Angina pectoris - Causes, Symptoms and Treatment .MF .
In based ischemic heart disease is the deposition on the walls, or rather in the walls of the coronary arteries of atherosclerotic plaques, which as "scum on the teapot" narrow the vessel lumen.Plaques gradually reduced lumen of the arteries leading to cardiac muscle malnutrition.The process of formation of atherosclerotic plaque is called atherosclerosis.its development speed varies and depends on many factors.Of these risk factors, you also already know.
coronary arteries play a crucial role in the life of the heart muscle.The blood flowing through it, brings oxygen and nutrients to all the cells of the heart.If the heart artery atherosclerosis impressed, then under conditions where there is an increased need for oxygen in the cardiac muscle (physical or emotional stress), there may be state of ischemia - insufficient blood supply to the heart muscle.This condition - the heart signal of oxygen deficiency is angina.Thus, angina is not a distinct disease, a symptom of ischemic heart disease.In people
There are several options for angina, or rather three:
Stable angina , which includes 4 functional classes, depending on the load tolerated.
Unstable angina , stable or unstable angina, defined by the presence or absence of connection between the load and the manifestation of angina.
variant angina , or angina Printsmetalla.Yet this type of angina called vasospastic.
It should be noted that in the year angina is fixed at 0.2 - 0.6% of the population with its predominance in men aged 55 - 64 years, it occurs in 30,000 - 40,000 adults per 1 million population per year, and the prevalence of envygender and age.Prior myocardial infarction, stable angina noted in 20% of patients after myocardial infarction - 50%.
is believed that for the occurrence of angina, heart artery must be narrowed because of atherosclerosis by 50 - 75%.If treatment is not carried out, the atherosclerosis progresses, plaque on the walls of damaged arteries.They formed clots, vessel lumen narrows even more, blood flow slows down, and frequent bouts of angina pectoris, and occur in mild exertion and even at rest.Stable angina (voltage) depending on the severity can be divided into functional classes:
- I functional class - fits of chest pain occur infrequently.Pains occur when an unusually large load quickly performed.
- II functional class - attacks develop during rapid climbing stairs, walking fast, especially in cold weather, the cold wind, sometimes after a meal.
- III functional class - marked limitation of physical activity, seizures appear during normal walking up to 100 meters, sometimes right at the exit to the street in cold weather during the ascent to the first floor, can be triggered by unrest.
- VI functional class - a sharp limitation of physical activity, the patient becomes unable to do any physical work without symptoms of angina attacks;a characteristic that can develop bouts of angina at rest - with no prior physical and emotional stress.
Allocation functional classes allows the physician choose the right medication and the amount of physical activity in each case.
If habitual angina changes its behavior, it is called unstable or preinfarction condition.What is it?Under unstable angina understand the following states:
first emerged in the life of angina not older than one month;
progressive angina, when there is a sudden increase in the frequency, severity and duration of attacks, the appearance of night attacks;
rest angina - the appearance of angina attacks at rest;
postinfarction angina - angina appearance of calm in the early postinfarction period (10-14 days after the onset of myocardial infarction).
In any case, unstable angina is an absolute indication for hospitalization in the intensive care unit.URGENT call an ambulance !!!
How to distinguish between stable and unstable angina?
|Stable angina||Unstable angina|
triggered by the same level of physical activity
triggered at exercise or at rest
least 15 minutes
a longer, but less than 15 minutes
helps 1 tablet
help badly need 1 tablet
variant angina symptoms occur due to sudden contraction (spasm) of the coronary arteries.Therefore, this type of angina called vasospastic angina doctors.In this angina, coronary artery atherosclerotic plaques may be amazed, but sometimes they do not exist.Variant angina occurs at rest, at night or early morning.The duration of symptoms 2.5 minutes, well helps Nitroglycerin and calcium channel blockers such as nifedipine.
