The cause of pain with angina pectoris is. How to recognize angina by pain. Signs of atypical angina attacks

In the further course of the disease, their anatomical lesion, coronary sclerosis (atheromatosis of the coronary arteries), very often develops, which was well known to the first authors who described this disease as “ossification of the coronary arteries.” Thus, the presentation of angina pectoris in the section on atherosclerotic heart disease is essentially insufficiently justified, and it would be more correct early stages diseases are classified as neurogenic functional vascular diseases. G. F. Lang describes angina pectoris in the section “Diseases of the neurohumoral circulatory regulating apparatus,” and atherosclerosis of the coronary arteries in the section “Diseases blood vessels"; however close connection functional disorders coronary circulation with organic lesions of the arteries of the heart makes it more reasonable to describe both forms within the framework of a single disease.

This disease, popularly sometimes called “angina pectoris,” was first described by the English physician W. Heberden in 1768. According to some data, angina pectoris develops 3-4 times more often in men than in women.

Angina develops as a result of acute insufficiency coronary blood supply, that is, a discrepancy between the blood flow to the heart and its need for it. As a result of disruption of the blood supply to the heart muscle, myocardial ischemia can develop - bleeding of a section of heart muscle tissue, which, in turn, provokes a disruption of metabolic processes in the myocardium and contributes to the excessive accumulation of metabolic products in it.

The most common causes of angina are the following:

atherosclerosis coronary arteries;
blood pressure disorders;
infectious and infectious-allergic lesions (much less often).

Chest pain during angina is characterized by the fact that the time of its onset and subsidence is clearly defined. Besides, painful sensations arise, as a rule, in certain conditions and circumstances - when walking, especially when accelerating, when climbing a mountain, a sharp headwind, as well as other significant physical effort and/or significant emotional stress. With the continuation or increase of physical effort, tension, pain also increases, and with relaxation, the pain subsides and disappears within a few minutes. The duration of the attack is usually 1-15 minutes. Angina pain quickly subsides and stops after taking nitroglycerin. However, sometimes attacks can be observed that last from 30 minutes to 1 hour. Such attacks in some cases lead to myocardial infarction. Therefore, if an attack of angina continues for 20-30 minutes or an increase in frequency or intensification of attacks of angina is observed, an electrocardiographic examination should be performed in the near future (within 24 hours). In the future, the patient must be under constant medical supervision, that is, hospitalization of the patient is required.

Angina attacks may not appear for a long time, and can happen quite often. Patients with a long history of the disease are at risk of developing cardiosclerosis, heart rhythm disturbances, and the appearance of symptoms of heart failure.

During an attack, you should take a calm, best sitting position and put 1 tablet of nitroglycerin on a piece of sugar or on a validol tablet under the tongue. If there is no effect, the drug must be taken again after 2-3 minutes. As a sedative, it is better to take 30-40 drops of Corvalol (Valocordin).
To prevent angina attacks, you should avoid strong physical and emotional stress.
No less important has treatment concomitant diseases, prevention of atherosclerosis, etc.
Take nitroglycerin if there are signs of stress that can trigger an angina attack. In addition to nitroglycerin, which relieves acute manifestations of angina attacks but has a short duration of action, it is necessary to take long-acting drugs (nitromazine, nitrosorbide, trinitrolong, etc.). These drugs are taken during courses determined by the doctor, and when the patient’s condition is stabilized, that is, there is a long absence of attacks, for example, before exercise, travel, etc.

Symptoms and signs of cardiac angina

It should be noted that the pronounced features of angina pectoris - the paroxysmal nature of the pain, a clear relationship between the occurrence of chest pain and physical (as well as emotional) stress, as well as the rapid relief of pain by taking nitroglycerin - are sufficient grounds for making a diagnosis and delimiting of this disease from other pain in the heart and chest associated with other causes.

It is important to remember that not all chest pain is a sign of angina.

Pain in the heart area associated with other causes, but not with angina, is often combined under general term"cardialgia". Similar manifestations occur in other diseases such as heart disease vascular system(for example, heart defects, aortitis, etc.).

Pain in the heart area during angina pectoris can last for many hours or even days. Sometimes patients feel lightning-fast piercing pain, which is localized at the apex of the heart. The use of nitroglycerin in such cases does not produce results. Relief of the patient's condition, as a rule, occurs under the influence of sedatives (calming) and painkillers. It should be noted that with neuralgia, pain points are felt along the intercostal nerves.

The picture of manifestations of the disease can also be supplemented by the following signs, which do not necessarily accompany angina:

localization of pain in the retrosternal region, which is quite typical; pain can radiate to the neck, lower jaw, teeth, arm (usually left), shoulder girdle and shoulder blade (usually left);
pressing, squeezing, less often burning nature of the pain;
Simultaneously with an attack of the disease, an increase in blood pressure and a feeling of interruptions in the heart area are observed.

These signs characterize the so-called exertional angina, which occurs as a result of exertion. It should be noted that patients often do not focus on a number of typical symptoms of angina, believing that these manifestations do not relate to the heart, and do not report them to the attending physician, which can complicate the diagnosis.

Unlike exertional angina, attacks of angina at rest are not associated with physical activity and often occur at night. However, in other respects the manifestations of these two types of disease are very similar. Attacks of angina at rest are often accompanied by a feeling of lack of air and suffocation.

