An attack of angina pectoris: symptoms. angina pectoris

- This is a condition in which a person has paroxysmal pain in the chest area. This is due to an acute lack of blood supply to the myocardium. Thus, the patient has clinical manifestations .

Types of angina pectoris

In medicine, it is customary to define several varieties of angina pectoris, depending on its frequency and nature. Yes, at new onset angina pectoris there is a manifestation of symptoms of angina pectoris for about a month, after which there is a regression of the disease, or the transition of the disease into the form of stable angina pectoris.

At tense (stable) angina pectoris there is a regular development of attacks of the disease. They arise at this stage as a consequence of various kinds of stress. This form of angina pectoris is said to be the most "pure" form of the disease. This stage of the disease often signals a high risk of the patient developing .

At progressive (unstable) angina the patient has seizures that occur suddenly and unexpectedly. Often they develop in a person who is at rest. During the development of such an attack, a person feels very severe pain in the chest. This type of angina is the most dangerous precisely because of the increased risk of developing myocardial infarction. Very often, with unstable angina, the patient is hospitalized.

At variant angina the development of an attack often occurs at night and is a direct consequence of vasospasm. You can track this form of angina pectoris by the results of an ECG. In general, it is a fairly rare disease.

Causes of angina pectoris

Angina pectoris is both a disease and a clinical syndrome. If we are talking about a separate disease, then most often angina pectoris occurs as a consequence coronary arteries . This phenomenon provokes a noticeable narrowing of the lumen of the arteries, which, in turn, prevents the normal blood supply to the myocardium. Especially often angina pectoris manifests itself in a person due to strong physical and emotional stress. If the arteries due to severe atherosclerosis are narrowed by 75% or more, then angina pectoris attacks are also manifested in the patient due to moderate mental and physical stress.

An attack of angina usually occurs after the blood flow to the mouths of the coronary arteries decreases. It occurs in patients arterial hypotension (especially dangerous in this case) diastolic hypotension ), at venous hypotension , fall in cardiac output , tachyarrhythmias . Also, a reflex effect from the esophagus, biliary tract, and spine can provoke an attack of angina pectoris, if there are concomitant ailments of these organs. Acute narrowing of the lumen of the coronary artery occurs as a consequence of a non-clotting thrombus, swelling of an atherosclerotic plaque.

An attack of angina pectoris subsides if the level of work of the heart muscle is normalized under the influence of or reduce the load. At the same time, blood flow to the coronary arteries is normalized.

Symptoms of angina pectoris

Symptoms of angina pectoris are always clearly defined. So, pain in angina pectoris is paroxysmal in nature, having a clearly defined time of onset and end of an attack. Pain always manifests itself under similar circumstances and conditions. After taking nitroglycerin, the pain gradually subsides or stops completely.

The main condition for the manifestation of an angina attack in a person is a state of tension. It most often develops when walking - for example, while accelerating, climbing up, in the process of carrying a heavy load, or when moving immediately after a hearty meal. However, the manifestation of symptoms of angina pectoris can also provoke other types of stress, as well as emotional overload. If physical efforts continue or their intensity increases, then chest pain increases. But if a person stops efforts, then the pain symptoms of angina pectoris gradually disappear after a few minutes.

Sometimes pain in angina pectoris is localized behind the sternum, which is the most typical symptom. In more rare cases, pain radiates to the neck, lower jaw, teeth, left arm and shoulder blade. Basically, the pain has a pressing, compressive character, in more rare cases, a burning, similar to pain appears. Sometimes a person feels heaviness in the chest, discomfort from the feeling of having a foreign body in the chest.

With angina pectoris, the patient experiences a sharp increase , perspiration appears, the person turns pale.

All of the above characteristic features of pain are taken into account in the process of diagnosing the disease. They make it possible to distinguish the manifestation of angina pectoris from pain in the region of the heart, which indicates other diseases.

Experts note that a similar mechanism for the occurrence of pain in angina pectoris is of great importance, since due to severe pain a person stops and stops physical activity, which is beyond the strength of his heart.

Diagnosis of angina pectoris

The diagnosis of angina pectoris often occurs at the very first time a person complains to a specialist. At the same time, to reject such a diagnosis, one should observe the patient's condition for a long time, conduct a series of examinations, as well as a thorough questioning of the patient.

