Angina pectoris: symptoms, treatment, attack, what must be done, what can not be done

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Angina ( popularly called "angina pectoris") is a heart disease that is part of the concept of coronary heart disease( CHD), along with myocardial infarction and cardiosclerosis. From the very term "angina"( "steno" - narrowing, "cardio" - heart), we see that the disease is associated with the narrowing of the heart( coronary - coronary) vessels through which the blood circulation in the cardiac muscle is intensively carried out. Oxygen, nutrients are brought into it, carbon dioxide and other waste products are disposed of.

Today we will talk about:

  1. angina of tension and rest,
  2. symptoms, treatment with official medicine - drugs, medications and folk remedies at home,
  3. first aid for angina attacks,
  4. what to do and what can not be done with heart attacksangina pectoris.

CONTENTS

rest: the symptoms, attack

disease develops when the heart muscle is not getting enough blood, nutrients, experiencing oxygen starvation.

In the initial stages of the disease with physical or nervous tension, there is a sharp pain in the chest( "the cry of a starving myocardium"), lasting several minutes. The pain arises in the form of attacks, often gives in the left arm, the left shoulder, under the scapula.

Particularly typical for the angina pectoris is the appearance of pain after the patient leaves the warm room in the cold. So the angina of stress manifests itself.

Sometimes an attack of angina begins at night( angina of rest ).These attacks are considered more dangerous, indicating that the disease has gone too far, you need to take urgent measures.

Angina attacks can be rare( 1-2 times a week) or frequent( many times a day).Usually one of the severe attacks ends with the appearance of a foci of necrosis in the heart muscle( myocardial infarction) followed by the formation of scar tissue on this site.

Angina: treatment, what should be done and what can not be done

Treatment in the interstitial period

In the complex treatment of angina, a great deal of attention has always been paid to nitrates :

  1. Nitroglycerin,
  2. Nitrog,
  3. Erinit,
  4. Nitrosorbide.

Erinit is produced in tablets of 0.01-0.02 grams. Take 1 tablet 3 times a day under the tongue. The course of treatment is 2-4 weeks.

Nitrosorbide is administered orally 5-10 mg two to three times a day for 10-12 days.

Of the other vasodilators, papaverine should be recommended in tablets at a dose of up to 0.1 g( intravenous papaverine may relieve angina attack).


The domestic preparation dibasol ( papaverine-like action) is administered at a dose of 0.05 g three times a day intravenously or intramuscularly.

All the agents used to treat angina pectoris can be divided into 4 large groups:

  1. Organic nitrates and nitrites: Nitroglycerin, long-acting Nitroglycerin preparations( Nitrogen, Sustak), Isosorbide Dinitrate, Isosorbide Mononitrate, Amyl nitrite.
  2. Calcium channel blockers: Nifedipine, Nicardipine, Diltiazem, Verapamil.
  3. Beta-blockers: propranolol, metoprolol, atenolol, talinolol.
  4. Coronary dilatation agents of myotropic action: Dipiridamol, Papaverin, No-shpa.

The main representative of the large group nitrates and nitrite is nitroglycerin .Nitroglycerin is used in medicine for more than a hundred years, but it should be recognized that, despite its age, the drug is still the main means of emergency therapy for an acute attack of angina pectoris. Because it quickly expands the coronary vessels of the heart!

Ingestion Nitroglycerin is destroyed by 90-95% in the liver already at the first passage through it. Therefore, for emergency therapy take it under the tongue in the form of rapidly absorbable tablets or alcohol solution, and for a longer effect - in the form of ointment, or inside in a microencapsulated form( Nitrogen, Sustak).

Nitroglycerin is rapidly absorbed from the hyoid area and has its effect in 2-3 minutes. However, its effect lasts no more than 30 minutes.

Due to the fact that Nitroglycerin acts very briefly, its long-acting drugs have been developed.

Tablets for ingestion Sustack and nitrong contain microcapsules of Nitroglycerin, which gradually dissolve in the gastrointestinal tract and, being absorbed, ensure a constant concentration of the drug in the blood.

Trinitrolong is a plate containing Nitroglycerin, which is fixed on the gum or inner side of the cheek, which provides an action for 3-4 hours.

Nitroderm is a transdermal therapeutic system, fixed on the inside of the shoulder, the duration of the effect depends on the area used, usually 6-8 hours.

The drawback of all these tools is that they are all less effective than Nitroglycerin for receiving under the tongue, and the fact that they quickly become addicted( tolerance, insensitivity), which extends to the entire group of nitrates. Prevention of this tolerance is the correct dosage regimen of long-acting nitrates with the establishment during each day of at least 8-hour non-nitrate period.