New-onset angina pectoris can develop in one of three directions: develop into stable angina pectoris, develop into myocardial infarction, or disappear.

The majority of patients with angina pectoris have a stable form of this disease, that is, the severity of the frequency and severity of attacks remains approximately the same for quite a long time, attacks occur under similar conditions and subside under rest conditions, as well as when taking nitroglycerin.

Depending on the intensity of the disease manifestations, four functional classes are distinguished stable angina.

I functional class- patients with rare attacks of angina pectoris that occur only under the influence of excessive physical exertion.
II functional class- patients who experience angina attacks during normal physical activity.
III functional class- attacks occur with small household loads.
IV functional class- attacks in patients occur with minimal physical activity and even in its absence.

Angina can be considered stable if the symptoms of the disease appear without significant deterioration for several weeks. As a rule, attacks of stable angina are associated with an increase in myocardial oxygen demand.

Sometimes, against the background of stable angina, asymptomatic (“silent”, painless) ischemia may develop, which is not accompanied by pain or any discomfort. Such a pathology can only be detected by special research- electrocardiograms and some other methods.

Angina pectoris in a more pronounced form is observed more often in men after 40 years of age, when coronary sclerosis is usually found.

Attacks of simple angina pectoris (angina pectoris), not complicated by acute necrosis of the heart muscle, usually occur when walking or other physical exertion - the so-called ambulatory angina pectoris, or angina pectoris, as well as at other moments characterized by increased demands on the coronary circulation, such as , when excited.

The classic description of “angina pectoris” (angina pectoris) (from ango - squeeze) was given back in the 18th century.

As soon as the patient stops, the pain stops. Apart from these signs, the patient feels completely healthy. The pain is localized sometimes in the upper part, sometimes in the middle or at the base of the sternum and often more to the left of the sternum. Pulse on radial artery does not change during an attack, the disease has nothing to do with shortness of breath.”

All these signs are extremely valuable for characterizing simple (outpatient) angina pectoris. An attack of pain occurs due to physical stress, mental excitement, in the cold, after lunch, relief is provided by complete rest, taking nitroglycerin, etc.

In seriously ill patients with advanced atherosclerotic cardiosclerosis, attacks of simple angina can also occur in a resting state, when the patient is lying in bed - angina at rest.

Severe attacks of pain may alternate with a sensation of numbness or tingling in the fingers of the left hand, with vague pain in the area of the left shoulder joint and neck on the left, etc., where skin areas of increased sensitivity are found during examination, respectively, in the VIII cervical and five upper thoracic segments ( zones of hyperesthesia).

Angina is based on a discrepancy between the blood supply to the heart muscle and the need for blood, which is increased when physical work, digestion, with. increased resistance to the left ventricle due to spasm peripheral vessels etc. The coronary vessels, intractable due to sclerosis, and most importantly, with impaired neuro-vegetative regulation, do not expand properly with an increased need for oxygen; the myocardium is insufficiently supplied with blood; as a result, ischemic, or anoxic, pain appears in an organ that is not sensitive to mechanical trauma, but responds with a specific pain sensation to adequate irritation in the form of impaired metabolism muscle tissue. The analogy often drawn between angina pectoris and intermittent claudication is indicative; with the latter, due to severe vasospasm of anatomically affected vessels lower limbs, suddenly painful cramps occur when walking calf muscles or first a feeling of numbness, stiffness of the lower leg and foot, urgently requiring complete rest, stopping, after which the blood circulation is again sufficient and the pain immediately subsides. It is characteristic that gradually, when walking, a certain adaptation may occur, and after a number of forced stops due to pain, the patient can already move much more freely; Apparently, the dystonic factor is reduced due to vasodilator substances formed in working muscles, and most importantly, due to the establishment of nervous regulation. angina pectoris was called “intermittent claudication of the heart” (claudicatio intermittens cordis). The main significance in the origin of angina pectoris should be given to the disturbance of coronary circulation due to changes in cortical activity and reflex influences from various internal organs. Changed in their activity, often sclerotic coronary vessels are also a source of irritation, a source of pathological signaling sent to the cerebral cortex. During an attack of angina, signs of irritation of the autonomic subthalamic centers are also observed, which were previously considered characteristic primarily of functional angina (“nervous toad”), such as: “emission of liquid spastic urine, urge to go down, increased blood pressure,” as well as “sharp hyperalgesia integument of the pre-cardiac region."

The recurrence of angina attacks is facilitated by residual, trace reactions in the cerebral cortex and coronary vessels of the heart.

Diagnosis and differential diagnosis of cardiac angina

A diagnosis of angina pectoris due to coronary sclerosis should be made in all cases where the patient may have atherosclerosis, in particular coronary sclerosis, and there is at least a blurred picture of a typical pain syndrome, even without sharp severe pain with typical irradiation. The most evidence for the diagnosis of angina pectoris is not the severity of the pain and not the classic fear of death (angor), but the appearance of sensations, even if little characteristic of walking, physical work, and their disappearance at complete rest or after taking nitroglycerin. The severity of the pain, as has been said, matters less; it can range from a feeling of great heaviness in the heart area, squeezing like pincers, to vague squeezing, numbness behind the sternum or on the left towards the neck or shoulder joint. The attack is often limited by numbness, an unpleasant sensation of stiffness in the left arm in the area of the branching of the median nerve.