In the process of diagnosing angina pectoris, an ECG study is used, as well as stress tests, myocardial scintigraphy, two-dimensional echocardiography, radionuclide ventriculography, coronary angiography and other methods. In the process of examining a patient using an ECG, a specialist can observe the presence of specific signs that indicate that the patient has a myocardial ischemia . True, in the process of diagnosis, the fact that such signs are not observed at rest should be taken into account, therefore, when performing a standard ECG, it is not always possible to establish the correct diagnosis.

To detect such signs, a patient with suspected angina pectoris is Holter monitoring . This technique consists in the fact that for a certain time, usually a day, a constant recording of the ECG is performed. At the same time, the person continues to live his normal life. Thanks to this technique, it becomes possible to fix the manifestations of ischemia, determine how dependent they are on various kinds of stress, find out how effective the treatment is and whether pathological changes are pronounced.

With the help of stress tests, in which the situation is modeled when the myocardial oxygen demand increases, it is possible to determine a number of points that are important in the diagnostic process. Such tests are carried out exclusively under the strict supervision of a specialist; in the process of their conduct, signs of ischemia are recorded. It is important to note that such tests are not performed in unstable angina and myocardial infarction. Also, a contraindication to the use of this method is heavy , Availability heart and respiratory failure , arterial hypertension with high blood pressure, strong .

To date, three types of stress tests are used: physical loads on a bicycle ergometer and treadmill, pharmacological tests, and pacing.

Using any of these methods, one of the methods is used to register ischemia: ECG, scintigraphy, echocardiography. The most commonly used tests with physical activity on a bicycle ergometer (special exercise bike) or on a treadmill (treadmill) using ECG control. With the help of special tables, which take into account gender and age, the permissible load level is calculated. The test is terminated after reaching this value. If there are no symptoms of ischemia, then the result of the test will be negative, and the person does not have angina pectoris. If there are signs of ischemia, then the person has angina pectoris. If a certain case seems to be very difficult for specialists, then coronary angiography can be used. This method is highly informative. In the process of conducting such a study, selective contrasting and visualization of the coronary arteries using X-ray equipment is performed. Coronary angiography allows you to determine the presence of stenotic areas of the arteries and the degree of their narrowing.

Treatment of angina pectoris

As the main mechanisms for relieving an angina attack: a rapid decrease in the level of work of the heart muscle and normalization of the adequacy of the inflow is determined. Therefore, the treatment of angina pectoris, first of all, involves the relief of attacks of the disease. Patients should be aware that this disease is a dangerous disease, so therapy should take place exclusively under the supervision of a specialist and preferably in a hospital.

With the help of adequate treatment of angina pectoris, it is important to achieve the following results: reduce the risk of myocardial infarction in the patient in the future, improve the overall quality of life of the patient.

In order for the therapy of the disease to be as effective as possible, it is important to follow the recommendations of the doctor without fail. So, it is necessary to completely stop smoking, balance the daily diet, optimize physical activity, constantly monitor blood pressure.

for patients with angina pectoris provides for the use of a minimum amount . It is important to avoid the appearance and also limit alcohol consumption to 30 g per day.

In order to eliminate those causes that directly affect the manifestation of angina attacks in a person, it is important to prevent those situations that increase myocardial oxygen demand. So, one should not allow both physical and emotional stress that provoke the appearance of pain. If this is difficult to implement, then for prevention it is necessary to take antianginal drugs . It is equally important to abandon physical activity that occurs in parallel with other factors that provoke angina attacks. These are cold, wind, the state of the body after eating and after sleep. You can not take drugs that increase myocardial oxygen demand for the treatment of other diseases.

As a medical treatment for angina pectoris, three main groups of drugs are prescribed that act on the coronary vessels, expanding them. These drugs are nitrates, β-blockers, calcium channel blockers. To stop an attack of angina pectoris, fast-acting drugs are chosen: these are, first of all, nitroglycerine in tablets, aerosols, applications, ampoules, as well as tablets . Most often, patients take these drugs sublingually, but today sprays are also gaining wide popularity. After nitroglycerin, the effect is noticeable after 1-3 minutes. If the effect after taking the pill is not observed, you can take another tablet of nitroglycerin after five minutes. In the most severe cases, nitroglycerin preparations can be administered intravenously.

