    frequency of painful attacks.
  • Spontaneous (Prinzmetala or vasostatic) – occurs in
    the result of spasm of the coronary arteries.
  • Early postinfarction stenocardia – in the period up to 14 days after
    heart attack.

Существует еще и так называемая вариантная стенокардия,
which most often declares itself at night or in the early morning.
Attacks occur when the patient is at rest.
They last an average of about 3-5 minutes. They are provoked by a sudden
spasm of the coronary arteries. In this case, the walls of blood vessels can be
loaded with plaques, but sometimes they are completely clean.

To distinguish between stable and unstable angina is necessary
evaluate the following factors:

  • What level of exercise is provoked by the attack
    angina pectoris;
  • Duration;
  • Efficacy of Nitroglycerin.

With stable angina, the attack is triggered by the same
level of physical or emotional stress. When unstable
form of attack is triggered by less physical exertion or even
arises alone.

With stable angina, the duration is not longer than 5 – 10 minutes,
when unstable, it can last up to 15 minutes.

The reasons

Risk factors include heredity, age and gender.
Men 50-55 years old are more susceptible to the occurrence of the disease than
women. If a talk about percentages then at the age
from 45 to 54 years old, angina attacks disturb 2-5% of people, while
time for 65-74 year olds, it increases to 10-20%.

The leading cause of angina pectoris, as well as coronary heart disease,
is atherosclerosis-induced constriction of the coronary vessels.
Symptoms develop when the lumen of the coronary arteries narrows to
50-70%. The more pronounced atherosclerotic stenosis, the harder
stenocardia proceeds.

Factors that contribute to the onset of strokes
are:

  • Haveсиленная физическая нагрузка;
  • Сильное эмоциональное переживание, стресс;
  • Tachycardia;
  • Exit from the warm room to the cold, cold and windy
    weather.

Наиболее склонными к стенокардии are:

  • Males;
  • Лица с лишним весом, ожирением;
  • Hypertensives;
  • Dependent on smoking, alcohol, drugs;
  • Lovers of fast foods;
  • People with a sedentary lifestyle;
  • People who are often under stress;
  • Лица с такими заболеваниями, как сахарный
    диабет, артериальная гипертензия (гипертония).

The first signs in men and women

The most significant symptom of angina is
pain. Продолжительность: от 1-15 мин (2-5 мин.).

Характер болевого синдрома: приступообразный дискомфорт или
pressing, squeezing, deep, dull pain, an attack can be described
as constraint, heaviness, lack of air.

Localization and irradiation:

  • localization behind the sternum or along the left edge is most typical
    sternum.
  • irradiation to the neck, lower jaw, teeth, interscapular
    space, less often – in elbow or wrist joints,
    mastoid processes.

Besides pain, so-called equivalents can also be signs.
angina pectoris These include:

  • shortness of breath – a feeling of difficulty breathing both on inspiration and on
    exhale Dyspnea occurs due to impaired heart relaxation.
  • severe and severe fatigue under load is
    due to reduced oxygen supply to the muscles due to reduced
    contractility of the heart.
Signs of
Have женщин Signs of стенокардии сердца у женщин

  • Pain in the heart.
  • Pain in the forearm, neck or back along with pain in
    chest
  • Dyspnea.
  • Increased sweating.
  • Dizziness.
  • Anxiety, fear of death.
  • Feeling weak and tired.

The following symptoms may also occur in women:

  • Кашель — частое явление при angina pectoris He most often
    occurs at night in the supine position. This is due to stagnation of blood.
    in the pulmonary circulation.
  • Numbness of finger tips.
  • The presence of shallow breathing.
Have мужчин Typical angina pectoris is often accompanied by such
characteristic features:

  • feeling short of breath;
  • fear and anxiety;
  • the patient groans and, because of the pain, presses his hand to his chest;
  • pallor;
  • cold or numb hands;
  • rapid pulse;
  • feeling of heartbeat;
  • high blood pressure.

Symptoms of angina pectoris

Characteristic symptoms in adults with angina:

  • Soreness is usually located in the upper or lower
    parts of the sternum (much less often in the lower), on either side of it or behind
    her.
  • In extremely rare cases, angina pectoris presents itself with pain in
    epigastric areas – it can be mistaken for manifestations of acute ulcers
    or symptoms of duodenal disease.
  • The pain gives mostly to the left side of the body – arm, neck,
    shoulder, back, scapula, lower jaw, earlobe.
  • Pain with angina often occurs at the time of walking, climbing
    Staircase, effort, stress, may occur at night. Attack
    pain lasts from 1 to 15-20 minutes. Facilitators
    state are nitroglycerin intake, standing or
    sitting.

If a болит слишком сильно, причем боль накатывает волнами, а
nitroglycerin almost does not help, it is necessary to urgently call “Ambulance
help “because it is one of the signs of myocardial infarction.