IN Lately they are trying to provide an objective basis for the diagnosis of angina attacks by carrying out dosed physical exercise on patients and noting the displacement in the electrocardiogram taken at this time S-T interval, absent under the workload of a healthy heart (the method, however, has no undeniable significance).

Having diagnosed the anginal nature of the pain, it is necessary to further establish whether the patient really has coronary sclerosis or whether a pain syndrome of a similar origin is not associated with coronary sclerosis.

These are:

Reflex angina pectoris of vagal origin when affected abdominal organs, especially with a diaphragmatic hernia in the hiatus oesophageus area, when the cardiac part of the stomach protruding into the chest like a hernia irritates the vagus nerve passing nearby - the beginning of the reflex. High-lying peptic ulcers of the stomach or cancer of the cardia may also be accompanied by reflex angina pectoris, which is eliminated after removal or mobilization of the cardia of the stomach. Inflammation of the gallbladder and hepatic colic can also be accompanied by angina pectoris, and a cholecystectomy operation can lead to the cessation of these referred pains for years. Apparently, any other hollow organ abdominal cavity, especially the stomach and intestines, can become, if it is overstretched, a source of the vagal reflex to coronary circulation hearts. So, Botkin describes the case sudden death, apparently of this origin, caused by excessive stretching of the stomach with pancakes. True, usually in this kind of patients, as, for example, with cholelithiasis in obese elderly people, it is more correct to suspect the presence of coronary sclerosis, with the leading significance being a violation of neurovascular regulation.
Angina pectoris of a hemodynamic-ischemic nature, caused by insufficient oxygen delivery to the heart with unchanged coronary vessels due to low systolic volume, insufficient pressure in the initial part of the aorta, oxygen deficiency in the blood with severe anemia, with illuminating gas poisoning, etc. So, even in young patients with severe rheumatic stenosis of the aortic mouth, severe anginal attacks are possible due to insufficient blood pressure in the sinuses of Valsalva, and hence insufficient blood irrigation of even unchanged coronary arteries, especially since the heart, which is sharply hypertrophied due to aortic disease, requires more oxygen. Aortic valve insufficiency also, although less frequently, leads to angina pectoris due to too rapid fluctuations in pressure in the arterial system, which do not provide a constant supply of blood to the heart muscle. Excessive tachycardia, for example, paroxysmal tachycardia, tachycardia during crises of Graves' disease, can also disrupt the blood supply to the myocardium and cause ischemic pain. At severe anemia, as, for example, with malignant anemia with very low hemoglobin numbers (about 20% and below), painful attacks can also be associated with insufficient oxygen supply to the myocardium, and with an improvement in blood composition, the attacks stop. Acute blood loss can also cause angina pain. Collapse with insufficient blood supply to the heart, for example, in a person recovering from a severe infection when taking the first steps in the ward or in a patient with hypoglycemic shock, can also be accompanied by ischemic pain in the heart. Of course, here too we should think more often about sclerosis of the coronary arteries. Thus, in patients with malignant anemia, especially in elderly men with symptoms of apparently anemic angina, as well as in patients with diabetes mellitus in the presence of seemingly only hypoglycemic angina, there is often severe coronary sclerosis. With rheumatism and valvular disease of the aorta, rheumatic coronaryitis, etc., can occur simultaneously.

Angina pain can also occur as a result of rapidly developing hypertension in acute nephritis, when the heart muscle cannot cope with a sudden obstacle and often also reduced blood flow through the coronary arteries, as well as an overdose of adrenaline when administered intravenously.

Excessive physical activity with a healthy heart is less likely to cause angina pectoris, since increasing shortness of breath forces you to stop working before the lack of blood affects the myocardium; significant expansion of the heart under these conditions can cause pain in the cardiac region, apparently due to stretching of the pericardium.

Occurs when chronic nephritis, and even more so when hypertension angina pectoris is neurogenic in nature, but is usually combined with coronary sclerosis. The so-called tobacco angina pectoris is also functional in nature, but is often combined with coronary sclerosis or leads to it. Angina pectoris must, further, be differentiated from pain of a different origin in the heart area, in the chest, independent of myocardial ischemia.

Aortalgia in syphilitic aortitis is characterized by constant mild pain mainly behind the manubrium of the sternum, not associated with walking, not relieved by nitroglycerin and at rest, and is explained by the involvement of inflammatory process nerve elements outer shell aorta and adjacent tissues. This character of pain in the upper part is especially obvious. chest detected clinically with significant saccular aneurysms with periaortitis. In practice, aortalgia is difficult to distinguish from anginal pain caused by syphilitic aortitis by specific damage to the orifices coronary vessels or a complication of ordinary coronary sclerosis.

Pain in acute sweating pericarditis is associated with excessive stretching of the pericardium when its supporting function is exceeded. When fluid accumulates in the pericardium under high pressure, the coronary arteries can apparently be compressed and the blood circulation in them is impaired.

The pathogenesis of pain in the heart region in acute myocarditis is unclear. Perhaps they arise as a result of overstretching of the heart or the formation in the severely affected myocardium of products of disturbed metabolism, similar to those arising in the ischemic muscle tissue of the heart.

Pain in the heart area can be a manifestation of diseases neighboring organs. These are the retrosternal pains associated with paramediastinal pleurisy, sometimes occurring with dysphagia, different pupil sizes, etc.; pain radiating to the shoulder, disrupting breathing, with diaphragmatitis; pain in the left nipple with intercostal neuralgia, fibrositis, myositis, gouty deposits, fractured ribs, osteomyelitis, periostitis, with painful cramps of the diaphragm in neuropaths - the so-called phrenocardia, or with a high standing of the diaphragm, especially in women during menopause.