Long-acting nitrates are drugs , ; among the drugs-in-blockers most often used, atherosclerosis. Therefore, preventive measures should be taken already in middle age - at 35-40 years. It is important to note that the prevention of angina pectoris is especially necessary for those people whose close relatives have had cases of angina pectoris.

It is important to balance the daily diet so as to limit the amount of easily digestible carbohydrates and fat that are of animal origin. Parents should ensure that children do not overeat, thereby preventing them from becoming overweight. In addition, the recommended diet should not contain broths from fatty meat and fish, fried and smoked dishes, herring, canned food, fatty meat, seasonings and sauces, alcohol, flour, strong coffee and tea. You can not overeat at night, it is important to divide food into several equal meals. Experts recommend regular fasting days: they can be done once every two weeks.

From an early age, you need to provide adequate and constant physical activity. The most suitable load in this case is swimming, leisurely running in the fresh air. Every day you need to walk for at least half an hour. In addition, an important point in the implementation of angina prevention measures is smoking cessation.

If a person has a tendency to heart disease, it is important to take all measures aimed at reducing pressure. People who have intermittent angina pectoris should always carry the pills prescribed by their doctor and take them both during the attack and to prevent angina pectoris. So, the patient can take nitroglycerin before serious physical exertion.

Complications of angina pectoris

Angina is fraught with the development of very serious complications. So, among them, progression is most often manifested in patients, as well as the subsequent development myocardial infarction . In this case, the first symptom of a heart attack is sometimes just a prolonged attack of angina pectoris, which lasts for about half an hour in a patient. In addition, manifestations of angina pectoris provoke the occurrence in the future arrhythmias .

What is angina? Signs, symptoms, treatment of angina pectoris - we will talk about all this below. This disease is also called angina pectoris.

How does this disease manifest itself and what can be done to prevent it? And what are the signs of angina pectoris?

Development of the disease

Angina pectoris is a manifestation of cardiac ischemia and a consequence of atherosclerosis. The coronary arteries play an important role in the functioning of the heart. They feed it with oxygen and other important substances. Under certain conditions, the lumen of these vessels narrows. Arteries can also constrict due to spasms. Up to a certain point (less than 50 percent), a decrease in the lumen of the vessel is not significant. However, exceeding this limit can lead to irreversible changes in the heart muscle. There is not enough oxygen, and pain occurs.

This usually happens during physical or emotional stress. At such moments, the heart, as a rule, needs more oxygen. There is a so-called angina attack, the symptoms of which are pain and shortness of breath. More severe symptoms are also possible.

The reasons

Coronary arteries can narrow for several reasons, but the main one is, of course, atherosclerosis. Due to not proper nutrition fatty plaques and blood clots form on the inner walls of blood vessels. In places of their deposition, the clearance is noticeably reduced. If a thrombus breaks away from its place, with the blood flow it can enter any thin artery, including the coronary artery, and clog it. But usually this happens in those places where the vessels are already narrowed. As a result, blood flow is markedly reduced, and oxygen starvation occurs in the tissues of the heart.

The cause of angina pectoris, as mentioned above, can also be vasospasm (this is how nicotine acts on them, for example). Almost all of the above does not appear by itself. In 90% of cases, the causes of angina will be malnutrition, smoking, alcoholism and a sedentary lifestyle. However, regardless of this, signs of angina pectoris are more likely to occur in people whose relatives have died from coronary heart disease or suffered from angina pectoris.

Sad statistic

To the above, it must be added that signs of angina pectoris in men appear more often than in women. What is it connected with? Most likely, it so happened historically that the life of a man is more connected with physical activity.

And that means the heart wears out faster. In addition, the stronger sex is more often seen in the use of alcoholic beverages and other substances harmful to the human body. There is also a genetic predisposition. Residents of Europe (Scandinavian countries) suffer from angina pectoris many times more often than the inhabitants of the African continent. In addition, the risk of this disease when reaching old age also increases dramatically. And both in men and women. There are also professions that give a high risk of developing heart disease. For example, this is the driver. It combines at least two unfavorable factors: a sedentary lifestyle and emotional stress. As for the place of residence, studies give sad statistics. In urban residents, signs of angina pectoris and cardiac arrhythmia appear more often than in those living in villages and villages. And this is largely due to the fact that labor in megacities ceases to be physical. Both men and women there lead a sedentary lifestyle, which in turn leads to excess weight and bad habits.

