Angina pectoris: symptoms, emergency, arresting an attack

Angina pectoris is a pain syndrome in the heart area( behind the sternum) caused by insufficient blood supply to the heart muscle. In other words, angina pectoris( popularly called "angina pectoris") is not an independent disease, but a combination of symptoms related to the pain syndrome. Stenocardic syndrome or simply angina is the manifestation of coronary heart disease( CHD).

The topic of our meeting today is an attack of angina pectoris, its symptoms, and also how to provide emergency help in stopping an attack of chest pain.

Angina pectoris: symptoms

Major symptomsangina pectoris - pains of a different nature, located behind the sternum, in the central part of the thorax in the region of location withheart. Usually angina is described as a feeling of pain, severity, squeezing, pressure, discomfort, burning, constriction or pain behind the sternum. Unpleasant sensations in the chest can extend to the shoulders, arms, neck, throat, lower jaw, shoulder blade and back.

Angina pectoris arises from insufficient blood supply to the heart muscle in ischemic heart disease. Moments in which there is a severe deficit in the blood supply to the heart muscle are called ischemia.

With any ischemia, oxygen deficiency occurs, as insufficient blood is brought to the heart muscle to fully meet its needs. It is oxygen deficiency in ischemia that causes pain in the heart, which is called stenocardia.

Ischemia of the heart muscle is usually caused by atherosclerosis of the coronary( cardiac) vessels, in which there are plaques of various sizes on the walls of the blood arteries that cover and narrow their lumen. As a result, much less blood is delivered to the heart muscle through the coronary arteries than necessary, and the body begins "starvation."In moments of particularly severe fasting, an attack develops, which is called ischemia from the point of view of physiology, and angina from the standpoint of clinical manifestations.

That is, angina is the main clinical manifestation of chronic ischemic heart disease, in which the myocardium experiences a pronounced oxygen starvation, because vessels with a narrow lumen do not receive enough blood to it.

Because IHD is a chronic disease that lasts for a long time, its main manifestation, angina, also occurs in humans for years. Angina pectoris usually has the nature of an attack that occurs in response to a sharp increase in the need for the heart in oxygen, for example, with physical activity, a strong emotional experience or stress.

In rest angina pain almost always absent. Angina pectoris, depending on the conditions of life, the presence of provoking factors and treatment, can be repeated with varying frequency - from several times a day to several episodes per month. You should know that as soon as a person has an attack of angina, this indicates an oxygen starvation of the heart muscle.

Symptoms and signs of an attack of angina

Symptoms of angina are few, but very characteristic, and therefore they are easy to distinguish from manifestations of other diseases. So, angina is manifested by intense pressing or compressive pain or a feeling of heaviness, burning and discomfort in the chest right behind the sternum. Pain, heaviness or burning sensation can be given to the left arm, to the left scapula, neck, lower jaw or throat. Relatively rare pain can spread to the right half of the chest, right arm or upper abdomen.

Angina is always an attack of described pain in the heart area. Outside the attack, angina does not manifest itself in any way. Usually angina pectoris develops against the background of physical exertion, strong emotional impact, cold air temperature, strong wind.

The duration of the attack is from one to fifteen minutes. The attack of angina always begins sharply, sharply, suddenly, at the peak of physical activity. The most severe physical exertion, often provoking angina, is fast walking, especially in hot or cold weather, or a strong wind, as well as walking after a heavy meal or climbing the stairs.

Pains can pass independently after the termination of physical activity or emotional impact, or under the influence of nitroglycerin 2 to 3 minutes after ingestion. Nitroglycerin has the ability to greatly expand the lumen of the coronary vessels, increasing the flow of blood to the heart muscle, which eliminates the oxygen starvation of the organ, with which an attack of angina occurs.

As the pain passes after the termination of physical exertion, a person suffering from angina pectoris often has to stop at movement in order to wait for the normalization of the condition and stopping the attack. Because of such intermittent, with frequent and numerous stops of movement, angina is figuratively called "a disease of browser shop windows".

The described symptoms of angina are classic, but with them there are also atypical manifestations of myocardial ischemia. In men, as a rule, angina is manifested by the classic pain syndrome in the heart.

Symptoms of atypical angina

Atypical angina attack can manifest with pain in the arm, in the shoulder blade, in the teeth or in dyspnea. And women, elderly people or those suffering from diabetes mellitus may not experience any pain with a stenocardic attack. In this category of people angina is manifested by frequent palpitations, weakness, nausea and severe sweating. In rare cases, angina pectoris is completely asymptomatic, and in this case it is called "mute" ischemia.