More than 30 years ago it was found that calcium channel blockers reduce myocardial contractility and cardiac output, that is, they have cardiodepressive action. These drugs include such as:

  1. nifedipine,
  2. nicardipine,
  3. diltiazem,
  4. verapamil.

antianginal is most commonly used in this group of Nifedipine, Nicardipine. Verapamil( isoptin) is an effective antiarrhythmic drug.

The third group - beta adrenoblockers - are:

  1. Propranolol( Anaprilin),
  2. Metaprolol,
  3. Atenolol.

The antianginal effect of beta-blockers is due to the fact that they block sympathetic effects on the heart and prevent the effect of circulating adrenaline in the blood. As a result, beta-adrenoblockers prevent tachycardia caused by stress or physical exertion, increased cardiac contractility and a rise in blood pressure. Thus, they reduce the need for myocardium in oxygen.

Numerous studies have established that the use of beta-adrenoblockers with angina pectoris significantly reduces their risk of developing myocardial infarction, that is, they have not only therapeutic but also preventive action.

Of the group of beta-blockers as antianginal drugs, metaprolol, atenolol, is preferred. They do not cause bronchospasm( unlike Anaprilin) ​​and muscle tone of the vessels of the striated muscle. The combination of beta-blockers with nitroglycerin preparations or calcium channel blockers( Nifedipine) prevents tachycardia caused by these drug groups.

What can not be done: treat a validol attack!

I would like to say a few words about the preparation Validol , which is a 25% solution of menthol in isovaleric acid ester. It is believed that when applied under the tongue validol, irritating the cold receptors in the bottom of the mouth, reflexively dilates the coronary vessels and has an antianginal effect.

This reflex is actually observed in some people at a young age, but after 45-50 years it disappears, especially quickly in people with coronary artery atherosclerosis.

Therefore, it should be recognized that Validol, in addition to a certain psychotherapeutic effect, does not have any proven antianginal clinical efficacy of , and its use in our country is conditioned by the habits of a certain patient population and the rigidity of a number of practicing physicians.

Validol does not relieve an attack of angina, it can sometimes give an imaginary effect without dilating the coronary vessels. This is misleading and the risk of complications in the form of acute myocardial infarction increases!

Prolonged treatment for angina pectoris: to avoid triggering factors

The optimal regimen is that the patient avoids the stresses that cause angina, but systematically transfers loads close to them in magnitude.

It is important for the patient to explain that only with this mode the endurance to the loads will increase. In many cases it is possible without medicinal treatment.

If from the experience of the patient it is known that the seizures are inevitable under certain circumstances( eating, defecating, coughing, going out), then before that it is necessary to take Nitroglycerin. In general, it is most rational to use Nitroglycerin with a preventive purpose.

Validol, mustard plasters can be used if they are effective, but only outside of the attack.

Drug medication

The main drugs for the systematic treatment of coronary insufficiency - long-acting nitrates ( Sustac, Nitrosorbide, etc.) and beta-blockers( propraparol, Trazicor, etc.).The most effective combination of drugs of these groups.

Treatment starts with small doses. The initial dose of Sustac is 1.3-2.6 mg 2 times a day( it is important to swallow quickly), Propranolol 20 mg 3 times a day. With good tolerability, the dose gradually( every 3-4 days) is increased to the effect.

Treatment with nitrate and beta-blocker should be continued for a long time, for months, and to cancel these medications - gradually, for about 2 weeks. If the treatment is repeated angina pectoris, then additionally use Nitroglycerin.

An important indicator of the effectiveness of the treatment is the decrease in the demand for nitroglycerin.

Such drugs as Intensain, Korontin, isoptin, have an auxiliary value and do not replace nitrates and beta-blockers.

If these basic drugs are contraindicated or poorly tolerated even in small doses, then curantyl ( 0.15-0.2 g / day) should be used. Papaverin, but-spawn may be useful if angina pectoris is associated with spastic phenomena in the upper parts of the digestive tract, which may enhance coronary insufficiency.

If angina pectoris is provoked by with an emotional strain of , sedative medications are useful. When high blood pressure is added soft antihypertensives .Usually, after a gradual decrease in arterial pressure, angina attacks become less frequent or disappear. In some patients with bradycardia, the antianginal effect is exerted by beta-adrenostimulants, Euphyllin. In rare cases, persistent angina pectoris, especially nocturnal, can soften after salt restriction and careful administration of a diuretic or cardiac glycoside, even in the absence of noticeable stagnant phenomena.

When an exacerbation of coronary heart disease, as a rule, shown hospitalization, additional restriction of the regime, the appointment of anticoagulants. After the improvement of the condition, the anticoagulants are gradually canceled.