The following symptoms of angina are less common:

  • Increased blood pressure, which in turn
    provokes headaches, dizziness,
    weaknesses.
  • Dyspnea is a common symptom of myocardial oxygen starvation.
    The man begins to sweat for no apparent reason.
  • Still often, angina pectoris is accompanied by irregular heart function,
    the person feels uneven and chaotic pulsation.
  • There may be nausea, vomiting.
  • A person experiences fear, increases motor
    activity.

As for the frequency of attacks, everything is individually –
gaps between them sometimes are long months and sometimes
repeated 60 or even 100 times a day.

Under angina can be masked:

  • Heart attack;
  • Diseases of the gastrointestinal tract (peptic ulcer,
    diseases of the esophagus);
  • Diseases of the chest and spine (osteochondrosis
    thoracic spine, shingles);
  • Lung diseases (pneumonia, pleurisy).

Remember that only the cause of chest pain can be determined.
doctor.

Myocardial infarction Stable angina pectoris
  • Acute chest pain that radiates to other parts.
    body.
  • Possible lowering of blood pressure, acceleration of the pulse,
    cold sweat, fever of 1-2 degrees.

Symptoms last longer than 15 minutes, nitroglycerin and rest not
help

  • Pressing down or compressive chest pain, can give to the neck,
    jaws, arms, shoulders.
  • Lowering blood pressure, accelerating the pulse, cold
    sweat – unlikely.
  • Raise body temperature does not happen.

Pass for 2-15 minutes, helps rest and
nitroglycerine

Attack стенокардии: симптомы и первая неотложная помощь

The main symptom of an attack of angina is sudden
pain in the chest, with such a state of people
describe in different ways. Some complain of a burning sensation and
aching pains with recoil in left hand. Others feel bursting
pains extending under the scapula or in the region of the stomach, neck, throat.

Attack продолжается чаще всего не более 15 минут и проходит сам
или после принятия nitroglycerineа. If a такое состояние не
passes, it may mean that an acute heart attack occurred.

There are many cases when the symptoms of an attack of angina
only manifested as discomfort in the stomach or
headaches. In this case, the diagnosis of the disease
causes certain difficulties.

It is also necessary to distinguish between painful angina attacks.
от симптомов инфаркта миокарда. They are short-lived and easy.
снимаются приемом nitroglycerineа или нидефилина. While
pain with myocardial infarction with this drug does not stop.

In addition, with angina, there is no congestion in the lungs and shortness of breath,
body temperature remains normal, the patient is not experiencing
excitement during an attack.

Providing emergency care for angina

Immediately first aid provided at angina pectoris
arrival of “ambulance”, is the following points:

  1. the patient sits down in a comfortable manner when the
    legs, it should also be reassured, not allowing its sudden movements
    and getting up;
  2. half the big aspirin tablet or 1 of it
    tablet;
  3. to ease the condition also given later
    nitroglycerine – под язык 1 tablet;
  4. вместо nitroglycerineа может быть использован аэрозоль изокет
    (single dose without inhaling) or nitrolingval;
  5. использование nitroglycerineа может быть произведено при
    respecting the interval of three minutes, the use of the same aerosol
    medication is made at intervals of one
    a minute;
  6. reuse of drugs is possible only up to
    three times, otherwise it may provoke a sharp
    drop in blood pressure.

After first aid, the patient should
See a doctor who specifies the diagnosis and selects
optimal treatment. For this diagnostic
examination

Diagnostics

When making a diagnosis, an important role is given to clarifying complaints.
patient history of pathology. Clinical symptoms are evaluated.
produced instrumental and laboratory studies in order
to accurately determine the severity of the disease.

The minimum list of biochemical parameters for suspected
ischemic heart disease and angina include definition
blood content:

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

Instrumental diagnostics:

  • Holter monitoring. To the patient for 24 hours is attached
    portable recorder that records ECG and transmits mined
    information in the computer clinic.
  • Testing. Heart reactions are checked by various loads.
    – a bicycle ergometer was created for this purpose (you can replace it with a treadmill
    track).
  • Computed multispiral tomography. Required for
    differentiation of angina from other ailments.
  • Coronary angiography. The doctor applies this technique to
    determine the choice of treatment (operative or
    conservative).
  • Echocardiography Determines the degree of damage affecting the heart
    vessels

Treatment of angina pectoris in adults

How to treat angina? Angina treatment is aimed at
relief of pain, prevention of heart attack, and
also stopping the development of atherosclerosis and cleansing the blood
vessels from atherosclerotic plaques.

All methods of treatment of angina are aimed at achieving
following goals:

  • Prevention of myocardial infarction and sudden cardiac
    of death;
  • Preventing the progression of the disease;
  • Haveменьшение количества, длительности и интенсивности
    seizures.