In this group of diseases, the localization of pain at the nipple and skin soreness in the same area often come to the fore, although such pain can also occur with typical angina pectoris of varying severity.

Finally, angina pectoris is often confused with cardiac asthma, although in the classical manifestation of these syndromes there is almost nothing in common: however, they are united to a large extent by the commonality of pathogenesis and in some cases can either be combined or alternate in the same patient.

Course and prognosis of cardiac angina

Angina pectoris, despite severe subjective sensations and the fear of imminent death experienced by the patient, usually ends well. However, once the attacks appear, they are usually repeated, gradually increasing in frequency; for example, first 1-2 times a year, then monthly and finally almost daily. Mild attacks that allow the patient to move freely over a considerable distance can last for decades. Only rarely do pain attacks stop for years or many years, which usually happens if the patient manages to lose excess weight and gradually exercise, stop smoking, etc.

However, the very next attack of angina pectoris can be fatal, accompanied by a heart attack. Angina at rest, that is, not associated with physical activity, is prognostically more severe than angina pectoris, since the latter indicates greater preservation of the coronary circulation.

Progressive angina

Progressive angina is characterized by the fact that the frequency and strength of attacks gradually (sometimes quite quickly) increases, attacks occur under conditions that have not been observed before, that is, the disease moves from functional classes I-II to III-IV. This form of the disease most often develops due to the formation of a crack or rupture of an atherosclerotic plaque and subsequent formation of a blood clot.

Sometimes spontaneous (variant, vasospastic) angina, or Prinzmetal's angina, is observed, which is characterized by the spontaneous nature of attacks, that is, attacks often occur at rest and not under the influence of stress.

Patients suffering from this form of angina, as a rule, do not have pronounced atherosclerotic lesions, and the deterioration of blood supply to the heart muscle occurs due to spasm of the coronary arteries. In spontaneous angina, the cause of ischemia - bleeding of a section of cardiac muscle tissue - is not an increase in myocardial oxygen demand, which manifests itself due to any circumstances (stress), but a significant decrease in its delivery.

A type of angina is the so-called syndrome “X” (microvascular angina). With this disease, patients experience typical symptoms of angina pectoris, but there is no pronounced narrowing of the lumens of the coronary arteries, which is detected as a result of coronary angiography.

Prevention and treatment of cardiac angina

A patient with angina pectoris should first of all reduce physical activity, avoid movements after lunch, when each additional stress especially easily causes a painful attack, and should not eat heavily at night, when, due to changes in central regulation and the predominance of the vagus, coronary blood flow may worsen. The patient should avoid anxiety and other conditions that previously caused an attack of angina.

The doctor should familiarize himself in detail with the patient’s daily routine, his workload, and give advice regarding possible pauses in work, less haste, and greater peace of mind at work and at home. Changing the routine can prevent seizures: for example, introducing an hour of rest after lunch, if you are sensitive to cold, warming the bed before bed, ensuring an extra hour of rest at night, taking prophylactic nitroglycerin before leaving the house, etc.

In case of neuroreflex toad, one should strive to reduce the sensitivity of irritated receptor apparatus, for example, treat gallbladder disease in the case of angina pectoris of reflex gall bladder origin.

At the same time, it is important to reassure the patient and point out the absence of changes in the heart muscle, such as for the most part and happens in early periods diseases, on the reversibility of functional disorders of vascular activity. With an exclusively sedentary lifestyle, especially in younger, overweight patients, as already mentioned, a regimen of movement with a more meager diet is certainly useful.

Warmth in any form: hot foot baths, hand baths, even immersing one left hand in a mug with hot water, applying a heating pad to the arm, to the area of the heart, can prevent an incipient attack or relieve pain.

The classic medicine is nitroglycerin, which for speed of action should be taken in the form of a 1% alcohol solution (recipe No. 41) 1-2 drops on the tongue, preferably on a piece of sugar - nitroglycerin in an alcohol solution is absorbed from the oral mucosa faster than from the stomach . An important condition is to take medication at the very beginning of an attack. Nitroglycerin is mostly tolerated satisfactorily, only some patients experience painful headaches and a feeling of heaviness in the head, which is why they are reluctant to resort to this effective means. Side unpleasant effects are even more often caused by amyl nitrite, 2-5 drops of which, when inhaled, also give a quick effect. The patient must always have nitroglycerin with him in the form of drops or tablets, which also has a psychotherapeutic effect. It should be noted that the tablets have a less rapid effect.

If you don’t have nitroglycerin at hand at the time of an attack, you need to use hot water and apply mustard plasters to your calves and heart. In all cases, it is very important to calm the patient, give him a few drops of validol (recipe No. 229), which helps many patients with angina, tincture of valerian, etc.

For a longer-term effect on blood vessels, sodium nitrite (recipe No. 43), eiphylline (recipe No. 44), papaverine in combination (for a calming effect) with luminal, which also acts as a vasodilator (recipe No. 49), are prescribed.

Physiotherapeutic agents affecting the reactivity of peripheral vessels and reflexively on the coronary circulation, for example, general darsonvalization or the heart region, diathermy and ionogalvanization of the cervical sympathetic nodes, irradiation with a mercury-quartz lamp in erythemal doses (carefully!), general water saline - pine baths (in milder cases). For more severely ill patients, physiotherapy and hydrotherapy are contraindicated as they disturb complete rest.