Symptoms of angina
for angina is characterized by sensations of compression, heaviness, bloating, burning sensation behind the breastbone that arise during exercise.The pain may spread to the left arm under the left shoulder, neck.Less pain renders in the lower jaw, the right half of the chest, the right hand, in the upper part of the abdomen.
angina attack duration is usually a few minutes.Since the pain in the heart area often occurs when driving, a person is forced to stop.Therefore angina figuratively referred to as "browsers disease windows", - after several minutes of rest pain, usually runs.
painful attacks of angina pectoris lasts more than one, but less than 15 minutes.Sudden onset of pain, at a height directly exercise.Most often, this is a load of walking, especially in the cold wind, after a heavy meal, when climbing the stairs.End
pain typically occurs immediately after reduction or complete cessation of physical activity, or in 2-3 minutes after administration of sublingual nitroglycerin.
symptoms associated with myocardial ischemia, but different from the pain attack - equivalents angina - this feeling short of breath, difficulty inhaling.Shortness of breath occurs under the same conditions as chest pain.
angina in men is usually manifested typical bouts of pain behind the breastbone.Women, the elderly and patients with diabetes mellitus during myocardial ischemia may not experience any pain, and feeling a frequent palpitations, weakness, dizziness, nausea, sweating.Some people suffering from coronary heart disease, myocardial ischemia during (and even myocardial infarction) generally do not experience any symptoms.This phenomenon is called painless, "silent" ischemia.
What is behind the pain in your chest?
should be remembered that chest pain may occur not only in angina, but also in many other diseases.Furthermore, both may be several causes of chest pain.Let's understand this in this.
Under angina may be masked:
- Myocardial infarction;
- diseases of the gastrointestinal tract (peptic ulcer disease, esophageal disease);
- diseases of the chest and spine (thoracic spine osteochondrosis, shingles);
- Lung disease (pneumonia, pleurisy).
Remember that establish the cause of the pain can only be a doctor in the chest.
In addition to pain, symptoms of angina may be the so-called equivalents angina.These include:
- shortness of breath - the feeling of shortness of breath as the inspiratory and expiratory.Wheezing occurs because of a violation of relaxation
- heart pronounced and sudden fatigue under load is the result of insufficient supply of muscle kislorodoi because of reduced contractility of the heart.
risk of angina
Risk Factors - it features that contribute to the development, progression and manifestation of the disease.
in the development of angina many risk factors play a role.Some of them can be influenced by, other - you can not.Those factors that we can influence, called removable or modifiable, which can not - repairable or non-modifiable.
- non-modifiable.Unavoidable risk factors - age, gender, race and heredity.For example, men are more likely to develop angina than women.This trend has continued until about 50-55 years, ie before the onset of menopause in women, when production of female sex hormones (estrogens), having expressed "protective" effect on the heart and coronary arteries is significantly reduced.After 55 years, the incidence of angina in men and women is approximately the same.Nothing can be done with a clear tendency, as the frequency and complication of cardiac and vascular diseases with age.In addition, as already noted, the effect on the incidence of race: the people of Europe, but rather living in the Nordic countries, suffer angina and hypertension is several times more than those blacks.Early development of angina often occurs when the patient's direct relatives in the male line ancestors suffered a myocardial infarction or died of a sudden heart disease up to 55 years, while direct relatives in the female line was a myocardial infarction or sudden cardiac death and 65 years.
- modifiable.Although it is impossible to change neither their age nor their gender, a person is able to influence its status in the future, eliminating the avoidable risk factors.Many of avoidable risk factors are interrelated, so eliminating or reducing one of them, you can eliminate the other.Thus, reduction of fat content in the diet not only leads to a reduction of blood cholesterol levels, but also to a decrease in body weight, which in turn leads to lower blood pressure.All together, this helps to reduce the risk of angina.And so list them.
