Stable angina pectoris ( stress angina pectoris ) - Causes, Symptoms and Treatment .MF .
To fully human heart could pump blood through the body, he himself need more power supply system.The blood supply to the heart, this system is represented by the left and right coronary arteries originating from the aortic arch, the envelopes of the heart from all sides and penetrating into the thickness of the myocardium in the form of a network of tiny capillaries.These arteries supply the heart muscle with blood and oxygen continuously and during exercise with an increase in heart rate, blood flow to the heart increases, enabling it to pump more blood to the skeletal muscles and internal organs.
But adequate load increase in coronary blood flow occurs only under the condition of healthy, resilient, free in the lumen of the coronary arteries.If the inner walls of the arteries affected by atherosclerosis, ie, inside the artery atherosclerotic plaque is formed, then there is a partial or total occlusion (blockage) of the vessel lumen and the blood can not flow to the heart muscle.The plaques are compos
Atherosclerotic plaque - the cause of ischemia (decreased blood supply) of the myocardium.
These processes are characteristic of coronary heart disease.CHD includes certain diseases combined this generic term.These include angina, myocardial infarction, myocardial infarction and some other diseases.
Angina pectoris is a clinical manifestation of myocardial ischemia in the form of pain attacks.Earlier angina were divided into angina (occurring during exercise) and angina at rest (at rest), currently use the terms stable and unstable angina.
Unstable angina is characterized by progression of myocardial ischemia and require timely treatment to the doctor to hospital admission, since in the absence of treatment is often complicated by the development of myocardial infarction.
Stable angina pectoris ( "angina pectoris», angina pectoris) - a set of clinical symptoms caused by lack of oxygen in the heart muscle and is manifested pressing pains in the heart.It is characterized by the appearance of pain during physical activity (so rnshe she called exertional angina), currently treated successfully when the load terminate or receiving nitroglycerin, and is divided into functional classes, depending on load volume, provoking pain.Angina is developing narrowing of the vessel lumen by more than 50%.
Reasons stable angina
main causes of the disease are the atherosclerotic lesions of the inner walls of the coronary arteries, they spasm (contraction), as well as increased activity of coagulation with the formation of blood clots in the coronary arteries.Also, stable angina may occur with heart diseases, for example, aortic stenosis, hypertrophic cardiomyopathy with, since there is an increase in mass of the heart muscle, which requires increase of heart vessels and increase in coronary blood flow, but these requirements are not implemented.
angina risk factors include:
- age - usually affects persons older than 45-50 years, but always with a disposition to the fact that younger disease, and heart disease as well.In recent years, angina often occurs in people younger than 40 years
- floor - often suffer from angina men, especially of 45-50 years, which is associated with features of hormonal levels in women before menopause - female hormones have a "protective" properties in relation to cardiovascular- vascular system
- race - often susceptible persons European
accessories - heredity plays an important role, especially if a close relative has heart disease or family history of deaths at a young age due to cardiac causes
- obesity increases the burden on the heart,as well as general detraining organism associated with a sedentary lifestyle
- disorders of lipid metabolism, including cholesterol contribute to reduce the level of "good" and raise "bad" cholesterol in the blood and deposition of it on
vessel walls - arterial hypertension accompanied by spasm of vesselsincreased load on the heart muscle
- smoking provokes a long spasm of blood vessels, including coronary
- diabetes is characterized by damage to the microvascular (capillary), including in the heart, causing spasms, disorders of the vascular wall with high adhesion(attachment) of platelets and form blood clots
contribute to the development of pain attack can not only psycho-emotional and physical stress (major or not), but also such triggers like cold weather, hearty meal, followed by a sharp load fast climbing stairs,walking against a strong wind or other aspects that may cause any - any discomfort to the patient.
