Angina pectoris is an ischemic cardiovascular disease that develops due to atherosclerosis of the arteries that feed the heart. As their lumen decreases, myocardial blood supply is inhibited, and ischemia develops. An attack of angina pectoris is the outcome of a short ischemia in the heart muscle, after which the blood supply is completely restored. This condition has a common origin with myocardial infarction, but, unlike the latter, a thrombus does not form in the coronary artery, and an area of necrosis does not form in the muscle. Every patient should know how it manifests itself and how to relieve an attack of angina pectoris.
Forms of angina pectoris
According to the generally accepted classification, stable angina (HF) is distinguished, characterized by the appearance of short pain episodes, well stopped by nitrates, unstable (NS), progressive, variant and vasospastic. Unstable angina is a heart attack lasting more than 30 minutes without symptoms.heart attack on the cardiogram and in the absence of a significant increase in cardiospecific enzymes.
An episodic spasm of the arteries of the heart is distinguished by a vasospastic attack of angina pectoris, which makes it possible to develop without ischemic vascular damage. Unlike vasospastic, variant angina develops in the presence of atherosclerosis of the coronary arteries. However, it is similar to vasospastic in that it develops due to spasm of the coronary arteries.
Progressive angina (PS) is a special kind of stable exertional angina, in which the frequency of anginal pain increases, exercise tolerance decreases, and the relief time increases. As an angina attack progresses, symptoms and emergency care are the same as for a traditional episode of anginal pain. However, in the case of an increase in seizures, hospitalization and the solution of the issue of angiography are indicated.
The reason for the transformation of exertional angina into progressive angina is an increase in the size of the atherosclerotic plaque. This significantly increases the likelihood of developing a myocardial infarction. The goal of hospitalization for PS and NS is to prevent it, while for exertional angina the risk is much lower.
Symptoms of angina pectoris
Traditionally, an episode of angina pectoris develops under conditions of physical exertion or with intensive expenditure of energy substrate in the heart. This phenomenon occurs during the performance of work, in some patients it is simply whenwalking or excitement. Often an angina attack develops at night and just before waking up. This happens due to the development of tachycardia in the phase of REM sleep, when the cardiovascular system is in good shape.
The first and most specific symptom of angina is angina pain. It is manifested by a feeling of strong squeezing behind the sternum directly when walking or with excitement, a burning sensation in the heart. Pain sometimes appears in the left hypochondrium, but the burning sensation remains in the region of the heart. Anginal pain often spreads to the area under the lower jaw, to the neck, to the interscapular region and under the left shoulder blade, less often to the area of the left shoulder.
Character of anginal pains
Anginous pain has a constant high intensity and is accompanied by nausea in 5-10%, shortness of breath in 10-20% and constant inspiratory dissatisfaction in 30-50%. This does not mean that with an attack of angina pectoris, the symptom of shortness of breath is specific. Shortness of breath characterizes the appearance of signs of left ventricular failure in a heart attack. But with angina pectoris, especially in the absence of chronic heart failure, it is practically uncharacteristic. It is the feeling of dissatisfaction with the breath that appears, although the respiratory rate does not increase.
In addition to specific anginal pain, the first signs of an angina attack may be as follows: the appearance of weakness, a feeling of constriction and tightness in the chest and heart, sweating and perspiration on the face. Oftenheadaches develop in the parietal and occipital region, which is a concomitant sign of arterial hypertension.
An important specific sign of anginal pain in angina pectoris is their rapid (3-4 minutes) elimination after the cessation of physical activity, taking nitroglycerin preparations or normalizing blood pressure after a crisis. The impossibility of stopping the symptoms of angina pectoris lasting more than 20-30 minutes after 2 times the use of nitroglycerin every 7 minutes is a signal that the patient needs to go to the EMS because of the risk of developing an acute coronary syndrome.