For particularly persistent pain or damage to extracardiac autonomic nerves, paravertebral injections of a solution of novocaine or alcohol into the sympathetic trunk or into the nodes that conduct pain from the heart are indicated. They also tried to use surgical methods of treatment, in particular, suturing a flap of tissue rich in blood vessels - pectoral muscle or omentum - to the heart, with the expectation of achieving the germination of the heart with new vessels and supplying it with blood from these tissues (cardiac revascularization).

In addition to long-acting nitrates, in the treatment of angina pectoris, individually selected combinations of antihypertensive drugs (beta-blockers, ACE inhibitors, calcium channel blockers, diuretics), antiplatelet agents (acetylsalicylic acid drugs), and statins are used.

In some cases it is necessary surgical intervention- coronary artery bypass surgery or balloon angioplasty and stenting of the coronary arteries.

Coronary artery bypass grafting consists of applying a bypass shunt between the aorta and the coronary artery, through which blood bypasses the area affected by atherosclerosis. In this case, autografts act as a shunt - the patient’s own veins and arteries, of which the shunt from the retrosternal artery is considered preferable, that is, this is a mammary-coronary bypass. Leg veins can also be used for bypass surgery.

Next, stenting is performed, that is, implantation of a special design - a stent, since without this, the operation to widen the artery is ineffective. In some cases, the stent is pre-coated with a special drug - a cytostatic.

Necessity of application surgical treatment determined by the doctor individually after conducting a special study - coronary angiography (coronary angiography). However, this is a rather complex examination method that is used in special cases. And the main method of examination for suspected angina is an electrocardiogram, which, for a more accurate diagnosis, can be performed at rest and after exercise.

Electrocardiographic examination is used to determine electrical impulses hearts, which show the presence or absence of ischemia (lack of blood supply to any part of the heart muscle tissue), as well as features of the heart rhythm, including disturbances, as well as some other characteristics.

An idea of the degree of blood supply to certain areas of the heart muscle tissue allows one to obtain differences in the concentration of a substance or its absence in a certain part of the heart.

Another way to detect vascular changes, which is often called the “gold standard” for diagnosing angina, is an angiogram (coronary angiography).

To avoid the consequences of angina, it is very important to prevent the disease.

Primary measures to prevent angina pectoris include:

moderate physical activity;
balanced diet;
body weight control;
quitting smoking and drinking alcohol.

The horizontal position of the patient's body can provoke an attack of unstable angina.

If, in the presence of the above symptoms, the patient has not been examined by a cardiologist, and the clear nature of the ischemic heart disease has not been established, a consultation with a specialist doctor is required to make a conclusion about the possibility and safety of the procedure. dental procedures V outpatient setting, possible medicinal preparation.

Data medical documentation, confirming that angina has a stable course, i.e. occurs due to load. The patient's condition is without angina attacks for a week or more with minimal drug support (no constant use of prolonged and short acting). All this indicates a compensated form of pathology. In the absence of signs of fear and fear of dental intervention, it is possible dental treatment without the prior opinion of a medical specialist.

The patient's unstable condition, the appearance of signs of angina within a week, significant drug support (continuous intake of long-acting nitrates, frequent intake of short-acting nitrates) - outpatient dental treatment should be postponed until consultation with the patient's attending physician and stabilization of his condition.

For patients using nitrates regularly to prevent angina attacks, it is necessary to ensure that the patient receives the drug on time and its peak pharmacological action occurs during dental care. If necessary, give the patient his usual dose of nitrates.

Afobazole 10 mg 60 minutes before dental surgery is recommended for patients with various types reactions (sthenic and asthenic).

The neuroleptic Carbidin in a dose of 0.025 g 60 minutes before treatment, according to research, is quite effective for premedication in patients with cardiovascular pathology.

If the patient has had a myocardial infarction within the last 6 months, due to the risk of relapse, outpatient dental care can be provided only to the minimum acceptable extent and for urgent reasons.

Massage for angina pectoris

Indications: angina pectoris, rehabilitation period after myocardial infarction.

The patient lies on his stomach. Massage of the back and neck muscles includes stroking, rubbing, kneading, and vibration. First, massage the areas adjacent to the cervical and thoracic spine. They use the techniques of planar stroking, rubbing with fingertips in circular directions, pressing, sliding, and light continuous vibration. Then stroking and rubbing the intercostal spaces are performed. Then the left shoulder and left shoulder blade are stroked, rubbed and kneaded.

The patient turns over onto his back; Rollers are placed under the lower back, knees and neck. Chest massage is performed by stroking and rubbing the area of the heart, sternum and left costal arch. Then apply the technique of light continuous vibration on the chest. Move on to abdominal massage: perform stroking, rubbing, kneading the muscles abdominals. After which they do general massage upper and lower extremities. The duration of the massage is 15-20 minutes.

Acute pain in the chest area is a frequent companion to coronary heart disease 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 can protect a person from serious complications.

There are several types of this disease:

Angina pectoris(stable and progressive). Symptoms usually occur against the background of intense physical activity, V 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 help, 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 trying to take a deep breath only intensifies the chest pain.
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 stable and progressive forms of the disease increases with smoking, alcohol consumption, diabetes mellitus, 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 medications offered for the treatment of the disease, many prefer to relieve an attack of angina 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 massaging reflex points on the neck, knees, wrist and shoulder joint. 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, a headache appears, which is relieved with a regular painkiller.

