Nocturnal attacks of angina. How to recognize angina by pain. Duration of anginal pain

Acute pain in the chest area is a frequent companion coronary disease heart and atherosclerotic lesions of the coronary vessels. The main reason for this condition is the discrepancy between the myocardial need for oxygen and its actual amount reaching the cardiomyocytes with the blood. Therefore, all patients and their close relatives suffering from pathologies of the cardiovascular system should know how to relieve an attack of angina at home.

This is necessary to help the patient before the ambulance arrives; in addition, correct actions in most cases they can protect a person from serious complications.

There are several types of this disease:

Angina pectoris(stable and progressive). Symptoms usually occur during intense physical activity, stressful situation, during sex. IN severe cases the attack begins after the usual climb up the stairs or with a sharp change in temperature.
Angina at rest. It appears against the background of advanced diseases of the cardiovascular system, with constantly elevated blood pressure, aortic stenosis, atherosclerotic growths that narrow the lumen of the coronary vessels. The onset of an attack is difficult to predict; symptoms occur abruptly, at any time of the day, although more often it happens at night.

Without emergency care hypoxia of the heart muscle progresses, which with a high degree of probability can result in acute myocardial infarction.

An angina attack can be recognized by the following symptoms:

Pain. It is sharp, diffuse in nature, localized behind the chest and radiates to left hand, leg, lower jaw. The sensations are so strong that the patient has to take a forced position, bending and pressing his hand to his chest.
Dyspnea. The feeling of lack of air forces the patient to breathe deeper, but an attempt to deep breath only makes the chest pain worse.
Tachycardia, a feeling of “fluttering” of the heart behind the sternum, pulsation “radiates” to the ears.
Numbness in the fingers, often turning blue.
Pallor.
Discharge of cold, sticky sweat.
Low or, conversely, high arterial pressure.

The main difference between a myocardial infarction and an angina attack, which can be relieved at home, is the relief of symptoms with Nitroglycerin tablets within 1-3 minutes.

The risk of developing a stable and progressive form of the disease increases with smoking, alcohol consumption, diabetes, excess weight, increased blood clotting and physical inactivity.

In addition, doctors note that angina attacks occur more often in males.

For traditional drug treatment of the disease, doctors offer a number of medications:

anticoagulants, the most common are acetylsalicylic acid(Aspirin), Clopidogrel, Markumar;
β-blockers (Anaprilin, Betalol, Nebivolol, Egilok) are prescribed to almost all patients with coronary heart disease;
lipid-lowering drugs (Rosuvastatin, Tulip, A nicotinic acid, Lipanor, Exlip) stop the progression of atherosclerosis, lowering the level of cholesterol and low-density lipoproteins;
ACE inhibitors(Anaprilin, Lisinopril, Captopril) are an alternative to β-blockers, but are sometimes prescribed in combination with them;
Calcium antagonists (Verapamil, Diltiazem) are often used for angina pectoris with nitrate intolerance, in the post-infarction state.

However, despite the variety of treatments offered for the disease medicines, many people prefer to relieve an angina attack at home. For this purpose, hawthorn tincture is widely used, repeatedly mentioned in the programs of Elena Malysheva, folk recipes based on garlic and medicinal plants.

But before taking various means alternative medicine, it is necessary to relieve the main symptoms of an angina attack.

To do this you should:

Stop any physical exercise.
Sit in a comfortable chair.
Drink drugs from the nitrate group.
Open a window to provide fresh air.
Remove clothing that is constricting your neck, stomach, and chest.

Many people recommend massage reflex points on the neck, knees, wrist and shoulder joints. If, 5-10 minutes after trying to relieve an angina attack at home, the patient’s condition does not improve, it is necessary to call an ambulance, but even relief of symptoms is not a reason to postpone a visit to the doctor.

How to treat angina pectoris at home: folk remedies, features of taking Nitroglycerin

Nitroglycerin, the main remedy for how to treat angina pectoris at home, refers to pharmacological drugs from the nitrate group. The mechanism of its action is the release of nitric oxide. It relaxes the muscles of the vascular wall, reduces the load on the myocardium and its need for oxygen. In addition, nitrates relieve spasm of the coronary arteries of the heart.

A feature of Nitroglycerin is its rapid absorption from the mucous membranes, so it is recommended to take it in the form of tablets sublingually (that is, under the tongue) or in the form of an aerosol.

Currently, there are several types of this drug:

short-acting (also called “regular”) is used only to relieve attacks of angina pectoris;
prolonged, used to prevent attacks of chest pain.

Nitroglycerin can be taken in several ways:

1% alcohol solution. Apply 1-2 drops under the tongue or on a piece of sugar, but do not swallow it, but keep it in the mouth until completely dissolved. This drug is also used for mild angina in combination with menthol, tincture of lily of the valley and belladonna (Watchal drops).
Tablets 0.25-1 mg. Place under the tongue and hold until dissolved.
Oily 1% solution of nitroglycerin in capsules containing 0.5 or 1 mg of the drug. The method of application is the same as for tablets, only the capsule can first be crushed with your teeth.
Aerosol. Sprayed in oral cavity, in a sitting position, 1-2 doses (but not more than 3) over 15 minutes. One dose contains 0.4 mg of nitroglycerin.

Nitrates, including nitroglycerin, are quickly addictive. For this reason, they cannot be used continuously to treat angina at home. Often after taking the medicine appears headache, which can be relieved with regular painkillers.