symptoms of stable angina
main manifestation of the disease is pain.Criteria for angina (anginal) pain are as follows:
- are in the nature of contracting, crushing, burning
- are located behind the breastbone or in the left half of the chest
cells - may radiate (give) in the left shoulder, arm, neck, jaw, and maybe without irradiation or localized only in the interscapular region
- occur during exercise, walking, climbing stairs
-dlyatsya a few minutes, no more than 10 - 15 minutes
- are themselves alone when the load terminate or stoped taking nitroglycerine under the tongue
-may be accompanied by fear of death and vegetative disturbances - sweating, dizziness, lack of air feeling
The figure shows the possible localization of the pain associated with angina
pain with angina do not change their intensity at the height of a deep breath, unlike intercostal neuralgia, which themselvespatients with osteochondrosis may take for heart pain (neuralgia pain on inspiration is enhanced).
Similar burning pain behind the breastbone can arise with gastroesophageal reflux, when the reverse casting of acidic gastric contents into the esophagus.This disease requires a more detailed examination of the patient.When reflux pain associated with food intake, and there is a need to wash down the solid food with water.
patient is important to remember that if the pain in my heart arose for the first time, there was an increase in the frequency, intensity and duration of pain attacks, developed intense pain attack, with the lack of effect of nitroglycerin, he should immediately consult a doctor (in the clinic or emergencycare), as may develop unstable angina or myocardial infarction.
Depending on the level of physical activity, provoking pain, stable angina are classified as functional classes (FC):
I FC - attacks occur very rarely, if significant, unusual for a patient loads
II FC - patient without pain may take more500 meters, up more than 2 floor
III FC - the patient may pass less than 500 m, rise only to the first floor without pain
IV FC - there is restriction of normal daily activity of the - the frequent attacks of pain in the heart
division into classes is importantin order to determine the correct treatment tactics since FC III and IV, when attacks occur frequently and prevent lead a full life, it shows the assignment of long-acting nitrates daily or loads (for example, before a long walking distance).
diagnosis of stable angina
diagnosis can be suspected in the course of a patient survey and detailing complaints of pain in the heart, associated with the load.On examination, no abnormalities observed in the severity of the patient's condition.There may be overweight, up to a high degree of obesity, high blood pressure, swelling of the legs and feet.Pathological tones and heart murmurs are auscultated in the presence of heart disease, congestive rales in the lungs - in chronic heart failure.
From laboratory survey methods are assigned common blood and urine tests, blood chemistry (estimated indicators of liver and kidney function, cholesterol levels - should be no more than 4.5 mmol / l), hormonal blood tests (eg, the hubbub of the thyroid gland at dyshormonal cardiomyopathy), studies of glycemic profile in patients with diabetes mellitus.
From instrumental diagnostic methods are shown:
- standard ECG.In the absence of pain in the heart may be uninformative, because often signs of ischemia are not registered in the interictal period.When removing the ECG at the time of pain recorded segment depression ST, negative T waves
patient's ECG during angina attack.
- daily monitoring of ECG Holter assigned to identify painless myocardial ischemia, and establishes a connection with the exercise due to keeping the patient diary, where it indicates the time of pain, said periods of physical activity, sleep and rest, receive
food- exercise test - treadmill test (treadmill) and veloergometry ( "bicycle").Appointed to estimate the amount of physical activity, triggering painful episodes and validation of a functional class
- CHPEFI can be shown in the impossibility of carrying out tests with the load and is based on electrical stimulation of the heart through the esophagus to the increase in heart rate, which is likely to provoke the development
attack - echocardiography (Echo- CT, ultrasound of the heart) is used to estimate stroke volume, ejection fraction, a common myocardium, can reveal hypo zone - and akinesia (reduced and the absence of myocardial contractility), which testifies to areas of ischemia
infarction - stress echo - CG can be administered at uninformativestandard Echo - KG and conducted by cardiac imaging after exercise
- coronary angiography is the "gold" standard for diagnosing coronary artery disease.Allows you to evaluate the presence of atherosclerotic lesions of the coronary arteries, the degree of vasoconstriction, the need for surgical intervention.It is carried out by introducing a radiopaque substance in the coronary vessels, followed by X-rays
Treatment of stable angina
disease therapy includes general measures, drug treatment and cardiac surgery.