Alternative medicine recipes offer the following ways to combat the disease:

In a saucepan with 1 liter of homemade red sweet 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. With increased stomach acidity, 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 of drug therapy. In addition, we should not forget that a patient with diseases of the cardiovascular system should be regularly examined by a cardiologist.

Painful sensations due to cardiac pathology are quite vivid. Their location is in the chest, sometimes they radiate to other parts of the body, causing pathological processes in the myocardium or arteries. But the nature of the pain can be different, and from it it is quite possible to determine what condition is developing in the most important body. It is important to know the nature of pain during angina pectoris, because this condition is life-threatening.

Angina pectoris needs to be recognized early

Characteristic

Pain syndrome during angina pectoris is characterized by a sharp manifestation, since the lumen of the artery narrows/occludes unexpectedly. The sensations themselves are squeezing and/or pressing - the person feels difficulty breathing. Pain can occur without previous action - angina at rest. At acute attack heaviness will be added to these sensations.

Important! It will be possible to relieve the discomfort of angina after taking any vasoconstrictor drug.

A person at the time of an angina attack has a feeling of a foreign object in the sternum; he does not feel the area where the blood path is blocked by blockage of the artery. In some situations, numbness/burning occurs - these manifestations of pain are considered typical. Another feature of the development of the condition is the systematic increase in pain, which disappears at the peak of the syndrome.

Discomfort may last 1…5 minutes. An attack begins after intense exercise or a sudden stop while walking. Pain that lasts a couple of moments is not typical for angina. If the attack is provoked by severe physical exertion or emotional stress, the pain may last for more than 15 minutes. This condition may indicate the onset of a heart attack. If the sensations persist for several hours, this is a non-coronary pathology.

Location of pain: sensations

Typical localization has one general appearance - pain during angina pectoris appears in the upper or middle part of the sternum with a shift to the left towards the heart, because there is a blockage of the artery. Pain can originate in any part of the sternum. This is explained by the specificity of the blood supply to the myocardium. If the pain syndrome is mild, it affects a small area and spreads throughout it at the time of the attack. discomfort. If the pain is severe, then with angina it spreads throughout the chest.

Based on a person’s behavior at the time of progression of the pain syndrome, it will be possible to determine what is happening to him:

Levin's sign - at the time of an attack, when pain manifests itself, a person puts his fist on his chest in the area of the heart.
Coronary insufficiency - the patient places one or both hands on the chest (heart), folding them. The “lock” with closed hands moves from top to bottom and from bottom to top.

Localization of discomfort during angina pectoris

Spread of sensations

Irradiation of pain is observed in patients in left side body: shoulder, shoulder blade, hand. Sometimes angina pectoris may cause pain in the ulnar nerve, but the sign is ambiguous. But a sure sign is pain in the neck, lower jaw, and shoulder. An attack of angina rarely occurs as discomfort in the abdomen or lower back.

Referring pain is not the same as the main one. If it hits the jaw, it is perceived as toothache. If it goes to the forearm, it is similar to numbness of the arm, weakness in it.

There are rarely complaints about increased sensitivity skin in one place or in several on the arm at the level where the heart is located. But this is not considered an accurate sign of attack progression.

With angina pectoris after exercise, it occurs sharp pain. Moreover, the load can even be simple walking, and it will affect the condition of the arteries and the development of the attack. Eating a heavy lunch or dinner and climbing stairs can also cause angina.

Systematically recurring attacks indicate that a person is experiencing stress, which provokes the development of heart disease.

Classes of angina and its prerequisites

The stable form of the disease has functional classes:

The first class of the disease develops after extreme stress. For example: climbing uphill, up stairs at a fast pace. Less common after walking against the wind at sub-zero temperatures.
The second is that the attack and pain occur during normal walking without load.
Third and fourth grades - the development of an attack in the morning after one or two simple movements is typical. As the day progresses, endurance increases, and the disease does not manifest itself with light exertion.

Peculiarities

Many factors influence how this type of heart disease feels:

Form of the disease.
Patient's age. And with age there is one specific trait– the attack becomes less pronounced, but the duration of pain with angina increases. In young people, the pain is sharp, intense, radiates to the upper parts of the body, and autonomic lesions may occur.
Other diseases of the heart and arteries.
Other features.

Spread of pain during an angina attack

An attack of angina is often accompanied by a strong feeling - the fear of death. This is not surprising, because the attack appears abruptly, in the morning hours, when the person is not fully aware of himself.

The following reactions occur against the background of angina pectoris:

Dizziness.
Dry mouth.
Increased pressure in the arteries.
Pallor of the skin.

How to get rid of pain?

You want to get rid of such sharp and frightening sensations, because recognizing them is not everything. The first effective aid is nitroglycerin. If attacks recur with enviable regularity, you must always have it with you. Nitroglycerin quickly dilates arteries and blood vessels, normalizing blood circulation. A couple of minutes after taking the drug, the pain subsides, the characteristic sensations decrease and disappear.

If relief does not occur, take another tablet. The drug has a number of side effects:

Headache.
Feeling of fullness above the waist.

Parallel intake of validol will help to eliminate them; for 1 tablet of nitroglycerin, take 0.5 tablets of validol. If taking the second pill does not give results, call an ambulance.