Offers alternative medicine recipes following methods disease control:

In a saucepan with 1 liter of homemade sweet red wine, add 10 ml of 9% vinegar, 12 stems with leaves of ordinary garden parsley and cook for 5 minutes. Remove from heat, skim off the foam and add 250 g of May honey, then heat again over low heat for 5 minutes. Then cool, strain, bottle and store in the refrigerator. Take 2 tbsp. twice a day.
Crush a head of garlic, pour a glass of unrefined sunflower oil, leave for 24 hours. Take 1 tsp, mixing with the same amount lemon juice on an empty stomach.
Combine adonis herb, lavender flowers and rosemary leaves in equal proportions. 1 tsp pour a glass of boiling water over the collection and leave for half an hour. Take 100 ml twice a day. At the same time, eat 4 tbsp. peeled pumpkin seeds per day.
Prepare a mixture of the following medicinal plants: spring bud, gray jaundice, mountain arnica, European sage grass, aromatic rue. 15 g of collection pour 500 ml hot water and leave for an hour. Strain and take half a glass with the addition of 0.5 tsp. honey three times a day for a month, then take a break for 2 weeks, and then repeat the decoction for another 10 days. Such courses of treatment are recommended to be carried out twice a year - in autumn and spring. At the same time, it is recommended to take 0.2 g of mumiyo in the morning on an empty stomach.
Eat 1 tbsp. pulp of feijoa berries half an hour before meals in the morning and evening.
Peel and grate 1 kg of celery roots, add 100 g of chopped horseradish rhizomes and garlic cloves and 2 lemons ground in a meat grinder. Leave the mixture for exactly one day, then take 1 tbsp. three times a day. At increased acidity stomach this amount is halved.

There are quite a few ways to treat angina pectoris at home. However, the best results can be achieved by combining them with classical methods. drug therapy. In addition, we should not forget that a patient with diseases of the cardiovascular system should be regularly examined by a cardiologist.

Angina is translated from ancient Greek as a tight heart (the old name is angina pectoris) and is a clinical syndrome in which the patient feels discomfort in the chest caused by insufficient blood supply to the heart. Attacks of angina pain are characterized by sudden onset and spread to areas of the body adjacent to the chest. It is a form of coronary heart disease.

First, let's look at the etiology and pathogenesis of angina. Physiological reason The occurrence of angina attacks is a disruption of blood flow through the coronary arteries.

How does angina pectoris manifest? Impaired blood flow helps reduce the concentration of oxygen supplied to the heart muscle along with the blood. As a result of the disorder, the patient feels pain, which is described as squeezing, squeezing.

How to distinguish angina pectoris? The difference between angina attacks and other painful heart conditions is that pain can radiate to the neck, left shoulder, area of the shoulder blades and to the jaw.

Situations favorable to the onset of an attack include nervous tension, physical overload, and heavy food intake.

Disturbances in the blood supply are called ischemia. The cause of ischemia is atherosclerotic plaques on the walls of blood vessels, which reduce their patency. In such a situation, the need of the heart muscle for oxygen is not fully satisfied and nutrients, which is why it begins pain syndrome which is called angina pectoris.

Angina attacks, being clinical manifestations coronary heart disease, which, as a rule, is chronic, can occur in a patient over many years.

A prolonged angina attack can lead to a heart attack, which is the death of an area muscle tissue heart, called the myocardium.

Clinical manifestations of coronary heart disease are observed in twenty-five percent of the female population and half of the male population under the age of fifty. Women in young and middle age are less likely to suffer from this clinical syndrome, because their hormonal levels more intensively prevent the formation of atherosclerotic plaques than in men.

However, closer to old age, the hormonal background of women is restructured, which reduces resistance female body atherosclerosis and can lead to ischemia.

Angina attacks in at a young age are usually associated with a hormonal explosion and emotional instability of young people.

Causes of angina

The causes of angina include pathological conditions in which damage and narrowing of the heart vessels occurs. The likelihood of an angina attack increases when the patency of the arteries is reduced by more than half. The severity of the syndrome depends on the degree of damage to blood vessels by atherosclerotic plaques.

Angina pectoris can also be observed during vascular spasms in the absence of atherosclerosis. Spasms can be triggered by certain diseases digestive system and gallbladder, as well as infectious and allergic diseases.

Thus, the following main reasons for the development of angina pectoris can be identified:

atherosclerosis;
diabetes;
high blood clotting;
chronically high blood pressure.

Pathologies of the heart muscle that may be accompanied by the described clinical syndrome include:

Post-infarction state. The death of the muscle tissue of the heart causes a disruption in blood supply, which provokes angina attacks. The risk of pain is significantly reduced after myocardial scarring.
Enlargement of the left ventricle.
Reverse movement of blood through the heart caused by acquired heart disease.

The causes of angina are divided into modifiable, i.e. those whose influence can be eliminated, and non-modifiable, i.e. those whose influence cannot be eliminated.

Among the unavoidable causes are gender and age, as well as the influence of heredity. Thus, the male population more often suffers from angina caused by the formation of atherosclerotic plaques due to certain properties of male hormonal levels. The risk of developing this clinical syndrome in women arises, as already noted, after changes in hormonal levels associated with menopause, in particular after a decrease in estrogen production.