In general, there are two main variants of atypical manifestations of angina pectoris:

• Shortness of breath, which occurs both on inspiration and exhalation. The cause of shortness of breath is incomplete relaxation of the heart muscle;
• Strong and sharp fatigue at any load, which arises from the insufficient supply of oxygen to the heart muscle and low contractile activity of the heart.

Atypical symptoms of the syndrome are now called equivalent to angina pectoris. The causes of angina pectoris: why does the heart ache?

The following factors may be the cause of angina pectoris:

1. Obesity. And the stronger the obesity, the higher the risk and the faster the person develops angina. The immediate causes of obesity do not play a role in the development of angina pectoris;
2. Smoking. The more a person smokes, the more likely and faster he develops angina;
3. High cholesterol in the blood;
4. Diabetes mellitus, the presence of which increases the risk of developing angina in 2 times. Currently, scientists and doctors believe that with a duration of diabetes for at least 10 years, a person already has angina pectoris, or it will manifest itself in the near future;
5. Strong emotional stress or nervous overload;
6. Chronic stress;
7. Insufficient physical activity( hypodynamia);
8. Arterial hypertension( hypertension);
9. Increased coagulability of blood( high values ​​of PTI, MNO, APTTV and TV), against which numerous blood clots are formed, which clog the lumen of the vessels. Thromboses of the coronary arteries are the direct cause of the development of stenocardic attacks or myocardial infarction;
10. Tendency to thrombosis, thrombophlebitis or phlebothrombosis;
11. Metabolic syndrome( obesity + hypertension + high cholesterol in the blood).

For the development of angina pectoris, it is not necessary to have all the causal factors in a person, sometimes only one, but usually there are several. The development of angina pectoris can occur against a background of various combinations of several causative factors. If a person has any of the listed causes of angina pectoris, but there are no seizures, this indicates a high risk of their development. This means that they can appear at any time.

All of the above factors are the causes of angina pectoris, but the immediate provocateurs of an attack are physical stress, emotional experience or unfavorable weather conditions. This means that under the influence of causes, a person develops angina pectoris, but her attacks develop only under the influence of provoking factors.

How to determine an attack of angina?

For the diagnosis of angina pectoris, it is necessary to evaluate clinical symptoms, perform a series of laboratory, instrumental studies and functional diagnostic tests that are necessary to determine the severity of the course and functional class of pathology.

First of all, it should be assessed whether a person has the following clinical symptoms:

1. The feeling of squeezing, buckling, burning and heaviness in the heart area;
2. The sensations are localized behind the sternum, but can extend into the left arm, left shoulder and shoulder blade, neck. Less common is the spread of sensations in the lower jaw, right half of the chest, right arm and upper abdomen;
3. The duration of the attack is at least one minute, but not more than 15;
4. Under what conditions is the attack developing - suddenly, at the peak of physical activity( walking, climbing stairs, abundant food intake, overcoming strong winds, etc.);
5. Than the attack is reduced - pain reduction occurs very quickly after discontinuing physical activity or after taking one Nitroglycerin pill.

If a person has all of the above clinical symptoms, then this is a typical angina. The presence of any two signs from all of the above means that the person has atypical angina. If there is only one any symptom of the listed, then it is a pain of non-cardinal origin. In this case it is necessary to be examined for the presence of peptic ulcer of the stomach or duodenum, pathology of the esophagus, osteochondrosis of the thoracic spine, shingles, pneumonia or pleurisy.

Emergency care for angina pectoris - an arrest of an attack

With the development of an attack of angina pectoris, it is necessary to sit down comfortably with your legs down. Against the background of the ongoing attack, it is strictly forbidden to get up, walk and perform any physical work. It is necessary to release the throat and chest of a person who developed an attack of angina, unbuttoned his shirt and removed his tie or scarf. It should also be possible to open the window or window, providing access to fresh air.

In a sitting, maximally relaxed position, a person with an attack of angina pectoris should chew half or one of the standard tablets, and then put for the pain relief. Nitroglycerin or Nitrolingival .Also for pain relief, you can use Isodet , sprinkling one dose under the tongue. Then you should sit still and wait for the end of an attack of angina, which should not last longer than 15 minutes.

If within 3 minutes after taking Nitroglycerin or Nitrorolingal, the pain does not subside, then you can take another pill. Isoket can be sprinkled with an interval of one minute in the absence of clinical effect. Do not use more than three tablets of Nitroglycerin and Nitrorolingval or three doses of Isoket to stop an attack of angina pectoris.

When to call an ambulance?