Conclusion

A condition such as angina pectoris is not considered rare - it occurs frequently, and severe cases can be fatal. Therefore, it is important to understand how clogged arteries manifest themselves. It is not difficult to recognize characteristic sensations; it is important to understand what to do about it.

Symptoms of an angina attack, modern methods of treatment and first aid

Angina is characterized by pain that occurs suddenly. The pain itself is somewhat compressive in nature - it is simply difficult for a person to breathe. Often pain occurs without prior action - this is a form of angina during the rest period. By taking any vasodilator drug in a timely manner, the pain goes away.

Typical anginal pain is a pressing and squeezing pain syndrome. It can be painful or perceived as an acute syndrome, which indicates the intensity of the attack.

Often the patient has a feeling of being in the chest foreign object. Sometimes there is numbness or, conversely, a burning sensation in the chest.
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We kindly ask you NOT to self-medicate, but make an appointment with a specialist!

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Localization

The localization of pain during angina pectoris is the upper or middle part sternum, which is slightly shifted to the left towards the heart. In this case, pain can occur anywhere in the chest, which is explained by the characteristics of the blood supply or innervation of the myocardium, as well as the localization of the lesion itself. Mild pain affects a small area, strong pain affects the entire chest.

Pain due to disturbances in the functioning of the heart and the formation of an attack of angina pectoris is determined by the movements of the patient himself.

Here they highlight:

The patient puts his fist on his chest during the period of pain. This is called Lewin's sign.
You can also notice how patients, during periods of pain, place a hand or two hands on their chest, bringing them together with their palms. Here there is a characteristic movement of the palm with closed fingers across the chest, pointing downwards and vice versa. This principle is called the silent diagnosis of pain due to coronary insufficiency. The gestures were described by V. Martin in 1957.

Irradiation

Most patients experience irradiation of pain due to angina pectoris in left shoulder, spatula, brush. Pain often occurs along the way ulnar nerve, which does not always characterize the onset of an angina attack. It is better to pay attention to pain in the neck or lower jaw, as well as in the shoulder.

In especially rare cases, patients complain of pain in the abdomen and even in the lower back, which can also be triggered by an attack of angina.

As a rule, radiating pain differs from the main one. For example, pain in the lower jaw can be perceived as pain due to inflammation of the dental nerve. Forearm pain is characterized by numbness or weakness in the limb.

Patients also often complain of increased sensitivity of certain areas of the skin on the left arm and in the area where the organ is located. Pain in the presented areas does not indicate the development of angina pectoris.

You can also use Eufillin. The drug is effective for and. But this medicine should be taken with caution because it lowers blood pressure, so be sure to rule this out before using it.

Differential diagnosis

Before providing assistance, the specialist carefully listens to the patient’s complaints and also asks him about the details - it is necessary to exclude heart diseases with similar symptoms. For example, cardiac neurosis has the same symptoms, but pain in most cases occurs outside of the chest area- at the top.

Cardiac neurosis does not manifest itself paroxysmally, but rather protractedly. The pain may bother the patient for several days. At the same time, the use of vasodilator drugs does not give positive results. Often, tincture of valerian or lily of the valley helps here.

Pain in the chest area may indicate lung or organ disease digestive tract that are nearby. The formation of a hiatal hernia should also be excluded.

Among diseases of the cardiovascular system, coronary artery disease (CHD) occupies one of the leading places in adults. In the vast majority of cases, the cause of IHD is atherosclerosis. Cholesterol plaques, narrowing arterial vessels lead to ischemia, and as a consequence, to severe consequences both from the heart and other internal organs. When a vessel is narrowed by a plaque, ischemia is observed - a decrease in blood circulation in the organ where it enters less blood. If speak about cardiovascular system, then the consequences directly mediated by the atherosclerotic process include myocardial infarction, severe cardiac arrhythmias, acute and chronic heart failure, and acute coronary death.

Causes of coronary artery disease and angina pectoris

Coronary heart disease is a disease associated with a decrease in blood supply to the heart, associated with an organic narrowing of the coronary arteries (heart vessels), the cause of which is often cholesterol (atherosclerotic) plaques, less often vascular spasm.

A plaque is a complex pathological formation on the inner surface of an arterial vessel. Cholesterol plaques can form in any artery, including the coronary arteries of the heart. In its development, the plaque goes through several stages, starting from a flat lipid spot and ending with a lipid (fat) formation protruding into the vessel. The main structure of a cholesterol (atherosclerotic) plaque is cholesterol with its fractions, various lipids in combination with proteins. Formed elements of blood (platelets, red blood cells), various inflammatory mediators, and proteins also take part in the formation of plaque.

Atherosclerosis, or more precisely, the beginning of the atherosclerotic process, the formation and development of plaque, begins in adolescence. With age, especially in the presence of a hereditary predisposition, the rate of growth of cholesterol plaques accelerates. The atherosclerotic plaque grows in all directions, and processes of inflammation, fibroformation and calcification are observed in it.

At the beginning of the disease, the plaque does not interfere with blood flow, since the lumen of the vessel is sufficient to provide the organ with oxygen despite the narrowing of the artery. At this stage, IHD cannot be recognized through a routine medical examination. Angina pectoris and ischemia do not manifest themselves in any way and the diagnosis cannot be made without additional studies.