The main goal is to relieve pain, therefore, if an attack occurs, the patient should immediately stop any load of and taking nitroglycerin or its derivatives( Amilnitrite, Nitron, etc.) under the tongue. The use of these agents almost always brings relief. The cessation or significant easing of pain occurs usually in 1-3 min. In some people, nitroglycerin causes a marked decrease in blood pressure, especially in an upright position, so when the patient first takes the drug, the patient must lie.

Angina pectoris: treatment during an attack - first aid

Tinnitus and headache are usually less pronounced with repeated appointments, but sometimes still interfere with treatment. In these cases, it is necessary to reduce the dose or take Nitroglycerin along with Validol( for example, as part of Votchal drops).

If there are contraindications( glaucoma) for taking nitro compounds, then you should take Amyl nitrite. Amyl nitrite acts more sharply than Nitroglycerin;it can be used if Nitroglycerin is well tolerated but does not relieve pain, especially in persons with concomitant uncomplicated arterial hypertension.

Angina pectoris can remove Cardiode ( 1 tab.), Corvalol or Valocordin ( 30-40 drops per quarter of a glass of water).


If these drugs are ineffective and the attack does not stop, the introduction of Atropine, Promedol, nitrous oxide is recommended.

Pain behind the sternum can be removed with the help of mustard plasters, warmers to hands, leeches on the heart area of ​​. Validol and Menthol may be approved for treatment only if all previous seizures have been withdrawn.

It should always be remembered that pain in the heart area can be kept at the expense of high blood pressure and as long as the pressure is not lowered, the pains will persist even despite the use of pain medications.

Treatment of stenocardia with folk remedies at home

Before beginning treatment of angina pectoris, it is recommended to conduct three courses of for fasting for 7 days( followed by a seven-day recovery).If complete starvation is impossible, then you can hold a partial starvation - during the course to eat only nuts, honey, fruits, roots and vegetables.

Mix in equal parts of the Adonis grass and the grass of the watch of the three-leaved .100 g of the mixture pour 1 liter of vodka and insist in a dark place for 21 days. Strain. Drink 20 drops three times a day for half an hour before meals.

Mix in equal parts raisins, dried apricots, prunes and kernels of walnut .For 1 kg of the mixture, add a slurry of lemon with skin , but without seeds and 300 g liquid honey .Take 1 tablespoon three times a day on an empty stomach with any heart disease. The medicine strengthens the heart muscle, helps restore normal rhythm.

Healers always advise the heart patient tea from the flowers of the violet tri-color .Such tea should be drunk constantly, from month to month for a long time.

Mix in equal amounts garlic clove and honey .Insist in tightly sealed dishes in a dark cool place for 7 days, stirring the contents daily. Take 1 tablespoon three times a day for ischemic heart disease, obliterating endarteritis, varicose veins and atherosclerosis.

Narvite lily of the valley flower and pour the sugar, during an attack of angina put under the tongue in the amount of one pea and suck.

Hawthorn ( flowers ).

Broth : 2 tablespoons dried flowers on a glass of water. Boil for 5-7 minutes. Strain. Take 1 tablespoon 3-4 times a day.

Tincture of : 10 g of dried flowers per 100 ml of vodka. Insist 14 days in a dark place. Strain. Drink 25-30 drops three times a day.

Useful tea from of hawthorn fruit .A tablespoon of fruit on a glass of water. Boil 10 minutes, infuse 2 hours, strain. Drink 1 glass three times a day as tea.

Hypericum .2 tablespoons dry herbs pour a glass of boiling water and leave for 1 hour. Strain. Drink 50 ml 2-3 times a day.

Motherwort .2 teaspoons of herbs, pour 500 ml of boiled water and leave for 8 hours in a warm place. Take one fourth of the glass 3-4 times a day for half an hour before meals.

Alcohol tincture motherwort mix with alcohol tincture lily of the valley ( pharmacy) and take 30 drops 2-3 times a day with angina pectoris.

The stinky smelly .Tincture( drugstore).Take 25 drops three times a day with angina pectoris, hypertension and circulatory disorders.

Prepare the collection :

  1. valerian( root) - 1 part,
  2. St. John's wort - 1 part,
  3. yarrow - 1 part.

Pour a tablespoon of salt in a glass of cold water. Insist 4 hours. Boil for 5 minutes. Insist at room temperature for 2 hours, strain. Drink one third of a glass three times a day.

Take 1 liter honey , squeeze or scroll through the mincer 10 lemons medium-sized with a crust, brush 10 heads garlic ( heads, not lobules).Mix together and leave for a week in a sealed container. Drink 1 teaspoonful 4 times a day, but not immediately, but slowly, relishing, not hurrying. Do not miss the days. Drink until the medication runs out, within two months.