Varieties of angina pectoris

There are three of them. These are stable, unstable and variant angina. The first case is the most common. It occurs mainly due to atherosclerosis and manifests itself during physical exertion. It is subdivided, in turn, into four classes, each of which indicates the stage of development of the disease. In the first, for example, the pain is quite rare, usually with significant physical exertion. This is followed by class 2 angina pectoris, the signs of which (attacks of pain) are already manifested simply when walking fast or climbing stairs. In the third stage, problems can already arise when going outside in cold weather and with little physical exertion.

Well, the most unfavorable situation is the fourth functional class of angina pectoris. Signs of it are the inability to perform any physical work without discomfort. But pain can still occur even at rest. In general, this, of course, is a pre-infarction state. Under the same definition almost immediately falls and unstable angina. Her symptoms are usually the following:

1. A patient with stable angina pectoris has an increase in the frequency and strength of attacks.

2. Pain occurs at rest.

3. There is post-infarction angina pectoris, the signs of which may appear within two weeks after the illness.

4. The disease occurs unexpectedly - for the first time in life.

All of the above are conditions of unstable angina and a reason for emergency hospitalization. Urgently call an ambulance! But what signs of angina suggest that it is unstable? First of all, this is an attack at rest or with little physical exertion. Secondly, one tablet of nitroglycerin does not help - you have to take at least two. And thirdly, the attacks are longer than with stable angina.

Variant angina

With this type of disease, attacks usually occur at rest at night or in the early morning. It is caused by spasms of the coronary vessels. Moreover, atherosclerotic plaques may be absent in the arteries. The attack usually lasts no more than five minutes. A nitroglycerin tablet helps with pain.

Signs of angina pectoris and ischemia

First of all, this is pain behind the sternum, which can radiate to the left arm, under the shoulder blade, and less often to the lower jaw and abdomen. There are cases when it extends to the right half of the body: to the leg and chest. The nature of the pain is usually burning, there is a feeling of squeezing. Sometimes an attack may be accompanied by sweating and vomiting. It lasts less than fifteen minutes.

When taking nitroglycerin, the pain passes quickly enough. Often occurs during physical exertion, for example, during intensive walking (in this case, you have to stop). But with the cessation of any action, the condition improves. Moreover, the signs of angina pectoris in women sometimes differ from those in men. They, as well as those suffering from diabetes, may not experience pain during ischemia of the heart. But increased heart rate, sweating, nausea and dizziness are present. However, as a rule, the first signs of angina pectoris are pain in the region of the heart and shortness of breath during physical or emotional stress. In addition, often during an attack, people experience fear. They put their hands to their chest, and it seems to them that the heart begins to beat unevenly, or even stops altogether, which is by no means always true. Signs of angina pectoris and cardiac arrhythmias are sometimes similar. But basically the first disease is the cause for the development of the second.

Treatment

Let's say right away: it makes no sense to fight the disease on your own. As soon as you have angina pectoris, the signs (symptoms) of which we have listed above, be sure to consult a doctor and undergo a thorough examination. It is necessary for making a diagnosis, determining the prognosis of the disease and prescribing the correct treatment. In the early stages (stable angina), medication is usually used. The patient is prescribed drugs that dilate blood vessels, thin blood clots, and others. A strict diet and moderate exercise are also required. In difficult cases, coronary artery bypass grafting or angioplasty is used. Sometimes laser removal of plaques from vessels is advisable. However, the prognosis of the disease is often unfavorable: the development of myocardial infarction is possible. It is important to remember: the first signs of angina pectoris appeared - and treatment should follow immediately.

Finally

So we learned what angina pectoris is. Signs (symptoms), treatment of angina have long been known to doctors around the world. It is the main cause of myocardial infarction and many deaths. Quit smoking, drink alcohol in moderation, eliminate junk food from your menu, and exercise. All this will help maintain the health of the heart and blood vessels.

Arrhythmias can manifest themselves:

• feeling short of breath;
• general and muscle weakness;
• darkening in the eyes;
• dizziness;
• loss of consciousness.

The development of these manifestations is due to a decrease in blood circulation in the brain, muscles and other organs, resulting from a violation of the pumping function of the heart. With severe tachycardia ( when the heart rate may exceed 200 beats per minute) diastole is shortened so much that the heart does not have time to fill with blood, so the amount of blood expelled into the arteries during systole is significantly reduced. With bradycardia, the heart may contract at a rate of less than 60 beats per minute, which is not enough to maintain blood flow to vital organs at a constant level.

