The treatment of heart pathologies should be approached very responsibly, as they are dangerous to human life. For example, there is such a type of angina pectoris as Prinzmetal's angina, which can lead to both a heart attack and sudden death. Such a state can be prevented if only one prepares for the possible consequences.
Specific pathology
Prinzmetal's angina is a type of rest angina that occurs with coronary angiospasm. The disease got its name in honor of M. Prinzmetal, a cardiologist who was the first to describe this form in 1959. In the international classification of diseases, it is listed under the code I20.
This pathology is also called spontaneous, variant and unstable vasospasm. The disease is rare, as it occurs in about three percent of patients. Most often it is typical for men from thirty to fifty years. In some cases it maybe observed along with exertional angina.
The main feature of variant angina is that it is distinguished by a long and severe attack of pain that can occur at rest.
Causes of occurrence
M. Prinzmetal was the first to suggest that coronary artery spasm was the cause of variant angina, which was confirmed in further studies. The appearance of spasm of the coronary artery is noticeable with coronary angiography. Spasms occur due to localized endothelial dysfunction with increased sensitivity to vasoconstrictor-type effects. Between 70 and 90% of patients with spontaneous angina are men. It is also noted that there are a lot of smokers among people with this disease.
Spontaneous variant angina is characterized by coronary artery spasm, severe painful anginal attack and significant transient elevation of the RS-T segment on the ECG.
The following studies have shown that patients with "pure" (isolated) spontaneous angina are very rare, less than 5% of all people with angina. Often in medical practice, patients with this kind of angina pectoris may not meet even for ten years. An increased frequency of variant angina was recorded only in Japan - about 20-30%. But the rate has now declined in Japan as well, at around 9% of total angina cases.
Comorbidities such as exertional angina ("mixed angina") have a high frequency - from 50 to 75 percentcases, with coronary angiography, approximately 75% of patients have significant hemodynamic stenoses of the coronary arteries somewhere within one centimeter from the location of the spasm.
Even if patients have coronary arteries unchanged during coronary angiography, then non-stenosing atherosclerosis is diagnosed by means of intracoronary ultrasound at the site of spasm.
Most patients have proximal narrowing in at least one major coronary artery. The spasm usually occurs within one centimeter of the aggravated site and is often accompanied by ventricular arrhythmias.
Symptoms
The hallmark symptom of variant angina is attacks of pain. They most often occur in the morning and at night, they can appear even without a good reason. Such pain comes from the region of the heart, is distinguished by a cutting and pressing character, and is also capable of radiating to other parts of the body. The attack itself can be described by enumerating its characteristic features:
- tachycardia;
- profuse-type sweating;
- hypotension;
- fainting;
- pain in the head;
- skin pallor.
In some cases, the symptoms of variant angina can be such as heart muscle rhythm failures, ventricular fibrillation and atrioventricular blockade.
Most often, seizures last no more than fifteen minutes. Very rarely, the pain can last up to thirty minutes, it is very difficult to tolerate. Against the backdrop of an attackmyocardial infarction may develop, and therefore, with prolonged therapy, you should immediately call an ambulance.
What signs are not typical for variant angina? The fact that physical activity is poorly tolerated is extremely rare.
Diagnosis
Before starting all diagnostic procedures, the specialist will collect an anamnesis of life and family. After this, auscultation is performed, where noises are heard, and a physical examination. These manipulations are required for the differential diagnosis of variant angina pectoris, as well as for determining the initial diagnosis.
Then the patient is discharged:
- blood and urine tests to detect comorbidities;
- biochemical blood test to assess the concentration of protein, cholesterol and other elements that help determine the cause of the disease;
- ECG, which determines the main indicator of variant angina - the rise of the ST-segment;
- Holter ECG monitoring, detecting transient ischemia;
- provocation test accompanied by hyperventilation for angiospasm induction;
- cold and ischemic tests;
- coronary angiography, which detects stenosis in about half of patients;
- veloergometry, which determines the patient's level of exercise tolerance.
In addition, an MRI can be prescribed for a patient if there is a suitable modern device in the locality.
Treatment
TherapyPrinzmetal's variant angina is optimally carried out in a hospital, as this allows you to control changes in the disease. Treatment is based on a combination of medical and therapeutic methods. It is very rare for a patient to require surgery.
It is not recommended to start therapy for variant coronary artery disease, vasospastic angina pectoris with folk remedies.
Therapeutic method
At the heart of the therapeutic technique of variant angina is an absolute revision of all life principles of a person. The patient must give up his bad habits, stop drinking alcohol and smoking. In addition, it is very important to make adjustments to the diet:
- limit the intake of animal fats (in total calories - up to 30%);
- limit s alt intake;
- reduce the use of spices and spices;
- drink multivitamins;
- pay special attention to vegetables and protein products.
The patient, along with these tips, needs to do exercise therapy, which includes cardio exercises.
Medication method
In the form of long-term medical treatment for variant angina, patients are prescribed:
- As a long-term drug therapy, patients are prescribed: alpha-blockers; calcium antagonists; nitrates.
- To stop angina attacks, the patient should take nitroglycerin under the tongue, as well as Nifedipine.
Surgery
The operation is indicated only in the presence of severe arterial narrowing and in cases where the development of angina pectoris occurs in the region of the heart. The following manipulations are used:
- angioplasty, in which the expansion of the vessel is carried out by means of a balloon and fixed in this state with a metal awning;
- coronary bypass grafting, which means suturing one or another vessel of the patient to the coronary artery to start blood bypassing a narrower place.
Very rarely, a disease can affect the heart in such a way that it can no longer function on its own. In this case, he is shown the intervention of a surgeon.
Preventive measures
Prevention measures for variant angina come down to a number of general recommendations:
- diet low in s alt and animal fat, high in grains and vegetables;
- exclusion of tobacco and alcohol;
- observance of the principles of the ratio of rest and work;
- eight hours of he althy sleep;
- avoiding stressful situations.
In addition, people who are at risk are advised to exercise regularly. Once every six months, everyone needs to go to a cardiologist to examine the patient for prophylaxis.
Complications
The most common complication of this form of angina pectoris is myocardial infarction, due to which a number of heart muscle cells die. ExceptIn addition, if there is no competent treatment, the disease can lead to:
- severe tachycardia;
- arrhythmias;
- CHS;
- The most dangerous complication of pathology is sudden death of the heart, which can be reversible with timely qualified assistance.
Forecast
It is difficult to predict the course of angina pectoris, since the condition is determined by the influence of various factors: the age of the patient, the severity of attacks, etc.
With mild heart disease, the chance of death is very low: about 0.5% per year.
If heart damage is severe, death occurs in 25% of cases.