The hereditary factor is confirmed frequent occurrences angina attacks in direct relatives of patients who have had a heart attack or have coronary heart disease.

But anyone can influence the modifiable causes of disease. Removable factors are usually interrelated, and the reduction negative influence one of them leads to a decrease in the others. TO removable reasons include:

Increased blood cholesterol levels. Cholesterol and other lipid formations can accumulate on the walls of blood vessels leading to the myocardium, reducing their patency. Hyperlipidemia occurs in ninety-six percent of patients with angina attacks.
Excess weight, typical for people consuming high-calorie foods. Patients need to significantly limit the consumption of animal fats, high-carbohydrate, cholesterol-rich and salty foods. It is recommended to increase your intake of fiber, which is found in vegetables and fruits.
Tobacco smoking. Nicotine provokes oxygen starvation blood cells, increased blood pressure and vasospasm. In people who smoke and suffer from atherosclerosis, the risk of angina attacks and myocardial infarction increases significantly.
Passive lifestyle. Small physical activity increases the likelihood of obesity, which in combination with increased level cholesterol in the blood can lead to disturbances in the blood supply.
Diabetes. In patients diabetes mellitus the risk of coronary heart disease and angina attacks doubles.
High blood pressure, which is one of the symptoms of coronary heart disease, increases the level of oxygen required by the myocardium and, as a result, complicates angina pectoris.
Anemia, which reduces the ability to transport oxygen to the myocardium.
Increased blood viscosity. Is a factor increased risk development of ischemic disease and blood clots.
Nervous overstrain. Helps increase blood pressure and reduce the supply of oxygen and nutrients to the heart muscle.

To the reasons causing the considered clinical syndrome, also include early menopause, which, as already mentioned, is accompanied by changes in hormonal levels and a decrease in the production of estrogen, a hormone that prevents the formation of atherosclerotic plaques. Also, changes in the hormonal levels of women are affected by the use of hormonal contraceptives.

The simultaneous influence of several causes increases the likelihood of an angina attack.

Signs of angina

Symptoms of angina include:

a sudden feeling of heaviness and squeezing in the chest closer to the spine;
shortness of breath caused by incomplete relaxation of the heart;
arrhythmia;
pale skin;
pathological increase in heart rate;
increased sweating;
spreading pain under the shoulder blades, in the left arm, lower jaw and neck;
abrupt end of the attack when the provoking factors are eliminated;

A symptom of angina pectoris is severe weakness without pain during any physical activity (this symptom is possible in the elderly and patients with diabetes).

These manifestations accompany the patient, as a rule, from one to fifteen minutes and can stop as abruptly as they began. If the clinical syndrome was caused by emotional overstrain, then it is often enough to calm down for the pain to disappear.

If the cause was physical activity, then to relieve symptoms it is necessary to stop physical stress as quickly as possible. Nitroglycerin taken sublingually also helps relieve symptoms, i.e. by dissolving the drug under the tongue.

The described symptoms of angina include both classic and atypical manifestations of the disease. The main signs of angina pectoris can manifest themselves both complexly and individually, depending on the type of angina attack.

Classification

According to the conditions of occurrence, they distinguish the following types angina:

stable (occurs in a state of tension);
unstable (occurs at rest).

Clinical syndrome of a stable type occurs under conditions of intense work of the heart (for example, during physical exertion), when increased blood flow flows through arteries narrowed by at least fifty percent.

If symptoms of angina pectoris appear, it is necessary to consult a doctor about further therapeutic measures, otherwise the narrowing of the arteries can reach levels of seventy-five and even ninety-five percent, which will contribute to an increase in the frequency of attacks.

The classification of angina does not end with grouping according to the conditions of occurrence. Classes of angina are also distinguished by the characteristics of attacks and their severity.

1st functional class (FC). Attacks in this type of clinical syndrome appear rarely and for a short time. As a rule, pain syndrome is provoked by strong physical stress.
2nd functional class (FC). Angina pectoris of the 2nd class is provoked by such minor physical activities as climbing stairs, speed walking and even eating a large meal.
3rd functional class (FC). An attack can occur even when walking slowly over short distances (up to hundreds of meters). Angina pectoris of the 3rd class significantly limits a person's motor capabilities.
4th functional class (FC). An angina attack can occur with any motor activity. This type of clinical syndrome usually precedes the development unstable angina.

The functional class of angina is determined by specialists based on characteristic symptoms in order to determine what the patient needs to do and what not to do.

In patients suffering from this clinical syndrome at rest, angina attacks differ significantly from the manifestations of a stable type of disease. They can be either longer or shorter, and the cause of their occurrence can be random.

The following types are distinguished:

Primary S. Angina attacks that have never appeared before continue for a month.
Progressive S. The frequency and duration of characteristic symptoms increases.
Angina at rest. Seizures occur spontaneously in the absence of reasons for their occurrence (there was no physical activity, stress).
Post-infarction C. Pain symptoms occur within two weeks after a heart attack.

If unstable S. is suspected, immediate hospitalization is necessary to avoid myocardial infarction.

To distinguish between stable and unstable S., you need to pay attention to the duration of the attacks. It is no more than five or ten minutes when stable. With unstable angina, attacks tend to increase in duration.

You also need to pay attention to the level of motor activity that causes pain symptoms. Stable is characterized, as a rule, by the same level of motor activity, while unstable can occur even during rest.