Angina in diabetes
In the study text above, information is provided that traditionally anginal pain is a specific sign of angina pectoris. This is not always the case, because many receptors are affected in diabetic neuropathy, including pain receptors in the heart muscle. Because of this, with diabetes, pain may not be felt by the patient, and with an attack of angina pectoris, other signs come to the fore: weakness, developing shortness of breath, discomfort in the chest. At the same time, it is impossible to speak reliably about angina pectoris without Holter ECG monitoring and verification of ischemia. The treadmill test and the bicycle ergometer test are also well suited for diagnosis. The appearance of signs of ischemia on the ECG during exercise is the most reliable criterion for diagnosing angina pectoris.
Pathogeny of angina pectoris
A typical angina attack develops in conditions of a discrepancy between the intensity of blood supply inmyocardium and its energy needs. That is, in a situation where the load on the heart muscle increases, and blood flow does not increase, ischemia and hypoxia develop in the heart. This episodic coronary insufficiency underlies the development of an angina pectoris episode. A necessary condition for the depletion of blood flow through the coronary arteries of the heart is coronary spasm. It occurs when breathing cold air or in case of emotional stress, exercise and smoking.
Immediately after the development of an angina attack due to tissue local factors (vasodilators), an attempt is made to increase the intensity of blood supply to the ischemic muscle by dilating the arteries. In the case of coronary spasm, this is successfully achieved within 5-7 minutes. But with the development of atherosclerosis of the coronary arteries and calcification, their expansion in order to increase the throughput is impossible. Therefore, under conditions of a higher functional load on the heart muscle and energy starvation, episodic ischemia develops. After taking nitrates, this pain episode stops in 5-7 minutes. It may also stop on its own after a short rest.
Actions for anginal pain
The appearance of anginal pain is a symptom that is well known to all patients with stable exertional angina. They feel it during physical exertion, climbing stairs or just walking, with a hypertensive crisis and severe emotional stress. It is difficult to confuse it with stomach symptoms orskeletal pains with thoracalgia, intercostal neuralgia. Therefore, patients with a diagnosis immediately understand that they are developing an angina attack, which must be stopped by taking nitroglycerin. They are well aware that rest and cessation of work allows you to stop this attack faster.
Stopping an attack
Help with an attack of angina is the provision of rest and the use of nitroglycerin preparations. Now there are tablet dosage forms and sprays. All of them are applied sublingually: 1 tablet of nitroglycerin 0.5 mg or 1 spray under the tongue. A typical episode of anginal pain after that stops within 2-4 minutes due to a decrease in preload, and, consequently, a slowdown in the consumption of oxygen and energy substrates in the myocardium.
If an attack of angina is not eliminated after a single dose of fast-acting nitrates, then after 5 minutes they can be taken again. This is allowed with normal or high blood pressure. But if the blood pressure is less than 90\60 mmHg, you should contact the SMP and stop using nitroglycerin due to a further decrease in pressure. If blood pressure readings are above 100\60 mmHg, then nitroglycerin can be taken again.
Actions for intractable seizure
The relief of pain indicates the complete cessation of the angina pectoris episode. But if after 4-5 minutes of repeated administration of anginal pain did not stop, you should contact the SMP for the diagnosis of acute coronary syndrome: progressiveor unstable angina, myocardial infarction. It is also possible that the patient himself misinterpreted his condition and interpreted pain from another source as an angina attack.
In fact, due to the peculiarities of the innervation of the abdominal organs, pain similar to anginal pain can be a symptom of a stomach ulcer or gastritis, reflux disease and esophagitis, cholecystitis and pancreatitis, appendicitis, adnexitis, ectopic pregnancy, mediastinal tumors or abdominal cavity, aortic aneurysm and pulmonary embolism.
All these conditions require diagnosis and special treatment in a short time. But this does not mean that if the assistance provided during an attack of angina pectoris did not have an effect, then a formidable disease necessarily develops. This only speaks of the need to consult with specialists (employees of the ambulance service or doctors in the emergency room of hospitals) to exclude a heart attack, acute diseases of the abdominal organs, and tumors.