Drug therapy involves the following
medicines:

  1. ACE inhibitors. Haveдерживают АД в норме, понижают сердечные
    cuts.
  2. Omega-3 polyunsaturated acids, statins, fibrates.
    Stabilize and slow down the occurrence of sclerotic plaques.
  3. Antiplatelet agents. Prevent formation in coronary vessels
    blood clots.
  4. Calcium antagonists. When vasospastic angina reduces
    formation of coronary spasms. Нитраты (nitroglycerine и прочие).
    Relieve seizures.
  5. They are prescribed for prophylaxis before prolonged physical
    load or before a surge of emotions.

Surgery

This type of surgical treatment of the disease involves creating
workaround for blood flow to an individual affected area
hearts. Below the damage is put the so-called shunt, called
such a procedure coronary artery bypass surgery.

This intervention is indicated for patients who have been diagnosed.
severe angina with reduced lumen of the heart vessels
(70% and more).

Surgical surgery is often used when
previously transferred myocardial infarction. The result of the operation is
restoration of impaired blood flow in the arteries that supply
muscle of the heart with oxygen.

Диета и соблюдение правильного питания

Diet for angina is aimed at slowing the progression
atherosclerosis. It aims to eliminate violations of exchange
lipids, weight loss and improved blood circulation.

General principles of nutrition:

  • Haveменьшение животных жиров и углеводов (легкоусвояемых). With
    cooking, you need to cut off the fat, remove
    cooking fat and skin from poultry. The degree of restriction of fat and
    carbohydrate depends on the weight of the patient.
  • Normal protein content.
  • Haveвеличено содержание линолевой кислоты, липотропных веществ,
    dietary fiber, potassium and magnesium due to an increase in diet
    vegetable oils, seafood, vegetables, fruits and cottage cheese.
  • Haveвеличение доли продуктов, содержащих йод (морская капуста,
    mussels, sea fish, squids, shrimps).

Man needs potassium, the daily rate of which is
about 300-3000 mg. This trace mineral normalizes heart rhythms,
improves the functioning of the endocrine system and heart
muscle. Withдержится калий в следующих продуктах:

  • mushrooms;
  • seafood;
  • a fish;
  • black currant;
  • cocoa;
  • milk products;
  • tomatoes;
  • potatoes;
  • parsley;
  • apricot;
  • prunes;
  • raisins.

Products that need to be abandoned or reduced intake:

  • Animal fats, because they have a lot of cholesterol,
    and it contributes to the appearance of cholesterol plaques in the vessels and as
    consequence, causes atherosclerosis. These include fatty meats,
    for example, pork, and poultry (duck, goose).
  • Flour and pastry, as they are rich in carbohydrates,
    which provoke obesity.
  • It is necessary to limit salt intake, as it slows down
    the process of removing fluid from the body. You can replace the salt
    in which, besides, there are many vitamins (A, B, C,
    PP) and minerals (folic acid, phosphorus, potassium, calcium,
    iron).
  • Drinks containing caffeine (coffee, strong tea), as they
    have a diuretic effect and remove a lot of fluid from
    organism.

Folk remedies

Before using folk methods of angina, be sure to
consult with your cardiologist.

  1. Withнимать свежий сок травы пустырника по 40 капель на 2 с. l
    before eating for a month. For winter storage, mix juice with
    the same amount of vodka. Withнимать по 1 ч. l 3 times a
    day.
  2. Mix the roots of valerian, licorice rhizomes, fruits of dill, grass
    sequences, woolly panzerias, marigold inflorescences (1: 2: 1: 2: 2: 2). AT
    a glass of boiling water brew a tablespoon of the mixture, insist in heat
    at least an hour, filtered and drunk on a third cup three times in
    day.
  3. AT народном лечении стенокардии применяется смесь чеснока с
    honey Scroll through a meat grinder 5 lemons, you can with the peel,
    squeeze the juice. Add 5 chopped garlic heads and 0.5 liters
    honey, mix. Keep the week in a cool place. Withнимать по
    2с.l every day for two weeks.
  4. Hawthorn tea – brings relief from heart pain already
    after a short time of daily use. Way
    preparations: for 1 liter of boiling water take 3-4 tablespoons of dried hawthorn.
    To preserve the properties of a medicinal plant, it is brewed in
    thermoses

Prevention

Primary prevention (for those who do not have angina):

  • Nutrition correction.
  • Haveмеренные физические нагрузки.
  • Control cholesterol and blood sugar 1 time per year.
  • With наличии гипертонической болезни – постоянный прием
    antihypertensive drugs with blood pressure
    level below 140/90 mm Hg
  • To give up smoking.

ATторичная профилактика (для тех, кто болен стенокардией,
reduces the frequency and duration of attacks, improves
forecast):

  • Avoid severe stress and excessive physical
    loads.
  • Before physical activity, you can take 1 dose.
    nitroglycerineа.
  • Regularly take medication prescribed by your doctor that improves
    prognosis of the disease.
  • Treatment of concomitant diseases.
  • Supervision at the cardiologist.

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