When determining the type of clinical syndrome important factor The effectiveness of the use of nitroglycerin also increases. In the case of a stable clinical syndrome, pain disappears within three minutes after taking one tablet, whereas in unstable angina, one tablet does not relieve sensations. As a rule, if more than one tablet is needed to relieve symptoms, then the patient is dealing with unstable angina.

Treatment and prevention

Treatment of this clinical syndrome is aimed at preventing angina attacks and complications of the disease.

During an attack, the first step is to take one nitroglycerin tablet sublingually. If the pain does not go away after one tablet, then you can take another one at three-minute intervals. It is not recommended to take more than three nitroglycerin tablets during one attack to avoid a strong decrease in blood pressure.

Drug treatment for angina includes taking anti-ischemic drugs because they help reduce the heart's need for oxygen. In addition to anti-ischemic drugs, anti-sclerotic agents can also be prescribed.

For complications that increase the risk of myocardial infarction, surgery may be required.

Prevention includes giving up bad habits, normalizing your daily routine, diet, and reducing the negative impact of other factors of angina pectoris.

If angina is diagnosed, it is necessary to avoid physical and emotional stress and treat comorbidities.

Angina pectoris is pain in the area of the heart, manifested by attacks that are provoked by a lack of blood circulation in the myocardium.

It is not a separate disease, but is included in the group of symptoms manifested in cardiac ischemia.

The disease can lead to chronic heart failure, as well as death of heart muscle tissue. In many cases, angina is noted as a symptom of damage to the coronary arteries of the heart.

There is also another name for angina, in simple words it is called "angina pectoris". It received this name due to the fact that pain is localized in the chest, near the heart.

The pain inherent in angina is described as severe, pressing, burning, squeezing pain, radiating to the back, throat, shoulder blades, upper limbs, and cervical spine.

Classification

Classification in the case of angina pectoris occurs in several groups, for a more correct and accurate assessment of the type of disease.

Among the types are:

Spontaneous (sudden, variant). This type It is quite rare and is provoked by spasm of the coronary arteries, which leads to a decrease in blood flow to the heart muscle.

This type of angina is characterized by severe pain in the chest area and heart rhythm disturbances.

An unexpected spasm does not lead to myocardial infarction and is eliminated quickly, but it provokes a prolonged lack of oxygen in the myocardium.

It is an unfavorable form, and in most cases.

Progressive (unstable). The patient may suddenly feel a deterioration in his condition, without obvious reasons. The progression of this type of angina is attributed to the formation of a crack in the wall of a heart vessel, localized near cholesterol deposits.

This leads to increased formation of blood clots located inside the vessels of the heart, which interfere with normal blood circulation.

Accompanied by prolonged pain at night, lack of air, and heart rhythm disturbances.

Stable (angina pectoris). The manifestation of symptoms is due to squeezing, burning pain in the chest. In most cases it radiates to the left shoulder. The pain disappears suddenly after finishing physical activity, or as a result of using Nitroglycerin.

The division also occurs according to the development of the disease with various symptoms:

1st period. Functional deviations occur that cause narrowing of the vessel. Attacks of pain begin after serious unrest, in people who do not have symptoms of atherosclerosis. Initially, the symptoms of angina are associated with climacteric neurosis(a condition in which mental disorders associated with changes in the hypothalamus occur) in females, as well as smoking in males;
2nd period. Prolonged contraction of heart vessels leads to the progression of atherosclerotic narrowing. Painful attacks are unstable in their manifestations;
3rd period. Obvious changes of an atherosclerotic nature appear, painful attacks are aggravated by arrhythmia and heart failure. Subsequent repeated attacks lead to the progression of small areas of development of cardiosclerosis.

Depending on the severity of the disease, angina pectoris is divided into functional classes.

Among them:

1st class. There is a rare manifestation of symptoms of short painful attacks. The appearance of symptoms of angina pectoris occurs with unusual or rapid physical activity (sudden lifting of weights);

2nd grade. The manifestation of symptoms of angina pectoris occurs when walking, running, or quickly climbing stairs. Auxiliary factors that provoke an attack may be dense food, cold frosty weather, as well as strong gusts of cold wind;

3rd grade. Symptoms appear when walking at a slow pace over distances of more than a hundred meters, or when climbing stairs to a low floor.

Sharp pain may occur when going out in cold weather or frosty wind. Symptoms also appear after nervous experiences.

At this stage, everyday life the person is severely limited in order to avoid recurrence of attacks;

4th grade. Symptoms occur with any type of physical activity. The person cannot perform any kind of physical activity, even such as sweeping the floor, or walking a distance of up to fifty meters. At this stage, painful attacks are possible even in the absence of physical and emotional stress.

In most cases, when diagnosing, the functional class (FC) is indicated. This happens using the abbreviation FC, as well as a number corresponding to the class number. It is important for the doctor to determine the FC of angina pectoris.

This provides the basis for prescribing medications and coordinating maximum physical activity on the body.

Symptoms

In case of progression of angina pectoris, the main symptom is compressive pain in the chest area and under the ribs in their central area. The pain manifests itself in the form of attacks, which last on average for five minutes.

If a painful attack does not stop within twenty minutes, this may indicate an acute myocardial infarction. The frequency of attacks varies and can range from several times a year to a hundred times a day.