One of the best ancient recipes for stenocardia and cardiosclerosis is:

10 tablespoons of hawthorn and five tablespoons of rose hips( take pre-chopped fruits) put in a pan. Spoons are superimposed on top. Pour 2 liters of boiling water. The pan is wrapped up warmly and placed for 24 hours in a warm place. Then strain through gauze and proceed to treatment. Take 200 g 3 times daily before meals. The medicine is useful to all patients with heart diseases. It works especially well after the myocardial infarction.

Row Ash bark .200 g of bark crush and boil on low heat for 30 minutes in 500 ml of water. Insist 2 hours, strain. Take 1 tablespoon half an hour before meals three times a day.

Sunflower flowers .With angina and cardiosclerosis, as well as with vascular diseases: 1 cup edge flowers of sunflower, pour 1 liter of water, boil for 5 minutes, infuse for 1 hour, strain. Drink 150-200 ml three times a day.

Devyasil high .30 g of dry ground root per 500 ml of vodka. Insist 14 days. Take 30-40 drops three times a day with cardiosclerosis and angina.

Mix the juice of two lemons with juice 3 of medium-sized aloe vera .Add 500 g of honey to the mixture. Insist in tightly closed dishes in the refrigerator for 7 days. Periodically stir. Take stenocardia 1 tablespoon three times a day on an empty stomach( one hour before a meal).Spend 3-4 courses of treatment with a break in one month.

With angina before each meal, crust from of the whole lemon should be eaten. Only one week will pass, and you will be surprised how much you will feel better. Daily chewing of fresh lemon peel improves the functioning of the heart muscle.

Also it is necessary to adhere to the certain diet: do not eat anything fried, eat only liquid, for example soups.

In case of heart palpitations and pains in the heart area, the following composition is used:

  1. valerian root - 2 parts,
  2. anise fruits - 1 part,
  3. hernia motherwort - 2 parts,
  4. yarrow herb - 1 part.

One tablespoon of the mixture, pour 300 ml of boiling water and leave for 1 hour. Take half a glass three to four times a day.

In some ancient medical institutions, authors strongly recommend drinking "beans" with diluted beet juice( 1: 3).

If you are concerned about pain in the heart, drip 30-40 drops of with valerian and hold 1-2 minutes in your mouth. Even better is the mixture of tincture of valerian root and hawthorn .

The famous healer Lyudmila Kim advises that when stroking angina 3-4 times a day, rub fir oil into the heart area( below the nipple).For one rubbing, 5-6 drops of fir oil are sufficient.

One tablespoon balm pour 300 ml of boiling water, insist 30 minutes and drink three times a day for half a glass with tachycardia and heart neurosis, which often accompany angina.

Before treatment of angina or other heart diseases( if you are over 50), be sure to follow the Tibetan method of cleansing the body: garlic and alcohol.

Old herbalists in angina pectoris recommend that mustard be applied to the heart area as soon as the attack begins, and on the back with .

Persons suffering from angina pectoris should constantly take vitamin B15 and as much as possible have of ox liver .It is also useful to them bovine blood .

All "cores" are recommended to stop smoking, as nicotine narrows the blood vessels of the heart.

The folk healer P.V.Karasev recommends the "core" following folk recipe:

  1. grind 50-70 g dioecious nettles ;
  2. the resulting mass in a small enamel pan;
  3. add 500 ml of water and after 30 minutes put on fire;
  4. boil for 10 minutes( with the lid open);
  5. strain, cool and store in the refrigerator for no more than two days.

Take 2 tablespoons of broth 3 times a day for 15 days. Every five days, take a break in treatment for two or three days.

To achieve a better effect before the "nettle cure" should be treated with decoction mulberry root ( mulberry).200 g fresh roots chop, rinse well and pour in enameled dishes with cold water for 1 hour. Then boil for 15 minutes over low heat, cool and strain. Take one third of the glass three times a day for half an hour before meals courses of three days( only five courses).

With an attack of angina( if there is no nitroglycerin), chew and swallow a small tooth of garlic .The pain is removed after 20-30 minutes.

5 tablespoons, finely chopped pine or spruce needles , mix with three tablespoons of chopped dogrose and two tablespoons of onion peels .The mixture is poured into 700 ml of water, bring to a boil and boil on low heat for 10 minutes. Insist the night in a warm place. Strain and drink 1.5-2 liters per day for 4 months instead of water. If the kidneys do not bother, then the onion husks can not be added.

This method of treatment is used in folk medicine also for the purification of blood vessels.

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Source: YNGogov. Official and traditional medicine. The most detailed encyclopedia.- Moscow: Izd-vo Eksmo, 2012.