Pulse changes

The most accessible arteries that allow you to determine the pulse are:

• Carotid artery - is determined on the lateral surface of the neck, 2–3 cm to the side of the Adam's apple ( adam's apple).
• Brachial artery - is determined in the region of the middle third of the inner surface of the shoulder.
• Radial artery - palpated in the area of ​​the anterolateral surface of the wrist or lower third of the forearm.

• An increase or, conversely, a decrease in frequency - Normal heart rate and pulse rate is 60 to 90 beats per minute.
• Rhythm disturbance - unequal time intervals between several subsequent pulse waves.
• Small filling ( empty or thready pulse) – the pulse wave is felt weaker than usual.
• Softness - the slightest effort is enough to clamp the artery and prevent further conduction of the pulse wave.

Paleness of the skin

On the other hand, narrowing of the skin vessels may be the root cause of an angina attack ( e.g. in the cold), which must also be taken into account when diagnosing.

Increased sweating

Behavior of patients during an attack

Frequent and strong heartbeat, shortness of breath and pain significantly affect the patient's psycho-emotional state, which is described by many patients as "fear of death". The patient's face during an attack is pale, frightened, "suffering", droplets of sweat appear on the forehead.

Types of angina pectoris

From a clinical point of view, there are:

• first-time angina pectoris;
• stable angina pectoris;
• progressive angina pectoris.

New onset angina pectoris

It is important to understand that the first attack of angina pectoris can be caused not only by narrowing of the lumen of the vessel, but also by rupture of an atherosclerotic plaque, thrombosis or spasm of the coronary vessels. These conditions belong to the so-called spontaneous angina pectoris and require immediate hospitalization of the patient.

Stable exertional angina

Stable exertional angina is divided into 4 functional classes, which are determined depending on the load required to cause a pain attack.

In stable angina pectoris, tensions are distinguished:

• I functional class. Attacks of angina pectoris rarely occur with extremely heavy physical exertion or stress. The duration of the attack usually does not exceed 2 - 3 minutes. The daily activities of the patient are not limited in any way.
• II functional class. Attacks of angina pectoris occur with prolonged, continuous walking ( over 500 meters), while running, when climbing stairs several floors. The likelihood of an attack increases with stress, in the cold, after eating or smoking, which slightly limits the patient's daily activities.
• III functional class. An attack occurs when walking slowly over a distance of more than 100 - 200 meters, when climbing to the 1st floor, with any excitement or stress, which significantly limits the patient's daily activities, but he is able to serve himself independently.
• IV functional class. An attack occurs with any, even the most insignificant load ( getting out of bed, putting on a coat) or even at rest ( more often at night when lying down). Any movement is accompanied by pain, so such patients need constant care and observation.

progressive exertional angina

Characteristic features of progressive angina pectoris are:

• Reducing the minimum load that causes a pain attack, including the onset of symptoms at rest.
• Increase in seizure duration.
• Increased frequency and severity of retrosternal pain.
• Accession of new symptoms ( in addition to pain, shortness of breath, heart rhythm disturbances, fainting may occur).
• Reduced effectiveness of nitroglycerin ( the previously taken dose becomes insufficient to eliminate the pain syndrome).

Diagnosis of angina pectoris

A correct questioning makes it possible to suspect angina pectoris, however, to finally confirm the diagnosis, determine the form of the disease and prescribe the correct treatment, it is necessary to conduct a number of additional studies.

To confirm the diagnosis of angina pectoris, the following is used:

• examination and clinical examination;
• electrocardiography ( ECG);
• functional load tests;
• 24-hour ECG monitoring using the Holter method;
• echocardiography ( echocardiography);
• heart scintigraphy;
• positron emission tomography ( PAT);
• coronary angiography;
• laboratory research.

Examination and clinical examination

During the clinical examination, the doctor evaluates:

• condition of the skin;
• body weight;
• cardiovascular system;
• respiratory system.

Another sign of atherosclerosis is the senile corneal arch - a light gray strip located along the edge of the cornea. Of course, the absence of these signs does not exclude the possibility of atherosclerosis, but their presence is a rather specific symptom of this disease.