Main typical symptoms that indicate progression of angina pectoris are:

Paroxysmal pain in the chest area;
Characteristics of attacks are squeezing, burning, heaviness in the chest;
The intensity of pain increases gradually until it becomes very strong;
Heavy breathing, feeling of chest tightness;
The pain will radiate to the left upper limb, and left shoulder blade, can also sometimes spread to the jaw and cervical region;
The person freezes to prevent the pain from increasing;
Feeling of impending disaster, fear of death;
Duration of pain from five to forty minutes;
Quick fatigue.

Less common are the atypical, but still inherent, symptoms of angina:

Symptoms of angina pectoris other than pain are also common. These include:

The appearance of pain after physical activity. The occurrence of an attack when walking stops, and resumption after walking begins;
Shortness of breath and heavy breathing are rarely bothered. This is due to acute insufficiency hearts. At the time of a painful attack, progression is possible pulmonary edema which will lead to death;
Fluctuations in heart rate in both directions. There is both a decrease and an increase in the frequency of contractions;
In most cases, blood pressure increases;
Pallor of the skin of the face, as well as a frightened look;
Feeling depressed and afraid.

If you notice any of the symptoms, seek medical attention from a qualified physician. Do not self-medicate.

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What to do if there is an attack?

If an attack occurs outside the hospital, then you need to know the algorithm of actions to calm the pain.

Such actions include:

The main task of first aid is to dilate the coronary vessels with the help of medications.

Treatment

Before prescribing treatment, the doctor sends the patient for the following examinations:

Clinical blood test,
Blood chemistry,
Blood for cholesterol, hemoglobin, and sugar levels, indicators of blood lipid concentrations,
Ultrasound examination (ultrasound) of blood vessels,
Bicycle ergometry,
Coronary angiography,
Daily monitoring of ECG (electrocardiography).

The most accurate study for determining the form of angina pectoris and the extent of spasm of the heart vessels is coronary angiography. It helps to accurately determine the length of the lesion and how large the narrowing has occurred.

Also, when examining using this method, it is possible to determine thrombosis and tearing of the arteries. This type of research does not have side effects and contraindications. Therefore, it is used for all patients, regardless of the severity.

To treat this pathological condition, like angina, both medications and surgical interventions. Moreover, the medications should be taken throughout life, after registering angina in a person.

The main goals of treatment are to prevent heart attack and unexpected death, prevent progression of the disease, eliminate large quantity attacks and their strength.

The following drugs are most often prescribed for drug treatment:

Group of drugs	Effect on the body
Medicines aimed against the formation of blood clots (Aspirin).	It is aimed at preventing the formation of blood clots, which can subsequently clog an already narrowed vessel, leading to early death. Long-term use of these drugs may lead to stomach upsets. So it is advised to use Thrombo ACC, which dissolves in the stomach without causing irritation. The effect of the drug begins approximately 15 minutes after administration and lasts several hours;
Beta blockers (Bisoprolol, Metoprolol, Atenolol, etc.).	These drugs reduce the myocardium's need for oxygen. This normalizes the imbalance formed by the low blood flow caused by the narrowing. They help lower blood pressure and slow the heart rate, which is the prevention of angina pectoris. The effect of the drugs begins approximately 2 hours after administration and continues throughout the day;

Statins (Atorvastatin, Simvastatin, etc.).	Such medications reduce the saturation of cholesterol in the blood. The drugs prevent more cholesterol from settling in coronary vessels, which prevents their narrowing. The maximum effect of the drug Atorvastatin begins 1-2 hours after consumption and lasts throughout the day. In the case of Simvastatin, the effect lasts only 12 hours;

ACE inhibitors (Perindopril, Lisinopril, Noliprel, etc.)	This group of drugs is aimed against vascular spasms. Perindopril has maximum effect 3-5 hours after administration. The effect of Lisinopril occurs after 4-6 hours, and lasts throughout the day, like the effect of Noliprel;

Nitrates (Nitroglycerin, etc.).	Helps to expand the lumen of the vessel, allowing more blood to flow into the heart. The effect is visible after 5 minutes, the effect lasts up to 45 minutes;

Antagonists calcium channels(Verapamil, Verogalid, etc.).	This group of drugs reduces the myocardium's need for oxygen. The action of Verapamil begins immediately after administration (up to 5 minutes), maximum effect is recorded 3-5 minutes after intravenous administration and lasts 10-20 minutes. - hemodynamic effect and 2 hours - antiarrhythmic.

Among those used surgical interventions the following apply:. With such an operation, through femoral artery a catheter is inserted, which reaches the area where the blood vessels narrow.

After this, the balloon expands, releasing the narrowing, which leads to restoration of blood flow.

In most cases, the operation is performed with the installation of a stent.

In the place where the balloon inflates the vessel, a special stent is installed, which maintains the lumen of the vessel.

The operation does not provide a complete guarantee of recovery; relapses are recorded in up to 40 percent of all cases.

That is why after surgery, constant maintenance of the body with medications is required.

The operating method is prescribed exclusively by the attending physician, based on all test results and assessment of the patient’s condition.

How to prevent angina?

For effective prevention angina pectoris, it is necessary to exclude factors that can provoke the pathological condition:

Get rid of excess weight(if any);
Quit smoking, drinking alcohol, drugs;
Contact the hospital in advance if you have symptoms of concomitant diseases;
In the case of a hereditary predisposition, it is necessary to carefully monitor the appearance of symptoms, as well as apply all preventive measures;
Healthy lifestyle;
Proper nutrition. It is necessary to reduce products from high content cholesterol.

