Angina pectoris - what is it? Causes, Symptoms and Treatment

Angina is a common heart disease, which, when progressing, leads to chronic heart failure and myocardial infarction.Angina is often regarded as a symptom of coronary artery disease - it is a sudden pressing pain behind the sternum, which occurs against a background of physical stress or a stressful situation.

Probably, many heard the expression "chest toad strangling." However, not everyone knows that the causes of such discomfort in the chest lie in the heart disease. Any unpleasant sensations accompanied by pain in the thoracic region are the first sign of a disease such as angina. All the fault - the lack of blood supply in the heart muscle, which is what causes a painful attack.

In this article we will consider angina pectoris, the symptoms of what to do, and what can not be done. In addition, we will talk about treatment, and effective ways to prevent disease.

Causes

Why does angina arise, and what is it? Angina pectoris is one of the forms of ischemic heart disease, characterized by a sharp pain in the chest region. It is associated with the fact that in a certain area of ​​the heart, normal blood supply is disrupted. This condition of the cardiac muscle was first described by V. Heberden in 1768.

All causes of impaired myocardial nutritionassociated with a decrease in the diameter of the coronary vessels, These include:

1. Atherosclerosis of the coronary vessels is the most common cause of myocardial ischemia, in which arteries of cholesterol are deposited on the walls, leading to narrowing of their lumen. In the future, atherosclerosis can be complicated by myocardial infarction (the death of a part of the heart muscle, due to the complete closure of the artery by a thrombus).
2. Tachycardia is an increase in heart rate, which causes an increase in the need for muscles in oxygen and nutrients substances, while coronary vessels do not always cope with adequate delivery.
3. Hypertensive disease - increasing systemic arterial pressure in the vessels above the norm causes spasm (constriction) of the coronary vessels.
4. Infectious pathology of the coronary arteries is an endarteritis, in which the lumen of the vessels narrows due to their inflammation.

Among the predisposing causes of angina pectoris is called senile age, which is associated with vascular wear, metabolic disorders, tissue susceptibility to degenerative changes. In young people, angina develops in the presence of various diseases, both cardiovascular system itself, and endocrine, nervous, and metabolic processes.

Risk factors are overweight, smoking, malnutrition, congenital heart and vascular malformations, hypertension, diabetes mellitus.

Classification

Depending on the reaction of the heart to provoking factors, several types of angina pectoris are distinguished:

1. Stable exertional angina- its symptoms are manifested in the form of pressing, boring pains or a feeling of heaviness behind the sternum. Typical is irradiation in the left shoulder or left arm. Pain is caused by physical activity, stress. The pain disappears spontaneously at the end of physical activity or after taking nitroglycerin.
2. Unstable angina (progressive angina). A person can suddenly feel that he is worse. And all this happens without any obvious reasons. The development of this type of angina pectoris is associated with the existence in the cardiac vessel of a crack located near the atherosclerotic plaque. This leads to the formation of blood clots inside the coronary vessels, which interfere with the normal flow of blood.
3. Spontaneous (variant) angina pectorisis rare, it causes a spasm of the coronary arteries, why the myocardium receives less blood and oxygen. It is manifested by severe pain behind the sternum, the heart rhythm is disturbed. Spasm does not lead to a heart attack, quickly passes, causing prolonged oxygen starvation of the myocardium.

Symptoms of stenocardia

When angina occurs, the main symptom, as in most heart diseases, is pain. Most often it appears during a great physical exertion, but it can also develop against the background of emotional excitement, which occurs less frequently.

The pain is localized behind the breastbone, it has a pressing character, therefore angina pectoris has the second name - "angina pectoris". People describe the sensations in different ways: someone feels as if a brick in the chest that prevents breathing in, someone complains of pressure in the heart, someone feels a burning sensation.

The pain rolls by attacks, which last on average no more than 5 minutes. If the duration of the attack exceeds 20 minutes - this can already indicate the transition of an attack of angina in an acute myocardial infarction. As for the frequency of attacks, everything is individual here - the intervals between them sometimes make up long months, and sometimes the seizures are repeated 60 or even 100 times a day.

The constant companions of attacks of angina are also the feeling of an impending catastrophe, panic and the fear of death. In addition to the above symptoms on angina may indicate signs such as dyspnea and fast fatigue, even with minor loads.

Symptoms of angina are similar to those of myocardial infarction. It can be difficult to distinguish one disease from another. The attack of angina passes in a few minutes, if the patient sits down to rest or takes nitroglycerin. And from a heart attack such simple means do not help. If the pain in the chest and other symptoms do not go away for longer than usual - call an ambulance urgently.

