Angina pectoris is a pain syndrome that occurs in the heart area. It is caused by insufficient blood supply to the heart muscle.
Angina pectoris is not an independent disease, it is a combination of symptoms, the manifestation of coronary heart disease.
There are several types of disease that differ symptomatology, but they are united by pain arising in the region of the heart.
Description of the disease
Vasospastic angina is one type of angina pectoris. Its difference is the fact that the pain behind the sternum is common to all types, in this case occurs irrespective of the provoking factors of in the form of physical or emotional loads.
In this case, the vessels supplying the heart muscles are compressed in the anginal episode
.There is an acute contracting pain behind the sternum, shortness of breath. As a result of this compression of the muscles, the lumen of the coronary artery decreases, and the blood flow to the myocardium decreases.This disease is a rather rare type of angina pectoris. It is diagnosed in about 2% of cases when patients are hospitalized in a cardiac hospital with complaints of heart pain. Most often it affects women aged 30-50 years.
Causes and Risk Factors of
Unfortunately, has not yet studied the exact causes of occurrence. It is suggested that most often the disease is caused by the high sensitivity of coronary vascular cells to a variety of active substances.
Also causes vasospastic angina disruption of the internal walls of vessels and arteries .
Internal walls of the heart vessels or endothelium, if damaged, increase the production in the body of substances that contribute to the occurrence of vasospasms and reduce the production of others leading to vasodilation.
Another cause is spasm of the coronary arteries. In this case, the arteries overlap, but their structure does not change. Risk factors in this case can be:
- subcooling;
- smoking;
- autoimmune diseases;
- violation of the composition of electrolytes.
The disease can also occur with when the blood supply of the heart muscle decreases. The number of cardiac contractions decreases, the myocardium becomes electrically unstable and conductivity and rhythm disturbance occurs.
Also the cause of this disease is considered appearance of stenosing coronary atherosclerosis .It occurs when there are problems with the arteries that feed the heart muscles - their lumen narrows, the blood supply of the heart decreases.
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Classification
Vasospastic refers to the of spontaneous astable angina pectoris .These types of angina occur in the form of bouts of chest pain that occur with sudden spasm of the coronary arteries. Attacks occur regardless of physical and emotional stress.
Dangers and complications
The main danger in an attack of vasospastic angina is the prolonged attack, it can go into myocardial infarction. On the background of the disease can occur cardiosclerosis and chronic heart failure.
The arrhythmia may also develop. The most serious complication is the development of a large-focal transmural infarction.
Symptoms and signs
The disease is characterized by the following symptoms:
- burning or pressing pain in the area behind the sternum, lasting no more than 5 minutes, occurring mainly in the morning and night hours;
- irregular heart work and fits of rapid heartbeat;
- no association between the onset of pain and physical or emotional stress;
- rapid disappearance of pain after taking a tablet of nitroglycerin;
- cyclicity of seizures.
Additional symptoms of vasospastic angina:
- arrhythmia;
- increased blood pressure;
- syncope;
- pallor of the skin;
- cold sweat;
- in rare cases of nausea.
If symptoms of vasospastic angina are observed, it is necessary to urgently consult a cardiologist. The earlier he clarifies the diagnosis, the sooner the treatment will be prescribed and the prognosis will be more favorable. Also, complications are less likely to occur.
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Diagnosis
Diagnosis of this disease is made by based on anamnesis analysis and patient complaints .The doctor assesses the nature of the pain, the time of day of its occurrence, the duration of the pain, with what its appearance may be associated and when it ceases.
In addition to personal analysis of the patient's medical history, the family history analysis of is carried out: whether the nearest relatives had similar illnesses or sudden deaths and so on.
A general analysis of urine and blood is mandatory for to identify possible concomitant pathologies.
Biochemical blood test for cholesterol content of ( total, low and high density) and blood sugar level are conducted.
During an attack, the ECG is mandatory. You also need to make a Holter ECG.
If necessary, cold sample is performed when the patient's wrist and forearm are immersed in cold water with ice slices for 5 minutes. At this time, the ECG records the data during and after the test, for 5-7 minutes. If the sample is positive, a pain arises in the region of the heart and the interval on the ECG rises.
The ergometric test is performed. With the help of ergometrine, you can cause a spasm of the coronary arteries or even myocardial ischemia. After the patient is administered ergometrine, the doctor monitors the changes in the state of the coronary arteries. If a spasm occurs, the diagnosis is confirmed.
If necessary, the echocardiography is performed, which allows finding or eliminating other problems affecting the heart, as well as assessing the ventricular function, cavity size and so on.
Coronary angiography of is also performed with suspected vasospastic angina. With the help of a catheter penetrating into the vessels, the doctor determines the presence of atherosclerotic stenosis of the coronary arteries.
If necessary, the load test is performed. It is based on the application of a step-by-step phys.load performed on a bicycle or treadmill under the control of an ECG apparatus. Thus, ischemia of the heart is revealed during exercise.
Tactics of treatment
The treatment is applied both non-surgical and surgical treatment. In non-surgical treatment, first of all eliminates all the factors that can provoke the disease :
- cold;
- smoking;
- stress.
As medicines, nitroglycerin is used. It can be used in any form, either in tablets or in a spray.
To prevent attacks, you can use nitroglycerin in the form of a patch, as well as prolonged nitrates( cardiac, nitrosorbide).If the endothelium of the vessels is damaged as a result of spasms, the risk of thrombosis increases. In this case desaggregants , for example, aspirin, are added to already used drugs.
For continuous treatment use calcium antagonists .The mechanism of action of these drugs is associated with a decrease in the calcium content in smooth muscle cells. Thus, the spasm of the coronary vessels is eliminated. Such drugs are used daily.
In rare cases, alpha blockers are used to treat variant angina pectoris. They reduce the effect of the nervous system on the muscular layer of the arteries.
Surgical intervention is allowed only in certain cases of .Angioplasty with stenting is performed. This procedure allows you to open the clogged and narrowed vessels with a thin metal tube.
Coronary artery bypass grafting is also used in the treatment of a disease. In this case, the patient's vessel is sutured to the coronary artery slightly higher and lower than its narrowing.
In case when the disease has an arrhythmic course, the patient is placed cardioverter-defibrillator , which, if necessary, restarts the heart with the help of an electric discharge.
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