Then, before the arrival of the ambulance, you should take a comfortable position (sitting or lying down), refuse to drink liquids, eat food and drugs, and smoke. EMS employees should tell the details of the deterioration in well-being that has occurred in a specific and objective form. When describing your condition, you need to abandon subjective facts, indicate the time of onset of an angina attack, provide available medical documents, extracts and epicrises from hospitals, cardiograms.
First angina pectoris
According to the results of the Framingham study, signs of an attack of angina pectoris are the first manifestations of coronary disease in 40.7% of cases among men, and in 56.5% of cases in women. This means that before the onset of anginal pain, patients may not pay attention to the decrease in exercise tolerance. But when there is a burning pain in the heart, it becomes too late to ignore. Despite this, the diagnosis of chronic coronary disease is slowed down, and treatment begins later. As a result, its effectiveness remains insufficient, and therefore chronic heart failure develops much faster.
If an attack of anginal pain occurred for the first time and did not occur before, then you need to follow the above recommendations. That is, stop it with nitroglycerin preparations, take Metoprolol 25 mg or Anaprilin 40 mg with a frequent pulse, lower blood pressure with Captopril if it was high at the time of the onset of pain. "Nifedipine" should not be used for angina pectoris, as it will increase pain due to the development of the "steal" syndrome.
Actions after relief of first-time angina pectoris
As soon as emergency care for an attack of angina pectoris has been provided, diagnostic measures are needed to clarify the stage of chronic ischemic disease. In addition, after the first attack, because there are atherosclerotic plaques in the narrowed coronary arteries, new episodes of anginal pain will constantly occur. This will significantly affect the patient's ability to work and limit hisfunctional ability.
The presence of plaque in a coronary artery, the size of which and the degree of occlusion is not clear, is a risk factor for the development of acute myocardial infarction. A heart attack preceding a heart attack can be characterized in the same way as an angina attack. The symptoms of these conditions are similar at first, as they include anginal pain. However, in a heart attack, they can be more severe, never completely stopped by taking nitroglycerin, and are often accompanied by shortness of breath due to left ventricular failure.
For comparison: relief of an angina attack occurs within 2-4 minutes after taking nitrates or 5 minutes after taking them again. Infarction anginal pains do not stop after taking nitroglycerin, although they may weaken somewhat. To prevent the development of myocardial infarction, as well as reduce the number of angina pectoris episodes, you need to contact a general practitioner.
Also during the period when outpatient facilities are closed, a patient with first-time angina pectoris should go to the emergency room of a hospital facility or to the EMS. First-time angina pectoris is regarded as a condition preceding myocardial infarction and is treated with anticoagulants, antiplatelet agents, statins, beta-blockers and antihypertensives in a hospital setting.
CV
The symptoms that occur during an attack of angina pectoris are the first signs of the presence of an atherosclerotic plaque in the coronary artery of the heart. With psychophysical stress,when the heart needs a more intense energy supply than at rest, ischemia occurs in the myocardium, which is accompanied by pain in the heart. Ischemia is a reversible phenomenon, which can be stabilized by drugs that stop an angina attack. Preparations: tablets "Nitroglycerin 0.5 mg" - 1 tablet under the tongue or spray, "Metoprolol 25 mg" or "Inderal 40 mg" - 1 tablet inside, antihypertensives.
Only "Nitroglycerin" is obligatory for taking, while the drugs "Metoprolol" and "Anaprilin" should be taken with a high pulse (above 90 per minute) and no history of bronchial asthma. Captopril 25 mg can be used as a means to lower blood pressure if the blood pressure during an attack is above 150/80 mmHg. If there is no effect from repeated administration of "Nitroglycerin 0.5 mg" or spray, as well as after relief of angina for the first time, you should seek medical help.
