Angina pectoris - myocardial ischemia, a symptom of coronary heart disease.

The symptoms of angina. Provoke angina can exercise or psychological stress, hypertensive crisis, arrhythmia, receiving sympathomimetic.

Angina attack begins suddenly, lasts a few minutes and stopped by nitroglycerine, sometimes it is enough to provide the patient physical and emotional rest.

The attack is characterized by chest pain, burning, pressure, radiating to the left arm, hand. There is shortness of breath, pale skin, sweating.

Stable angina pectoris It appears relatively constant bouts with the same threshold of tolerable load, localization and irradiation of pain.

Functional class of stable angina is used to differentiate the expression:
-1 Functional class - slight limitation of physical activity; attack triggered a heavy load;
-2 Functional class - attack occurs when walking long distances or fast up the stairs; moderate limitation of physical activity;
-3 Functional class - attack occurs when walking up to 500m and climbing the 20 steps; significant limitation of physical activity;
-4 Functional class - an attack occurs at low loads; recommended bed rest.

Unstable angina a worsening of coronary heart disease. It is changing the nature of the attack, the frequency, severity. Deteriorating tolerability loads.

Surveys of angina pectoris:
ECG. Reduced ST segment horizontal or downwardly to 1mm in the limb leads or 2mm in the chest leads.

For the diagnosis of angina are important inversion and reversion of the T wave, signs of arrhythmias and conduction abnormalities, deepening of Q wave at the time of the attack, which is fixed on the ECG.

As a result, Holter ischemia set the frequency of attacks per day, limit exercise tolerance, identify bezsimptomno episodes of myocardial ischemia.

Pharmacological tests in the diagnosis of angina. Test with dipiridolom I / O on the physical. a solution of 0.75 mg / kg of patient weight has a vasodilatory effect which manifests symptoms of ischemia and associated ECG changes.

echocardiography identifies violations of myocardial contractility.

Радионуклидные исследования - Stsintirovanie infarction Ts99t pyrophosphate accumulating in the hearth of necrosis makes it visible on stsintigramah. This method differentiates unstable angina and acute myocardial infarction.

Coronary angiography evaluates the atherosclerotic lesions of the coronary vessels.

Laboratory research:
-Increase the level of troponin T indicates ischemic attacks, which developed no later than 48 hours.

Treatment of angina:
1.Prekratit exercise, sit down.
2.Prinyat sublingual nitroglycerin. If the attack continues, after 5 minutes you need to repeat nitroglycerin.

Treatment of stable angina:
-Avoid provoking factors: an increase in physical activity; overeating etc.
-treatment coronary insufficiency:
- A long-acting nitrates (nitrosorbid 5 - 10 mg of 3 - 4 p per day by mouth or under the tongue, sustak, nitrong, nitromak 2.6 mg 3 - 4 p per day only inside Trinitrolong in the form of applications);
-beta-blockers: propranolol (Inderal 20 mg 3 - 4 p per day gradually increasing the dose.
calcium antagonists: nifedipine (Corinfar, 10 - 20 mg per day p 3; Verapamil 40 - 80 mg of 3 - 4 day p.
-Antiagregant: Acetylsalicylic acid
-Sedativnye drugs

Clinical variants of unstable angina:
1.Vpervye emerged.
2.Progresiruyuschaya exertional angina is characterized by increased frequency of seizures, severe degrees of severity and duration, with the ongoing changes in the ECG. It reduces the effect of nitroglycerin.
3.Spontannaya angina - experience one or more episodes of ischemia at rest, with the ongoing changes in the ECG, which are not removed nitroglycerin.
4.Variant angina (Prinzmetal angina). Spazmiruyutsya changed and affected by atherosclerosis of the coronary arteries. Attacks last 10 - 15 minutes or longer. There have been changes in the ECG and symptoms of arrhythmias during ischemia.
5.Постинфарктная стенокардия возникает через сутки и до 2 месяцев после развития инфаркта миокарда. Ранняя постинфарктная стенокардия протекает по характеру спонтанной стенокардии. Поздняя постинфарктная стенокардия – после 2 недель и провоцируется физической активностью пациента. Может осложняться увеличением зоны некроза миокарда, что ведет к левожелудочковой недостаточности.

Treatment of unstable angina: carried out in a hospital, using the same preparations as in the treatment of stable, but at higher doses under continuous ECG monitoring.

Surgical treatment of angina is indicated for persistent angina, frequentexacerbations CHD marked stenosis in the proximal portion of one, two or three coronary arteries. It lies in the operation aotokoronarnogo bypass using a venous autograft.

Percutaneous transluminal coronary angioplasty balloon expansion of the coronary artery is recommended for patients with stenosis of the proximal main coronary arteries, without calcifications.

Prevention of angina:
— Рациональное питание и физическая нагрузка;
— Санаторно-курортное лечение (для этого вам потребуется sanatorium card);
— Здоровое психоэмоциональное состояние;
— Отказ от курения и алкоголя ;
— Лечение первичных заболеваний.

Forecast angina depends on the disease, treatment and complications. Often unfavorable.