What to do in case of an attack of angina pectoris - an emergency

When there is a symptom of angina, what should I do, what can not be done? Before the arrival of an ambulance with such an attack of angina, the following treatment at home is necessary:

1. In no caseYou can not give in to emotions and panic, as this can significantly aggravate the spasm. That is why it is necessary to soothe a sick person with all methods and not show your own fear.
2. Sit the patient with his legs down, do not let him get up.If an attack of angina pauses in the room, you need to ensure a good supply of fresh air into the room - open the windows or door.
3. Givea tablet of nitroglycerin under the tongue at the indicated dose, which was previously prescribed by a cardiologist, if nitroglycerin is in aerosol form, then do not inhale one dose. The concentration of nitroglycerin in the blood reaches a maximum after 4-5 minutes and starts to decrease after 15 minutes.
4. Why under the language?Absorbed in the oral cavity, nitroglycerin does not enter the total bloodstream, but directly to the coronary vessels. They expand, the flow of blood to the heart muscle increases several times, the symptoms of angina stop.
5. Ifthe attack does not subside within 10-15 minutes even after repeated intake of nitroglycerin, you need to use analgesics, since a prolonged attack can be the first manifestation of an acute myocardial infarction. Usually, the attack of angina pierces through 5, maximum after 10 minutes.
6. More than 3 times you can not use nitroglycerin, as there can be a sharp fall in blood pressure, which will entail serious consequences.
7. First Aidit is necessary to call in the event that the attack of a stenocardia has appeared the first time in a life, and against the background of carrying out of all the above-stated actions does not pass more than ten minutes.

In general, first aid in case of an attack of angina reduces to taking medications that dilate the coronary vessels. These include chemical derivatives of nitrates, that is, nitroglycerin. The effect comes in a few minutes.

Treatment of angina pectoris

All methods of angina therapyaims to achieve the following goals:

1. Prevention of myocardial infarction and sudden cardiac death;
2. Prevention of disease progression;
3. Decrease the number, duration and intensity of attacks.

The most important role in achieving the first goal is played bychanging the patient's lifestyle. Improvements in the prognosis of the disease can be achieved by the following measures:

1. To give up smoking.
2. Moderate physical activity.
3. Diet and weight loss: limiting consumption of salt and saturated fat, regular consumption of fruits, vegetables and fish.

Planned pharmacological therapy of angina includes the use of antianginal (antiischemic) drugs that reduce the need for cardiac muscle in oxygen: prolonged action nitrates (erinite, (anapriline, tracicore, etc.), molsidomine (Corvatone), calcium channel blockers (verapamil, nifedipine), preductal, etc.

In the treatment of angina pectoris it is advisable to use antisclerotic drugs (statin group - lovastatin, zokora), antioxidants (tocopherol, aevita), antiplatelet agents (aspirin). In the far-advanced stages of unstable angina, when the pains do not disappear for a long time, surgical methods of treating angina are used:

1. Aortocoronary bypass surgery: when from the own vein an additional cardiac vessel is made, directly from the aorta. The absence of oxygen starvation completely removes the symptoms of angina pectoris.
2. Stenirovanie heart vesselswhen angina pectoris allows you to create a specific diameter of the arteries, not subject to narrowing. The essence of the operation: inserted into the heart arteries tube, which does not shrink.

The course of angina and the outcome of the disease

Angina is chronic. Attacks can be rare. The maximum duration of an attack of angina pectoris is 20 minutes, may result in myocardial infarction. In patients with long-term angina, cardiosclerosis develops, cardiac rhythm is broken, symptoms of heart failure appear.

Prevention

For effective prevention of angina pectoristhe elimination of risk factors:

1. Watch your weight, trying not to admit obesity.
2. Forever forget about smoking and other bad habits.
3. In time, treat associated diseases, which can become a prerequisite for the development of angina pectoris.
4. With a genetic predisposition to heart disease, more time to strengthen the heart muscle and increase the elasticity of blood vessels, visiting the cabinet of physiotherapy exercises and strictly following all the advice of the attending physician.
5. To lead an active way of life, because hypodynamia is one of the risk factors in the development of angina pectoris and other diseases of the heart and blood vessels.

As a secondary prevention in the already established diagnosis of angina pectoris it is necessary to avoid unrest and physical effort, prophylactically take nitroglycerin before the load, carry out the prevention of atherosclerosis, to conduct concomitant pathologies.

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