Angina pectoris is a common heart disease that, when progressed, leads to chronic heart failure and myocardial infarction. Angina pectoris is often seen as a symptom of coronary artery lesions - a sudden pressing pain behind the sternum that occurs on the background of physical exertion or a stressful situation.
Probably, many have heard the expression "angina strangles". However, not everyone knows that the causes of such discomfort in the chest are rooted in heart disease. Any discomfort associated with pain in the chest area is the first sign of a disease such as angina. All because of - the lack of blood supply in the heart muscle, which is why there is a painful attack.
In this article, we will consider angina pectoris, symptoms of what to do and what not to do. In addition, we will tell about the treatment, and effective ways to prevent the disease.
Why does angina occur, and what is it? Angina pectoris is a form of coronary heart disease characterized by a sharp pain in the sternal area. It is connected with the fact that in a certain part of the heart the normal blood supply is disturbed. For the first time such a condition of the heart muscle was described by V. Geberden in 1768.
All causes of myocardial eating disorders are associated with a decrease in the diameter of the coronary vessels, these include:
- Atherosclerosis of coronary vessels is the most common cause of myocardial ischemia, in which cholesterol is deposited on the artery walls, leading to a narrowing of their lumen. In the future, atherosclerosis may be complicated by myocardial infarction (death of a part of the heart muscle, due to the complete closure of the artery with a thrombus).
- Tachycardia is an increase in heart rate, which causes an increase in muscle demand for oxygen and nutrients, and the coronary vessels do not always cope with adequate supply.
- Hypertension - an increase in systemic arterial pressure in the vessels above the norm causes a spasm (narrowing) of the coronary vessels.
- Infectious pathology of the coronary arteries - endarteritis, in which the lumen of the vessels narrows due to their inflammation.
Among the predisposing causes of angina pectoris are called senile age, which is associated with vascular wear, metabolic disorders, susceptibility of tissues to degenerative changes. In young people, stenocardia develops in the presence of various diseases, both directly of the cardiovascular system and endocrine, nervous, and metabolism.
Risk factors are overweight, smoking, unhealthy diet, congenital heart defects and blood vessels, hypertension, diabetes.
Depending on the reaction of the heart to the provoking factors, there are several types of angina pectoris:
- Stable angina of tension - symptoms of it manifest themselves in the form of pressing, boring pains or a feeling of heaviness in the chest. Typical irradiation in the left shoulder or left arm. Caused by pain, physical exertion, stress. Pain disappears spontaneously at the end of physical exertion or after taking nitroglycerin.
- Unstable angina (progressive angina). A person can suddenly feel that he has become worse. And all this happens without any obvious reason. Doctors associate the development of this type of angina pectoris with the existence of a crack in the heart vessel located near an atherosclerotic plaque. This leads to the formation of blood clots inside the coronary vessels, interfering with normal blood flow.
- Spontaneous (variant) angina is rare, it is caused by a spasm of the coronary arteries, causing the myocardium to receive less blood and oxygen. It is manifested by severe pain behind the sternum, the heart rhythm is disturbed. The spasm does not lead to a heart attack, quickly passes, causing a prolonged oxygen starvation of the myocardium.
Symptoms of angina pectoris
When angina occurs, pain is the main symptom, as in most heart diseases. Most often, it appears during heavy physical exertion, but it can also develop on the background of emotional excitement, which occurs somewhat less frequently.
The pain is localized behind the sternum, is oppressive, therefore angina pectoris has the second name - “angina pectoris”. People describe sensations in different ways: someone feels as if a brick in the chest, which prevents breathing, someone complains of pressure in the heart area, someone tends to feel burning.
The pain rolls attacks, which last an average of not more than 5 minutes. If the duration of an attack exceeds 20 minutes, this may indicate a transition of an angina attack to an acute myocardial infarction. Regarding the frequency of attacks, everything is individual - the intervals between them sometimes take long months, and sometimes the attacks are repeated 60 or even 100 times a day. .
Permanent companions of angina attacks are also a sense of impending catastrophe, panic and the fear of death. In addition to the above symptoms, angina pectoris may indicate symptoms such as shortness of breath and fatigue even under slight exertion.