Expert forecast

If the patient complies healthy image life, and eliminates factors that provoke angina. When visiting the hospital early, diagnosing and effective therapy the outcome is favorable.

If attacks last more than twenty minutes, this leads to acute heart attack myocardium, which can lead to death. The patient requires urgent hospitalization and surgical intervention.

If you notice symptoms, go to the hospital immediately. Do not self-medicate and be healthy!

The word "angina" is of Greek origin: "steno" means narrowing, tightness, and "cardia" means heart. Literally - “tightness of the heart.” The concept of angina is related to the concept coronary heart disease (CHD)- heart disease, in which the delivery of blood to the heart muscle stops or decreases due to pathological processes in the coronary (coronary) arteries that supply the heart. Reduced blood flow leads to disruption of the heart, which requires a sufficient amount of oxygen carried by the blood to perform its functions. In conditions of lack of oxygen, attacks of chest pain - angina pectoris - periodically occur.

As a disease, angina has been known for a very long time. The famous ancient Greek doctor, the “father of medicine” Hippocrates (460 BC - 357-356 BC) pointed out the danger, sometimes fatal, frequent attacks sudden chest pain. Roman Stoic philosopher, poet and statesman Lucius Annaeus Seneca (4 BC - 65 AD) wrote about an attack of angina pectoris: “With any other disease you feel sick, but with “angina pectoris” you feel dying, because the pain is short-lived , but strong as a storm." “Pectoris angina” is an outdated name for angina pectoris. It was proposed by the English physician William Heberden (1710 - 1801). In 1768, he described an attack of angina pectoris as follows: “If the pain in the chest is very strong and unusual ... accompanied by suffocation and a feeling of fear ... then they pose a serious danger, and they can be called ... “angina pectoris” ... Most often they occur when walking (especially uphill) and soon after eating in the form of painful and extremely unpleasant sensations in the chest, which get worse and do not go away. The person feels as if he is about to die, but when he stops, the feeling of tightness in the chest goes away, and in the intervals between attacks the patient feels quite well. Sometimes the pain occurs in the upper, sometimes in the middle, and sometimes in the lower part of the sternum and is more often located to the left than to the right of it. Very often it spreads to the left shoulder. If the disease continues for a year or more, then the pain that occurs when walking does not go away after stopping. Moreover, it can occur even when a person is lying, especially on the left side, and forces him to get out of bed.”

Causes of angina pectoris

Perhaps the main cause of angina is the narrowing of the lumen of the coronary arteries (their spasm), which occurs against the background of pathological processes in these arteries. As a result of the spasm, a discrepancy appears between the myocardial need for oxygen and its delivery. The most common (92%) pathological process - the cause of arterial spasm - is atherosclerosis, sometimes it can be combined with thrombosis. Another cause of stenosis may be a dysfunction of the endothelium (inner lining) of blood vessels.

Rice. 1. Causes of narrowing of the coronary arteries.

IN last years Researchers have identified risk factors that can lead to coronary atherosclerosis. All of them are divided into 3 main groups.

Group 1 - lifestyle.

The risk factors of this group are modifiable, i.e. changeable:

a diet high in cholesterol (egg yolks, caviar, cheeses, margarine, pork, etc.);
smoking;
excessive alcohol consumption;
low physical activity (hypodynamia).

Group 2 - physiological characteristics , which are also modifiable characteristics:

increased level of total cholesterol in the blood plasma (normally it should be 3.6-5.2 mmol/l);
high blood pressure;
low levels of “good” cholesterol (HDL cholesterol);
increased level of triglycerides in blood plasma (normal - less than 1.7 mmol/l);
diabetes;
obesity.

Group 3 - personal characteristics(non-modifiable factors):

age (over 45 years for men and 55 years for women);
male gender;
family history of atherosclerosis.

The combination of several risk factors significantly increases the likelihood of developing atherosclerosis and, as a consequence, coronary artery disease and its form - angina pectoris. Today, IHD is main reason population mortality. According to the State Scientific Research Center (State Research Center) of Preventive Medicine in Russia, about 10 million of the working population suffer from coronary artery disease. It must be borne in mind that angina pectoris as the onset of coronary artery disease occurs in almost 50% of patients. Moreover, about 40-50% of these people are aware of the disease they have, while 50-60% of cases of the disease remain unrecognized and untreated. It is for these reasons that it is very important to recognize angina pectoris in time and seek help from a doctor.

Symptoms of angina

The main symptom of angina is pain, which has characteristic features:

it is paroxysmal;
by nature - pressing, squeezing;
localized in the upper or middle part of the sternum;
the pain radiates to the left arm;
the pain increases gradually and quickly stops after taking nitroglycerin or eliminating the cause that caused it.

An attack of pain can be triggered by:

brisk walking, climbing stairs, carrying heavy objects;
increased blood pressure;
cold;
large meals;
emotional stress.