Subsequently, as the plaque grows and evolves, the formation of a fibrous cap and internal fatty substance, it begins to cover 25-50-75 or more percent of the internal diameter of the artery. Typical complaints appear, the main one of which is an attack of angina (typical pain in the heart area, behind the sternum).

At the onset of the disease (typically), coronary heart disease is associated with physical activity. As the plaque develops and enlarges, the degree of exercise tolerance changes. If at the beginning of coronary artery disease an attack of angina develops under an extreme load for a given patient, then subsequently chest pain may appear with mild, everyday stress, and sometimes at rest.

The occurrence of an angina attack can be explained as follows. At rest, when oxygen requirements are not so high, despite significant constriction of the heart vessel, blood enters the myocardium in sufficient quantities. But as soon as you perform any physical exertion or experience emotional stress, the oxygen demand of the heart muscle increases. The narrowed vessel is unable to supply the heart sufficient quantity blood, ischemia occurs, and symptoms of angina pectoris appear.

What should you do if you have heart pain? Symptoms and signs of angina

Angina is a typical chest pain (pain in the heart) of a squeezing and pressing nature. The pain lasts several minutes, usually no more than five. Pain in the heart is accompanied by palpitations, weakness, fear, and can radiate to the left hand, little finger, under the left shoulder blade, shoulder, jaw and teeth. Angina goes away if the patient takes nitroglycerin (in the form of tablets, drops, spray or capsule under the tongue).

Heart pain (angina attack) is relieved after cessation of physical activity. Nitroglycerin is a drug that quickly dilates coronary vessels.

A typical attack of angina is NOT accompanied by a drop in cardiac activity, serious violations rhythm, sharp decline blood pressure, wide irradiation of pain and its pronounced intensity.

If pain in the heart lasts more than 5-10 minutes and angina pectoris is felt as an intense burning, bursting retrosternal unbearable pain that cannot be relieved with nitroglycerin, then these symptoms, with a high degree of probability, may indicate a developing myocardial infarction (necrosis of the heart muscle).

Necrosis of an area of the myocardium is irreversible process. Therefore, at the first suspicion of myocardial infarction (severe attack of angina), it is necessary to urgently call an ambulance. In the first 2 hours from the onset of blockage of the coronary artery by a thrombus, revascularization of the heart muscle is possible (restoration of blood flow at the site of complete closure of the lumen of the vessel).

This is achieved by pharmacologically dissolving the blood clot with special drugs, or by surgical intervention at the nearest vascular center. With timely treatment, the consequences and complications of myocardial infarction can be avoided. Important! Any delay in calling an ambulance can have irreversible consequences.

In addition to the coronary arteries, the blockage of which is manifested by coronary heart disease, the formation of cholesterol plaques can occur in all large arteries. The cerebral (cerebral) arteries, arteries of the lower extremities and kidneys are most often subject to atherosclerotic modification. Often cholesterol plaques are localized in various parts of the aorta and mesenteric arteries.

Atherosclerosis of certain localizations has characteristic manifestations. For example, with atherosclerotic damage to the brain, narrowing of the arteries can lead to both a rapid increase in symptoms ( stroke), or to a slow decline in brain function (encephalopathy, cognitive changes, dementia).

In some cases, ischemia occurs without typical angina attacks, which makes this disease even more dangerous and unpredictable.

What help should be provided for heart pain due to angina pectoris?

If pain in the heart appears (an attack of angina), you should stop moving, you need to calm the patient, give him a comfortable position (sitting or lying with the head of the bed raised), provide air flow, call a doctor, and measure blood pressure. If systolic pressure (BP) is not lower than 100 mm. rt. Art., you need to give a tablet or capsule of nitroglycerin, or apply a nitroglycerin spray under the tongue.

If the pain in the heart does not go away and the angina attack is not stopped, these steps can be repeated after a few minutes, having previously measured the blood pressure level. You can apply distracting procedures (mustard plasters on the heart area, a warm bath for the left upper limb). If the attack lasts, give the patient an aspirin tablet.

If you have an angina attack, especially if this situation happens for the first time, you must call an ambulance.

Diagnosis of coronary artery disease and angina pectoris

After an attack of angina, the patient is recommended to undergo an in-depth examination by a cardiologist, including an ECG, a biochemical blood test for lipid composition (cholesterol, its fractions), and ultrasound of the heart. In some cases, a more complex study is required - coronary angiography (x-ray contrast method), which makes it possible to more accurately diagnose the degree and location of narrowing of the coronary vessel.

If severe and (or) multi-vessel stenosis (narrowing of several coronary arteries) is diagnosed, if there are no contraindications, coronary artery bypass grafting or stent installation is resorted to.

Prevention of angina

For the prevention of coronary heart disease and other diseases based on increased level cholesterol, all people, especially over 50 years of age, need to undergo timely screening. It can be completed within medical examination, and individually with a cardiologist or therapist.

When visiting a doctor, the patient will be diagnosed with complaints of heart pain, increased blood pressure, and a hereditary predisposition. The doctor will find out whether blood relatives have had similar diseases (heart attacks, strokes), and at what age?

The patient will undergo anthropometry (measurement of height, weight), examine the total content of cholesterol in the plasma, its fractions, lipoproteins, and the state of the blood coagulation system. An ECG examination is mandatory. If necessary, it is possible to use Holter ECG monitoring (an ECG study is carried out throughout the day and allows you to record everything, including painless episodes of ischemia).