Body weight assessment
More than half of patients with angina have overweight, up to obesity of varying degrees. It is possible to estimate the patient's weight using the body mass index ( BMI) - a standardized indicator calculated by the formula - BMI = ( weight in kilograms) / (height in meters) 2 . An indicator that is in the range from 18.5 to 24.9 is considered normal.

Study of the cardiovascular system
On percussion ( tapping) and palpation of the chest can be determined by the displacement of the borders of the heart to the left. This is due to hypertrophy increase) myocardium - a compensatory reaction that occurs with prolonged increased stress on the heart.

When listening to the heart during an attack of angina pectoris, muffled heart tones are determined ( due to decreased myocardial contractility), the appearance of pathological noises, arrhythmias, rapid or rare heartbeat. Outside of an attack in mild cases of the disease, no changes are noted. In severe forms ( III -IV functional class) muffled heart tones and arrhythmias can be determined at rest.

The characteristics of the pulse during an angina attack have been described previously. It is very important to simultaneously listen to the heart and determine the pulse on the radial artery, since with some arrhythmias the heart rate may be greater than the pulse rate.

More than half of the cases show an increase in blood pressure above 140/90 millimeters of mercury ( at a rate of 120/80 mm. rt. Art.).

Examination of the respiratory system
The nature and frequency of breathing, the participation of the chest and auxiliary muscles ( neck and shoulder girdle) in the act of breathing, the presence or absence of shortness of breath. If, when listening to the lungs, moist rales are determined, this may be a sign of heart failure and the exit of the liquid part of the blood into the respiratory tract ( development of pulmonary edema), which is characteristic of the later stages of the disease.

Electrocardiography

Electrocardiography takes no more than 2 - 5 minutes. Electrodes are attached to the patient's body, connected to a special device - an electrocardiograph, which records data on the electrical activity of the heart on paper.

Half of patients with angina especially in young patients) outside the attack, the ECG will not reveal any changes. In III - IV functional classes in elderly or long-term ill patients, changes characteristic of various complications of the disease can be determined. During an attack of angina pectoris, signs of myocardial ischemia are always noted.

Outside of an angina attack, an ECG may reveal:

• rhythm and conduction disturbances;
• signs of myocardial hypertrophy;
• signs of myocardial infarction;
• increase in cardiac cycle time.

• Change in the amplitude and polarity of the T wave. This wave represents the process of repolarization ( relaxation) of the ventricles of the heart during diastole. Normally it is positive that is, directed in the same direction as the QRS complex representing systole), its height is not more than 3 - 6 mm. With ischemia, the myocardium does not receive enough oxygen, and therefore the processes of muscle relaxation are disturbed, which can be manifested by high ( over 8 mm) and/or a negative T wave on the ECG.
• depression ( decline) of the ST segment. The ST segment displays the time interval from the end of the contraction of the ventricles to the beginning of their relaxation, that is, the moment when the myocardium is maximally stressed. Normally, this segment is at the level of the isoline. With ischemia of mild or moderate severity, the maximum force of contraction of the heart muscle decreases, which will be reflected in the decrease in the ST segment below the isoline.
• ST segment elevation. Indicates severe ischemia, extending to the entire thickness of the myocardial wall.

The ECG is recorded in 12 standard leads, which allows not only to detect the presence of ischemia, but also to determine the area of ​​the heart in which it develops. The described changes are recorded exactly as long as the pain attack lasts, and disappear without a trace after it stops.

Functional load tests

It is important to understand that these studies are associated with certain risks, so they should only be performed in a hospital setting in the presence of a qualified doctor with the tools and medicines necessary for first aid.

Contraindications for performing stress tests are:

• suspected acute myocardial infarction;
• unstable angina;
• severe heart failure and / or respiratory failure;
• fever ( increase in body temperature over 39ºС);
• pronounced increase in blood pressure ( over 200/100 mm. rt. Art.);
• severe arrhythmias;
• frequent history of fainting.

• bicycle ergometry;
• treadmill ( Treadmill);
• dobutamine test;
• dipyridamole test;
• transesophageal electrical stimulation of the heart.

Treadmill
In this case, instead of a bicycle ergometer, a moving track is used, the angle of inclination and the speed of which is regulated by the doctor. The patient walks or runs along it, and at this time an ECG and other indicators of the work of the heart are recorded.