"First aid" should necessarily be called in the following cases:

1. If an attack of angina occurred for the first time in life;
2. Pain in the heart area lasts more than five minutes, does not subside or increases;
3. Pain in the heart area increases, lasts more than five minutes and is combined with difficulties with breathing, weakness and vomiting;
4. Pain in the heart area did not stop or worsen after taking Nitroglycerin Tablets for five minutes.

In the above cases, it is absolutely necessary to call an "ambulance", because a person may not have an attack of angina pectoris, but the initial stage of an infarction.

Angina pectoris: treatment outside of attacks

Treatment of angina pectoris can be conservative or operative. The surgical operation is performed according to the indications, and the conservative treatment of angina pills by the person should be performed throughout the life after the pathology is revealed.

All the methods of angina therapy are aimed at achieving the following goals:

1. Prevention of myocardial infarction and sudden cardiac death;
2. Prevention of disease progression;
3. Reduction in the number, duration and intensity of seizures. Conservative

angina therapy is the use of the following drugs:

Formulations for improving angina

means

Preventive Means, and profilaktiruet reduce thrombus formation( acid acetylsalicylic, Aspirin).

than a dozen years for the prevention of thrombosis and ischemic disease used aspirin( acetylsalicylic acid), however long its reception can cause problems with the gastrointestinal tract, such as heartburn, gastritis, nausea, stomach pain.

To reduce the risk of such undesirable consequences, it is necessary to take the drugs in a special enteric coating. For example, you can use the drug "Trombo ACC, each tablet is covered with an enteric film membrane, resistant to the action of hydrochloric acid in the stomach and dissolving only in the intestine. This avoids direct contact with the gastric mucosa and reduces the risk of heartburn, ulcers, gastritis, bleeding.

Beta-adrenoblockers( Metaprolol, Atenolol, Bisaprolol, Nebivolol, etc.) reduce the need for cardiac muscle in oxygen. This eliminates the imbalance between the need for oxygen in the heart and the small amount of blood delivered through the tapered vessels;

Statins( simvastatin, atorvastatin, etc.) reduce the concentration of cholesterol and its fractions in the blood. Due to this, the lumen of the coronary arteries does not clog even more, and the blood supply of the myocardium does not deteriorate;

Angiotensin-converting enzyme( ACE) -. Perindopril, Enalapril, Lisinopril, Noliprel, etc. Formulations Sonoprel profilaktiruet vasospasm.

Antianginal drugs

Antianginal agents( anti-ischemic) aimed at reducing the number, duration and intensity of anginal attacks:

1. Beta-adrenoblockers( Metaprolol, Atenolol, Bisaprolol, Nebivolol, etc.) reduce the heart rate, reduce blood pressure, thereby preventing attacks of angina pectoris;
2. Calcium channel antagonists( Verapamil, Diltiazem, Veragalid, etc.) reduce the consumption of oxygen by the heart muscle;
3. Nitrates( Nitroglycerin, Isosorbide Dinitrate or Mononitrate) dilate blood vessels, reducing the need for the heart in oxygen.

For complex therapy of angina, the doctor necessarily selects drugs from the group of antianginal drugs and improves the course of angina pectoris. Usually, 1 to 2 preparations from each group are selected. Drugs will have to be taken continuously, throughout life. If at some point the selected therapy is ineffective, the doctor prescribes other drugs.

Currently, ineffectiveness of vitamins, antioxidants, female sex hormones, Riboxin and Cocarboxylase has been proven for the treatment of angina pectoris.

Surgical treatment of angina pectoris

Surgical treatment of angina pectoris consists in restoration of normal blood supply to the heart muscle. For this, the following types of operations are currently performed:

• Coronary( balloon) angioplasty;
• Aorto-coronary bypass.

Coronary( balloon) angioplasty is a non-invasive procedure in which a catheter is guided through the femoral artery to the area of ​​narrowing of the cardiac vessels. Then, a balloon located at the tip of the catheter is placed in the area of ​​narrowing of the lumen of the vessel and is filled with air. In the process of expansion, the balloon crushes the plaque, removes its clogging and, thereby, restores the lumen of the vessel completely. As a result of the procedure, the blood flow in the cardiac arteries is restored. Coronary angioplasty is performed under local anesthesia.

In addition, coronary angioplasty is often combined with vessel stenting, laser burning of atherosclerotic plaques or their destruction by drill. Stenting of the vessel is the installation of an endoprosthesis on it, which is a metal frame that will maintain the capillary lumen constant.

After angioplasty, angina attacks stop, however, unfortunately, the operation does not give a 100% guarantee of recovery, as relapse of the disease develops in about 30-40% of cases. Therefore, despite the good condition after the operation and the absence of angina attacks, it is necessary to conduct maintenance conservative treatment.

