Unstable angina, symptoms, treatment and everything associated with it

Angina pectoris is a pathological condition in which a person experiences severe pains in the chest, extending into the neck, shoulders, sometimes - upper limbs.

This problem is caused by insufficient blood supply to the heart and is called stable angina.

Unlike stable unstable form of angina pectoris is an extremely unpredictable disease in development. It can provoke a heart attack even without specific external factors, and therefore presents a particular danger to human life.

Learn all about the symptoms of unstable angina, its diagnosis and treatment tactics from this article.

Contents

• 1 Description of the disease
• 2 Causes and risk factors
• 3 Classification of species
• 4 Dangers and complications
• 5 Clinic: signs and symptoms
• 6 Diagnosis
• 7 Tactics of therapy
• 8 Prognosis and prevention measures

Description of the disease

The main condition for the development of coronary heart disease is the presence of atherosclerosis, in whichwalls of arterial vessels are deposited cholesterol and other harmful lipids.

Almost all the blood vessels of the of the body suffer from atherosclerosis, but it is the coronary arteries located in the heart that are most susceptible to the negative effect of this pathology.

Over time, cholesterol plaques proliferate, reducing the lumen of blood vessels and preventing normal blood flow. If the person is calm, the disturbance of blood circulation almost does not manifest itself, but the increases the rhythm of the with nervous or physical exertion, and the blood begins to run faster through the vessels.

Because the vessels are narrowed, movement of blood is difficult, resulting in myocardium lacking oxygen. Hypoxic processes prevent the removal of unprocessed metabolic products, and this leads to the appearance of pain in the heart of the .This condition is called an attack of angina pectoris.

A stable type of disease can be successfully controlled - do not overload yourself physically, avoid stress, take nitroglycerin during an attack. Unstable form of the disease manifests itself in a different way.

Unstable angina can be considered a borderline between an ordinary heart failure and such a threatening phenomenon as myocardial infarction. This pathology, without the timely provision of medical care, can lead to the development of an acute infarction, therefore it requires urgent hospitalization and constant medical supervision.

Causes and risk factors for

Angina pectoris becomes unstable when rupture of fibrotic plaque occurs in the coronary artery, followed by the formation of a thrombus obstructing normal blood supply to the myocardium.

Fibrous plaque can be destroyed by inflammation, excess fat deposits, hemodynamic disorders or lack of collagen.

The main cause of unstable angina is IHD .It appears with the accumulation of fatty deposits on the walls of the arteries. In this case, the lumen of the vessels narrows, the heart stops to get enough oxygen, which leads to pain symptoms.

Other causes that can cause the development of pathology are:

• rupture of capillaries followed by hemorrhage into the plaque;
• increased ability of platelets to glue;
• release serotonin or other vasoactive agent into the blood, in which there is a sharp narrowing of the lumen of the coronary vessels;
• decrease in antithrombotic properties of endothelial cells.

Classification of species

There are 4 main varieties of unstable angina:

1. Primary , in which the disease causes anxiety for a month.
2. Postinfarction , manifested by attacks in the first 2 days after a heart attack, or during an acute period, which usually lasts about eight weeks.
3. Progressive , at which the state of health worsens and the frequency of attacks increases with increasing, throughout the month.
4. Prinzmetal angina pectoris, in which the vessels contract as a result of spasms, and not because of atherosclerosis.

Also it is divided by prescription and severity:

• 1 degree .The disease started less than 2 months ago, it is very difficult to progress, it progresses rapidly, it manifests itself in a state of rest.
• 2 degree .Refers to the subacute phase of the disease, with the symptoms appear for the first time, and pain can last more than two days.
• 3 degree .Painful sensations occur the last 2 days.

Depending on the factors of appearance and clinical picture is divided into three classes:

• 1 class .Pain syndrome first appears at a high load, then - at a minimum. The number of seizures increases with time. The first attack is not earlier than 2 months ago. In a calm state, seizures may not appear for 2 months.
• 2nd class .It is characterized by constant pain in a calm state. The first case of an attack was registered not earlier than 2 months ago.
• 3rd class .To it the acute stenocardia in a state of rest which has arisen for last two days concerns.