Dobutamine test
Dobutamine is a drug that, when administered intravenously, causes an increase in heart rate and blood pressure, which increases the workload on the heart and increases its need for oxygen. If at the same time the patient has atherosclerosis of the coronary vessels, a typical clinical and electrocardiographic picture of an angina attack will occur.

This study is indicated if it is not possible to perform a bicycle ergometry or a treadmill test ( for example, with fractures or other diseases of the musculoskeletal system, with respiratory failure).

Dipyridamole test
Dipyridamole ( Curantyl) is a drug that causes a rapid and pronounced expansion of small coronary arteries. With intravenous administration of this drug, blood flow is redistributed in the heart muscle - healthy arteries expand, and more blood enters them. At the same time, arteries affected by atherosclerosis cannot expand, so the amount of blood entering them decreases ( there is a phenomenon of stealing), which leads to the development of ischemia of the affected area of ​​the myocardium.

This study is indicated when it is impossible to perform exercise tests, as well as in young, physically strong people ( to cause an attack of angina pectoris in an athlete, extremely heavy or prolonged loads are needed).

Transesophageal electrical stimulation of the heart
This method is indicated in cases where exercise tests cannot be performed. In this case, the esophagus ( through the mouth or nose) a special electrode is inserted, which is installed at the level of the atria and begins to send electrical impulses to the heart, thus increasing the heart rate and provoking an attack of angina pectoris. Registration of cardiac performance indicators is carried out in the same way as with other stress tests.

24-hour Holter ECG monitoring

The main advantage of this method is the ability to study the work of the heart during the daily activities of the patient. This allows you to identify the conditions for the occurrence of angina attacks and possible risk factors.

echocardiography

Echocardiography allows you to determine:

• the size of the heart and its chambers;
• the degree of filling of the heart with blood;
• stagnation of blood in the pulmonary veins;
• myocardial hypertrophy;
• violation of blood flow in the coronary arteries ( doppler echocardiography);
• past myocardial infarction.

Cardiac scintigraphy

The effectiveness of the method increases significantly if it is used during exercise tests or during the dipyridamole test.

Positron emission tomography

Coronary angiography

Performing coronary angiography is contraindicated:

• with systemic infections;
• with severe heart failure;
• with arrhythmias;
• in violation of cerebral circulation.

Laboratory research

For angina pectoris, your doctor may prescribe:

• General blood analysis. A decrease in the concentration of red blood cells and hemoglobin in the blood indicates the presence of anemia, exacerbating myocardial ischemia.
• Blood chemistry. The glucose level is determined to rule out diabetes), as well as the levels of all lipoproteins in the blood. An increase in the level of total cholesterol can indicate a violation of the metabolism of fats in the body ( more than 5.2 mmol/l) and LDL ( more than 3 mmol/l), as well as a decrease in the concentration of HDL ( less than 1 mmol/l).
• Determining the level of thyroid hormones ( T3 and T4). A decrease in their concentration in the blood can be observed with hypothyroidism.
• Determination of biochemical markers of myocardial damage. These markers are intracellular enzymes that enter the blood after the destruction of cardiomyocytes ( with myocardial infarction). The most informative is the determination of the level of troponins, myoglobin, creatine phosphokinase ( MW fractions) and lactate dehydrogenase ( LDH).

Treatment of angina pectoris

• elimination of pain attack;
• drug treatment;
• diet therapy;
• lifestyle changes;
• folk methods of treatment;
• surgery.

Elimination of a pain attack

When an attack of angina pectoris occurs:

• Stop any physical activity immediately. You need to calm down and take a comfortable position. It is not recommended to lie down, as this may increase the pain. It is best to sit down or, if the attack happened on the street, find something to lean on. If the attack developed at night, you should take a semi-sitting position. Do not get out of bed abruptly, as this can lead to dizziness and loss of consciousness.
• Take a nitroglycerin tablet under the tongue. Nitroglycerin ( drug from the nitrate group) relaxes the musculature of blood vessels ( predominantly veins), reducing the amount of blood flowing to the heart. This reduces the load on the heart muscle and its need for oxygen. When taken under the tongue, 1 tablet of nitroglycerin ( 0.5 mg) there is a fast ( after 30 - 60 seconds) the onset of the effect, which is due to the intake of the drug directly into the bloodstream. If after 5 minutes the pain has not decreased, you can take 1 more tablet. If, after resorption of 3 tablets, the pain attack has not passed, you should immediately call an ambulance, since in this case there is a high probability of developing a myocardial infarction.
• Contact a specialist. If the pain occurred with less than usual physical activity, if during the attack there were symptoms that were not there before ( shortness of breath, dizziness, loss of consciousness), or if the attack occurred for the first time, it is necessary to consult a doctor, since the described manifestations may indicate the progression of the disease or unstable angina.