- Obesity - it is the excessive accumulation of adipose tissue in the body.Over half of the world over the age of 45 years are overweight.What are the causes of excess weight?In most cases, obesity is alimentary origin.This means that the causes of obesity is overeating with the excessive consumption of energy, especially fatty foods.The second leading cause of obesity is lack of physical activity.
- Smoking - one of the most important factors in the development of angina.Smoking is highly likely to contribute to the development of coronary heart disease, especially if combined with an increase in the level of general holesterina.V kurenieukorachivaet average life of 7 years.Smokers also increases the content of carbon monoxide in the blood, resulting in decreased amount of oxygen that can enter the body's cells.In addition, nicotine contained in tobacco smoke, leads to a spasm of arteries, thereby leading to increased blood pressure.
- important factor in the risk of angina is diabetes.If you have diabetes, the risk of angina and coronary artery disease increases by an average of more than 2 times.Patients with diabetes often suffer from coronary heart disease and have a worse prognosis, especially in the development of myocardial infarction.It is believed apparent that the duration of diabetes 10 years or more, regardless of its type, all patients have a sufficiently pronounced atherosclerosis.Myocardial infarction - the most common cause of death in patients with diabetes.
- Emotional stress may play a role in the development of angina, myocardial infarction, or lead to sudden death.In chronic stress, the heart begins to work with the increased load, increased blood pressure, worsening of oxygen and nutrient delivery to organs.To reduce the risk of cardiovascular disease by stress is necessary to identify its causes and try to reduce its impact.
- physical inactivity or lack of physical activity is rightly called the disease of the twentieth and now the twenty-first, century.It is yet another avoidable risk factor for cardiovascular disease, therefore, to maintain and improve health is important to be physically active.Nowadays, in many areas there is no need in physical labor.It is known that coronary heart disease is 4-5 times more common in men aged 40-50 years, who were engaged in light work (compared to performing heavy physical work);the athletes a low risk of coronary heart disease and angina preserved only if they are physically active after the departure of big-time sports.
- Hypertension is well known as angina pectoris and coronary heart disease risk factor.Hypertrophy (increase in size) of the left ventricle as a consequence of hypertension - a strong independent predictor of mortality from coronary disease.
- increased blood clotting.Thrombosis of a coronary artery - the major mechanism of myocardial infarction and circulatory failure.It contributes to the growth of atherosclerotic plaques in coronary arteries.Disorders that predispose to an increased formation of blood clots, are risk factors for complications of angina and coronary artery disease.
- metabolic syndrome.
prevention methods are similar to angina prevention of coronary heart disease.
How to identify angina without additional
surveys necessary to evaluate the clinical manifestations of the disease (the complaint).Pain in angina have the following features:
- nature of pain: the feeling of compression, heaviness, bloating, burning sensation behind the breastbone;
- their localization and irradiation: pain concentrated in the sternum, often radiating pain along the inner surface of the left hand, left shoulder, shoulder, neck.Less pain "give" in the lower jaw, the right half of the chest, the right hand, in the upper part of the abdomen;
- duration of pain: pain attack angina lasts more than one, but less than 15 minutes;
- conditions for the occurrence of pain attack: sudden onset of pain, right at the height of physical activity.Most often, this is a load of walking, especially against the cold wind, after a heavy meal, when climbing a ladder;
- factors that facilitate and / or relieves pain: a decrease or disappearance of pain occurs almost immediately after the reduction or complete cessation of physical exertion or 2-3 minutes after taking nitroglycerin under the tongue.
chest pain or discomfort characteristic quality and duration
arises during physical exertion or emotional stress
Passes at rest or after taking nitroglycerin.
Two of the above symptoms.
one or none of the above symptoms.
What laboratory studies should be done?
Minimum list of biochemical parameters in suspected coronary heart disease and angina pectoris involves the definition of blood:
- total cholesterol;
- cholesterol in high density lipoprotein;
- cholesterol low density lipoprotein;
- AST and ALT.
What instrumental diagnostic methods need to pass?