Symptoms of angina pectoris are similar to signs of myocardial infarction. It can be difficult to distinguish one disease from another. An attack of angina takes place 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 chest pains and other symptoms do not go away longer than usual, call an ambulance immediately.
What to do in case of an attack of stenocardia - emergency care
When symptoms of angina occur, what should be done, what should not be done? Before the arrival of an ambulance with such an attack of angina, the following home treatment is necessary:
- In no case 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 by all means and not to show one’s own fear.
- Seat the patient with his legs down, do not allow him to get up. If an attack of angina found in the room, you need to ensure a good flow of fresh air into the room - open the windows or the door.
- To give a nitroglycerin tablet under the tongue at the indicated dose, which the cardiologist had previously prescribed, if the 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 begins to decline after 15 minutes.
- Why just under the tongue? Absorbing in the oral cavity, nitroglycerin does not enter the general bloodstream, but directly to the coronary vessels. They expand, the blood flow to the heart muscle increases several times, the symptoms of angina pause.
- If the attack does not subside within 10-15 minutes, even after repeated administration of nitroglycerin, analgesics should be used, since a prolonged attack can be the first manifestation of an acute myocardial infarction. Usually an attack of angina stops in 5, maximum 10 minutes.
- More than 3 times you can not use nitroglycerin, as there may be a sharp drop in blood pressure, which would entail serious consequences.
- An ambulance needs to be called in if an attack of angina appears for the first time in life, and against the background of all the above actions, more than ten minutes pass.
In general, first aid in case of an attack of angina pectoris is reduced to taking medications that expand the coronary vessels. These include chemical derivatives of nitrates, that is, nitroglycerin. The effect comes within a few minutes.
Treatment of angina pectoris
All methods of treatment of angina aimed at achieving the following goals:
- Prevention of myocardial infarction and sudden cardiac death;
- Preventing the progression of the disease;
- Reducing the number, duration and intensity of attacks.
The most important role in achieving the first goal is a change in the lifestyle of the patient. Improving the prognosis of the disease can be achieved by the following activities:
- To give up smoking.
- Moderate physical activity.
- Diet and weight loss: limiting the consumption of salt and saturated fat, regular consumption of fruits, vegetables and fish.
Planned drug therapy for angina includes antianginal (antiischemic) drugs that reduce the oxygen demand of the heart muscle: prolonged-acting nitrates (erinitis, sustaka, nitrosorbide, nitrone, etc.), b-adrenergic blockers (anaprilina, trazikora, etc.), ), calcium channel blockers (verapamil, nifedipine), preductal, etc.
In the treatment of angina pectoris, it is advisable to use anti-sclerotic drugs (a group of statins - lovastatin, zocor), antioxidants (tocopherol, aevit), antiplatelet agents (aspirin). In the advanced stages of unstable angina, when the pain does not disappear for a long time, surgical methods of treating angina are used:
- Coronary artery bypass surgery: when an additional heart vessel is made from its own vein, directly from the aorta. The absence of oxygen starvation completely relieves the symptoms of angina.
- Steniization of cardiac vessels in angina allows you to create a certain diameter of the arteries, not subject to narrowing. The essence of the operation: inserted into the heart of the arteries of the tube, which is not compressed.
Angina course and outcome
Angina is chronically. Attacks can be rare. The maximum duration of an attack of angina pectoris is 20 minutes, which may result in myocardial infarction. In patients with long-term angina pectoris, cardiosclerosis develops, the heart rhythm is disturbed, and symptoms of heart failure appear.
Effective prevention of angina pectoris requires the elimination of risk factors:
- Watch your weight while trying to prevent obesity.
- Forget about smoking and other bad habits forever.
- Timely treat concomitant diseases that may be a prerequisite for the development of angina.
- With a genetic predisposition to heart disease, take more time to strengthen the heart muscle and increase the elasticity of blood vessels, visiting the physical therapy room and strictly following all the advice of the attending physician.
- Lead an active lifestyle, because hypodynamia is one of the risk factors in the development of angina and other diseases of the heart and blood vessels.
As a secondary prophylaxis for the already established diagnosis of angina, it is necessary to avoid anxiety and physical effort, take nitroglycerin prophylactically before exertion, carry out prevention of atherosclerosis, and treat concomitant pathologies.