First aid for angina pectoris:

Take a comfortable position, optimally sitting.
Take nitroglycerin: 1 tablet under the tongue or 1-2 drops of 1% nitroglycerin solution on a piece of sugar, which must also be placed under the tongue. The drug should be taken immediately when pain appears. You can take ½ tablet if the drug causes a severe headache.
If the pain has not stopped 5 minutes after taking nitroglycerin, you can take the drug again, but do not repeat it more than 3 times!
To reduce headaches, which are sometimes observed when taking nitroglycerin, you can take validol (under the tongue), citramon (orally), and drink hot tea. For severe headaches, instead of nitroglycerin, you can use Sidnopharm (1 tablet = 2 mg sublingually) or Corvaton (1 tablet = 2 mg sublingual).
For rapid heartbeat (tachycardia), take anaprilin up to 40 mg under the tongue.
If, after repeated administration of drugs, the pain does not go away, and moreover, symptoms such as develop:

increased pain in the heart area;
severe weakness;
difficulty breathing;
cold profuse sweat;

You should call an ambulance, as there is a risk of myocardial infarction.

Prevention of angina

Treatment of an attack of angina is, of course, an important part in preventing the progression of coronary artery disease and the development of complications. Treatment is carried out in three areas:

impact on modifiable risk factors;
drug treatment;
surgical methods.

The second and third fusion are carried out only with the help of a medical specialist, but every person can influence risk factors.

The recommendations of the American College of Cardiology provide a list of activities whose usefulness and effectiveness in preventing angina pectoris and coronary artery disease has been proven and is beyond doubt among experts. Such events include:

Treatment arterial hypertension, while the target pressure level is below 130/80 mmHg. Preference is given to such groups of drugs as β-blockers, calcium antagonists, ACE inhibitors. Drug treatment is selected by a doctor!
To give up smoking. People who smoke are at risk of developing myocardial infarction ( acute form IHD) is 2 times higher than in non-smokers, and the risk sudden death- 2-4 times. Interesting fact: The risk of developing coronary heart disease caused by smoking is completely eliminated 2-3 years after a person stops smoking.
Treatment (adequate compensation) of diabetes. Uncompensated diabetes mellitus, like concomitant disease, accelerates progression coronary atherosclerosis and, as a result, angina pectoris. Type 2 diabetes mellitus increases the risk of death by 2 times in men and 4 times in women. And with type 1 diabetes mellitus, this risk increases by 3-10 times, so the need for optimal glucose-lowering therapy is generally recognized.
Physical training. In people with a predominantly sedentary lifestyle, the risk of developing coronary artery disease is increased by 1.5-2 times. Experts recommend doing physical exercise 30 minutes at least 4 times a week, or even better every day. The most the best views sports that have a beneficial effect on the entire body are swimming, jogging, nordic walking, gymnastics, aerobics, cycling. Remember: best medicine for the heart it is to train its endurance.
Lipid-lowering therapy (therapy aimed at lowering blood lipid levels) is prescribed by a doctor and is an important component treatment of ischemic heart disease.
Reducing excess body weight in the presence of arterial hypertension is important component treatment of patients with ischemic heart disease. It is important to follow a hypocaloric diet with sufficient amounts plant products, rich in fiber.

A very interesting addiction risk of ischemic heart disease from alcohol were discovered by experts after conducting an analysis that combined the results of 34 studies from different countries (USA, England, Japan, Germany, Russia, France, Australia and many others). Scientists have concluded that moderate alcohol consumption reduces mortality from coronary artery disease. Experts have described a so-called U- or J-shaped relationship between alcohol consumption and CHD mortality.

Rice. 2.J-shaped curve of the relationship between the risk of coronary heart disease and alcohol.

1 - group of people who abuse alcohol;

2 - group of people who drink alcohol moderately;

thick line - those who do not drink alcohol at all.

The graph shows that there is an increased risk among people who do not drink alcohol at all and among heavy drinkers compared to moderate drinkers. Moderate alcohol consumption is defined as no more than 1 fluid ounce (28.41 ml) pure ethyl alcohol per day. According to the study, consumption of 10-30 g of absolute alcohol per day reduces the risk of coronary artery disease by 20-50%, and stroke and sudden death. coronary death- by 20-30%. This phenomenon was called the “French paradox”, because In France, heart disease is relatively less common (death rate from cardiovascular diseases there it is 2.5 times lower than, for example, in the UK). This paradox is explained by the fact that the French consume a lot of red wine.

It also follows from the graph that mortality is minimal when alcohol consumption averages 5-10 grams, and relatively safe doses, in which mortality is the same in all study groups - 30-40 grams of ethanol.

The question of the influence of psychosocial factors on the risk of developing CHD remains controversial. The book of Ecclesiastes teaches: “Envy and anger shorten life.” Much compelling scientific evidence suggests that hostility, anger, and anger may be associated with the risk of CHD, but no definitive conclusions have yet been drawn. The connection between IHD and stress can be traced to the fact that, being in upset feelings, a person smokes a lot, drinks, overeats, quits playing sports - and all this directly increases the risk of IHD. Therefore, to prevent the development of IHD, relaxation and psychotraining are recommended as a method of reducing chronic stress.

Conclusion

Coronary heart disease is a terrible disease that ranks first in the structure of mortality. Angina pectoris is a clinical syndrome of coronary artery disease, which over time turns into clinical form IHD becomes a disease. A person’s health largely depends on himself.

According to the World Health Organization (WHO), human health is 20% determined by heredity, 10% depends on medical care, 20% is allocated to the influence of the environmental situation and 50% of the health of each person is the result of his lifestyle.