For reasons of formation, the disease is classified into three groups:

• Group A - seizures arise from diseases that are not related to the heart - thyrotoxicosis, hypoxia, anemia, acute infection.
• Group In - angina develops on the background of other cardiac problems.
• Group C - the origin of the disease is associated with a previous infarction.

The diagnosis of unstable angina is made precisely on the basis of its classification and looks like this: "unstable angina, 1 A grade."According to this characteristic, it can be determined that seizures occur with a small load for 2 months already, and the patient has a disease that provokes the narrowing of the coronary vessels.

Dangers and complications of

In the absence of treatment, unstable angina pectoris can cause the following problems :

• acute myocardial infarction;
• pulmonary artery thromboembolism;
• abrupt fibrillation of the ventricles of the heart followed by a fatal outcome;
• acute heart failure, accompanied by pulmonary edema.

Clinic: signs and symptoms

It is sometimes difficult to detect the disease, because the symptoms of this ailment can be attributed to many other cardiac pathologies.

Define an unstable angina if the following symptoms are observed:

• Symptomatic change: the frequency and duration of pain attacks increased, nitroglycerin helps already less, the pain intensifies and spreads to nearby parts of the body, seizures occur even under lower loads than before.
• A pain attack that lasts more than 10 minutes, not dosed off with nitroglycerin.
• Attacks began to bother a month ago or later.
• Painful sensations in the chest during treatment of the post-infarction state - this sign indicates the formation of a new thrombus in the affected vessel.
• Attacks began to occur at rest.
• Symptoms appear after aortocoronary bypass surgery, performed less than three months ago.

Prinzmetal angina has its own specific symptoms:

• is most often attacked by young men;
• pain is not related to physical activity;
• attacks occur more often in the mornings than at other times of the day;
• high efficiency of treatment with calcium antagonists and drugs from the group of nitrates.

Since this pathology poses a great danger to human life, should immediately contact the cardiologist when the first symptoms appear. People suffering from coronary heart disease and angina pectoris should regularly see a doctor and undergo examinations.

Diagnosis

The following diagnostic procedures are used for diagnosis:

• general examination of the patient , listening to heart sounds, studying symptoms and anamnesis;
• blood test , allowing to identify inflammatory processes;
• urine analysis - is necessary to exclude other pathologies;
• ECG - for the detection of complications of ischemic disease;
• Holter ECG - used to determine the conditions, frequency and duration of the presence;
• Echo-ECG - required for studying the structure and dimensions of the heart, as well as the state of the valves and blood circulation;
• coronary angiography , which allows to investigate the blood flow in the cardiac vessels;
• Stress-echo-ECG - conducted to identify areas of myocardial hypoxia under conditions of physical exertion;
• scintigraphy , allowing to study the condition of the walls and cavities of the heart.

Only after collecting the complete data of all the examinations, they put the corresponding diagnosis.

Tactics of therapy

When an unstable angina is detected, emergency hospitalization with strict bed rest and medical therapy are prescribed. The following agents are used in treatment:

• painkillers - neuroleptanalgesia, nitroglycerin;
• preparations that improve blood flow - desaggregants and direct anticoagulants( clopidogrel, prasugrel, aspirin and others);
• drugs that reduce the need for myocardium in oxygen - calcium antagonists, beta-blockers.

In the absence of a positive effect of drug therapy, surgical ways of treating the disease can be shown:

1. Angioplasty .A stent( metal tube) is introduced into the narrowed vessel, which keeps the vessel walls from sticking together and provides normal blood flow.
2. Aorto-coronary bypass .This operation is used if the main coronary artery, or most of the coronary vessels, has been struck. In this case an additional bed is created to bypass the affected vessels, which ensures the delivery of blood to the heart.

It is also important to know about the first signs of an attack of angina and ways of its relief - this is covered in a separate article. Sometimes the treatment of angina with folk remedies can help.

Prognosis and prevention measures

The prognosis of the disease depends on the degree of its severity, duration of development and concomitant pathologies. To prevent attacks of angina, is recommended to follow preventive measures:

• quitting;
• fight against excess weight;
• sports;
• moderate drinking;
• a large number of fruits, fish, vegetables, whole grains and lean meat in the diet.

In addition, should promptly treat diseases that cause increased blood pressure and narrowing of the arterial vessels .Taking a pill of aspirin a day can reduce the number of pain attacks and reduce the likelihood of developing an acute myocardial infarction.