General measures boil down to lifestyle modification, correction of elevated blood pressure numbers, appointment sedatives herbal (valerian, St. John's wort, motherwort).Sometimes these events in patients with FC I enough to pain attacks ceased to trouble for a long time.
Drug treatment of stable angina is to appoint the following groups of products:
- beta - blockers (atenolol, carvedilol, propranolol etal).Appointed to reduce the heart rate, reduce blood vessels tone, reducing the burden on the heart muscle and reduce its need for oxygen.In the absence of contraindications (asthma, chronic obstructive pulmonary disease) taken daily.
- nitrates are peripheral vasodilators, dilate the coronary arteries and veins, reducing blood flow to the heart and the load on the heart muscle.Short-acting preparations are made for the relief of pain attacks in the form of tablets (nitroglycerin) and aerosol (Nitromintum, nitrosprey).Takes effect within 1 - 2 minutes, the duration of no more than 15 minutes.long-acting drugs (isosorbide, kardiket, monocinque) are used to prevent strokes in patients with FC III - IV daily or before exercise.
- antagonists (amlodipine, verapamil), calcium channel blockers reduce the workload on the heart by reducing vascular tone and blood pressure.In the presence of contraindications to beta-blockers may be taken daily.
- antiplatelet (thrombotic Ass, aspikor aspirin cardio) are assigned to prevent platelet aggregation and settling them in atherosclerotic plaques.Enteric-coated film that protects the stomach wall from the irritating effects of aspirin.Taken daily after a meal once a day.
- lipid-lowering drugs (lovastatin, atorvastatin, rosuvastatin) reduce cholesterol levels in the blood, preventing further formation of new plaques.It is taken once a day at night.
- ACE inhibitors (perindopril kvadripril) are used for the correction of arterial hypertension and to protect vessels, kidneys, brain, heart, high blood pressure in the vessels.
to surgical treatments include:
- stenting of the coronary arteries - the arteries installation of metal structures - stent mechanically dilates blood vessels
- balloon angioplasty of the coronary arteries.Conducted by introducing via the femoral vein catheter with a balloon at an end in the expanding and narrowing of vessel location "squashing" the plaque, thereby artery patency restored.After angioplasty can be immediately carried out stenting due to frequent restenosis (re-narrowing) after it
- aorto - coronary bypass surgery - the creation of a shunt (fistula) between the aorta and the affected artery, bypassing the constriction
Indications for operations are ineffective drug therapy, the presence ofangina functional class high in young people, a critical narrowing of the lumen of the artery (75%), post-infarction angina and others.Indications and contraindications are determined by the attending physician on an individual basis.
Lifestyle in stable angina
lifestyle modification is as follows:
- fighting overweight
- smoking cessation and alcohol
- proper nutrition - fast food prohibited, sharp, salty, fatty, fried, spicy food.Welcome dairy, cereals, vegetables, fruits, lean meats, poultry, fish.Limited animal fats, sugar, salt, confectionery
- moderate physical activity
- exclusion of significant physical exertion and
stress - compliance with treatment adherence, ie the regular intake of prescribed drugs to prevent strokes and complications, especially in patients withdiabetes complications
If untreated, angina can progress further due to the formation of atherosclerotic plaques on the walls of blood vessels.This can lead to unstable angina, acute myocardial infarction, sudden cardiac death.
prevention of complications is timely access to a doctor in case of pain in the heart or in the case where the pain lasts longer and stronger in intensity.To prevent the development of severe complications will receive prescription drugs that slow the progression of atherosclerosis and coronary heart disease.
forecast of stable angina in the absence of complications relatively favorable.Mortality is low and amounts to 2 - 3% annually of the total number of patients with angina - this group includes those who developed a fatal heart attack.
If developing heart attacks or other complications, the prognosis is determined by the severity of established disease.
therapists Sazykina OJ