Our own health is in the hands of each person; we ourselves largely determine whether we should get sick or not, and if we get sick, then with what. It is much more effective and cost-effective to prevent a disease rather than treat it. This also applies to angina. The need to lead a healthy lifestyle is not just empty words. Changing your lifestyle in favor of maintaining health is quite possible, realistically achievable and uncomplicated. All that is required from a person is his desire. It's hard to imagine that there might not be a desire.

What can motivate better than the real opportunity to live a healthy, fulfilling life?

Be healthy!

From this article you will learn: what an angina attack is, what causes it, its characteristic symptoms and how it differs from other pathologies. How to relieve an attack and prevent its occurrence in the future.

Article publication date: 12/19/2016

Article updated date: 05/25/2019

During an attack of angina, a pathological narrowing of the coronary arteries occurs by 50% or more. This condition leads to a lack of oxygen in the heart, which is characterized by certain symptoms (pain, burning, pressure behind the sternum) and threatens with a complication - myocardial infarction.

An attack of angina can lead to myocardial infarction

The attack can be completely relieved by taking nitroglycerin, but this will not affect the cause of the problem - it is only a temporary solution. After eliminating the symptoms, you should definitely contact a specialist - a cardiologist - for further treatment.

Causes of angina attack

An angina attack can occur for three reasons:

as a result of atherosclerosis - narrowing of the lumen of blood vessels due to deposits of atherosclerotic plaques);
thromboembolism - acute blockage blood vessel thrombus;
spasm - a sudden repeated narrowing of the lumen of blood vessels.

Provoking factors can be any condition in which the work of the heart increases:

stress tension;

hypothermia;

overheat;

drinking alcohol;

rich and spicy food.

Predisposing factors:

excess weight;
age (more common in older people);
smoking;
increased blood clotting;
lack of physical activity;
high blood pressure;
diabetes;
high cholesterol;
congenital anomalies of the heart and blood vessels;
heredity.

Diseases of the lungs and stomach can also cause pathology due to a deterioration in the supply of oxygen to the heart.

Symptoms of an angina attack

Main features:

pain behind the sternum, in the stomach, in the shoulder blade, left arm, shoulder, lower jaw;
burning sensation;
the appearance of shortness of breath - rapid and difficult breathing, a feeling of lack of air;
dizziness;
increased sweating;
weakness;
feeling of panic and anxiety.

Some people may not have any symptoms during an attack: women, people with diabetes, and older people. In men, such an attack of angina pectoris is much more likely to pass with pain.

Pain syndrome (complex of symptoms) can have different localization, duration and intensity:

Nature of pain	There may be a feeling of squeezing or squeezing, boring or pulling.
Pain intensity	From insignificant sensations to very strong, unbearable
Duration	From 2–5 minutes to 20; if longer, then this indicates the development of a heart attack
Localization of pain syndrome	In the area of the sternum, in its upper region; radiates to the lower part, to the abdominal area (in this case, the attack can easily be confused with an exacerbation of a peptic ulcer or gastritis); shoulder; shoulder blade; hand; collarbone on the left side of the body; sometimes (rarely) the pain radiates to the lower jaw or earlobe; The syndrome may also manifest itself on the right side.

Locations and main signs of an angina attack

Features of the attack depending on the type of angina

At different types angina signs of the problem will differ:

With, the severity of which is divided into 4 classes, attacks also have their own characteristics.

Differential diagnosis (difference from other pathologies)

Since an attack of angina is similar in pain to some diseases, in order to provide competent assistance, it is necessary to carry out a differential diagnosis.

Comparison of an attack of angina with other pathologies:

First aid (relieving an attack) and treatment

If an attack happens to you, then you need to be able to provide yourself with first aid.

You need to sit down, stop any activity, call an ambulance.
Unbutton your clothes, if possible, or remove your outer ones. It is advisable to unfasten your belt, bra, and untie your tie.
Place nitroglycerin (1 tablet) under your tongue.
If after 5-8 minutes the symptoms still continue, then you can put another one.
Pay attention to your pulse and blood pressure: if it rises, you need to take the appropriate medication.

If a problem occurs to someone close to you, you should provide him with the same emergency assistance.

Most often, nitroglycerin completely relieves symptoms and the person can move independently, but this does not mean that the problem will not recur.

There is no treatment for an attack as such - it is simply removed. And since an attack of angina is not an independent disease, but a syndrome (complex of symptoms) of other pathologies, after relieving the attack with nitroglycerin, it is necessary further treatment main problem pathology.

Prevention

To prevent the occurrence of angina attacks, you should exclude those factors that lead to them, especially if you have a predisposition to the disease of cardio-vascular system. Of course, it is impossible to prevent the influence of factors such as age or gender, but we can help ourselves and protect ourselves from problems in the future. To do this you need:

get rid of bad habits;
Healthy food;
fight excess weight;
be physically active;
undergo preventive examinations in a timely manner, measure cholesterol and blood sugar levels.

Lifestyle recommendations to prevent angina attacks

Health forecast

It is impossible to make an unambiguous prognosis for health after an attack of angina for all patients. The course of the disease is individual and depends on the person’s conditions and lifestyle. Therefore, in one case, subject to preventive measures Some people will not have attacks at all, while others may experience a complication or a tragic outcome.

At the moment, angina pectoris has become significantly younger. Signs of angina occur in people under 45–50 years of age (and even in teenagers). It is important to explain to your child in time the dangerous consequences of bad habits and the importance of sports, healthy eating and an optimistic outlook on life situations. After all, a healthy attitude to life is the best prevention of heart disease.