Aorto-coronary bypass is an operative measure of large volume. As can be seen from the name of the operation, its essence lies in the fact that a bypass shunt to other cardiac vessels is superimposed from the artery below the site of its narrowing, which makes it possible to deliver blood to them, despite the existing obstacle. That is, artificially created a bypass route for transporting blood to the heart muscle. During the operation, several shunts can be applied that will provide blood supply to all parts of the myocardium suffering from ischemia.

The operation allows to completely eliminate angina pectoris, but for the prevention of relapse it will be necessary to conduct conservative treatment throughout life. Relapses of angina develop in 20 - 25% of people within 8 to 10 years after the operation of aorto-coronary bypass.

Angina pectoris prophylaxis

Currently, the procedure for the prevention of angina pectoris is very simple and consists in the implementation of the IBS rule, where

1. And means - to get rid of tobacco smoke. If a person smokes, you should quit. If you do not smoke, you should avoid places where the risk of inhaling tobacco smoke is high;
2. B means - to move more;
3. C means to lose weight.

This simple set of rules IBS.effectively prevents the development of angina pectoris in any person regardless of sex, age and associated diseases.

Angina: treatment with folk remedies

Folk remedies can be used only to stop an attack of angina pectoris, as well as to prevent its occurrence. However, for full control over the course of the disease a person will still need treatment with traditional medicines. Therefore, folk methods can be a good addition to the main treatment of angina pectoris.

So, in the treatment of angina, the following folk remedies can be used:

1. The mustard plasters or pepper plasters put on the calves of the feet will reduce the pain in the heart and accelerate its passage;
2. Sucking menthol plates reduces the severity and duration of pain during an attack;
3. Rubbing fir oil into the heart area stops an attack of angina pectoris;
4. The massage of the little finger of the left hand during the attack will speed up its cupping.

Before applying any of the above described means, consultation of a therapist and cardiologist is necessary.

Author: Pashkov MK

Video: First aid for an attack of angina

On the video channel "LIFE OF HYPERTONICS".

Angina arises from the lack of oxygen in the myocardium, which is negatively reflected on the work of the heart. This is a serious disorder that can cause myocardial infarction. Angina pectoris develops in seizures, in which a person feels anginal pain( pressing and burning nature of pain) and other symptoms. These symptoms should be known to everyone, since today this disease is quite common. It is necessary to understand the full risk of angina pectoris. The faster the help is given, the less likely the occurrence of complications.

Typical symptoms of angina pectoris:

1. Angina pectoris;
2. Pain syndrome is present when inhaled and exhaled;
3. Shortness of breath, feeling of lack of air;
4. Painful sensations in the forearm of the left arm;
5. Breath weak;
6. The blood pressure index is rising.

Atypical symptoms of angina:

1. Attack of nausea, vomiting;
2. Pale skin;
3. General weakness;
4. Pain gives to the neck, jaw, back, toothache;
5. Plentiful sweating;
6. Unstable pulse and heart rate;
7. Heartburn and intestinal colic.

Most often, the symptoms of an attack include chest pain, shortness of breath, weakness, cold sweat, and the person is frightened and anxious.

First aid at home

What if I have an attack? First aid for angina pectoris is aimed at normalizing the patient's condition. The main rule for all people suffering from angina pectoris is to have always Nitroglycerin. In any situation, it should be at hand. Coping pain at home is to take this medicine under the tongue. Nitroglycerin promotes vasodilation. If there are signs of an attack of angina pectoris, you do not need to wait for severe pain, you should immediately take the medicine.

You can use drugs in the form of a spray. These are substitutes for Nitroglycerin, for example Nitromint. It is possible to remove symptoms quickly only if sprinkled under the tongue. If there is a headache, then it can be removed with the help of analgesics.

If there is an attack of angina, then the person needs to stop the work that he was doing, and try to calm down if there is a stressful situation. It is better to take a lying position on the floor. Also need to ensure the flow of air. All items of clothing that compress the chest, you need to unbutton.

Angina attacks can also be alleviated if the face and the patient's chest are wiped with cool water, but not cold. If after taking Nitroglycerin after 5-10 minutes to remove the pain did not work, then you can re-take the medicine.

If the attack of angina does not go away, doctors are allowed to take Nitroglycerin no more than 3 times, but without increasing the dose. It is important that the person who is nearby, in every possible way calms the patient and reminded that it is necessary to breathe deeply and deeply. This is necessary, because at the time of an attack, fear and anxiety can manifest.

If, after taking all the drugs, the attack does not stop within 15-20 minutes, then you need to call an ambulance to provide medical assistance.

Source: http: //www.tiensmed.ru/news/ stenokardia-bc2.html