Medical treatment

The main directions of medical treatment of angina pectoris are:

• Antiplatelet therapy - reduces the risk of thrombus formation on the wall of an atherosclerotic plaque ( what is the main cause of heart attack and death).
• Anti-ischemic therapy - drugs are used that reduce the load on the heart, thereby preventing or eliminating an attack of angina pectoris and other symptoms of the disease.
• Improving metabolism in the ischemic zone - drugs are used that increase the resistance of the myocardium in conditions of lack of oxygen.
• Correction of fat metabolism - prevents further progression of atherosclerosis.

Medical treatment of angina pectoris

diet therapy

According to the WHO ( World Health Organization) a healthy person should not consume more than 300 mg of cholesterol per day. In patients with atherosclerosis or angina pectoris, this figure should not exceed 200 mg per day.

Diet therapy in patients with exertional angina

Lifestyle change

Folk methods of treatment

For the treatment of angina pectoris is used:

• Infusion of hawthorn. To prepare the infusion, you need to take 3 tablespoons of hawthorn berries and pour 2 liters of boiling water. Infuse for a day in a dark place, then strain, squeeze out the swollen berries and take 1 glass a day with meals. It has an antiarrhythmic effect, lowers blood pressure, improves blood supply to the heart, and also reduces the amount of cholesterol in the blood. The duration of treatment is not more than 3 weeks in a row.
• Infusion of valerian root. You need to take 1 tablespoon of chopped valerian bark and pour 1 cup of boiling water. Insist in a dark place for a day, then strain and take 1 tablespoon 3 times a day 30 minutes before meals. Valerian has a calming effect, dilates the coronary vessels, and also lowers blood cholesterol ( increasing the excretion of bile from the body).
• Motherwort tincture. 100 grams of dry motherwort leaves pour 500 ml of 70% alcohol and insist in a dark place for 3-4 weeks. Strain and take 5-7 drops of tincture 3-4 times a day 30 minutes before meals. Motherwort has a calming effect, improves heart function, and also helps to remove fluid from the body, which reduces the load on the heart muscle.

Surgery

For the purpose of revascularization of the coronary arteries, the following is used:

• Percutaneous transluminal coronary angioplasty. A special balloon is carried to the site of stenosis, which is inflated under pressure of several atmospheres, destroying the atherosclerotic plaque and increasing the lumen of the artery by 50-80%. The risk of re-stenosis with this method is more than 30%. In this regard, the stenting method has recently been used - after the expansion of the stenotic artery, a special wire frame is installed in it ( stent), which prevents re-stenosis.
• Coronary artery bypass grafting. The essence of this operation is the imposition of an anastomosis, that is, a bypass that conducts blood from the aorta to the coronary artery beyond the narrowing site. For this purpose, a part of the saphenous vein of the patient's thigh is usually used. The efficiency of this operation is almost 90%, which ensures normal blood supply to the myocardium for 10 years or more.

• damage to two or three coronary arteries;
• damage to the left coronary artery larger, feeding the left ventricle);
• pronounced decrease in the pumping function of the heart ( regardless of the number of affected arteries).

• With diffuse stenosis of all coronary arteries.
• With a decrease in the pumping function of the heart, due to the presence of many scars ( after a heart attack).
• In the presence of severe comorbidities ( kidney failure or liver failure, cancer in the last stage and so on).

Prognosis for working capacity and quality of life for patients with exertional angina

With unstable angina pectoris ( new onset or progressive) or with III-IV functional classes of stable angina, the prognosis is less optimistic. Such patients are often unable to work, and their daily activities are significantly limited, which sometimes requires constant monitoring. Without timely treatment, the life expectancy of such patients is reduced. This is due to the high risk of complications, many of which can be fatal.

Angina pectoris can be complicated by:

• Myocardial infarction. A heart attack is the most formidable complication of angina pectoris, resulting from a rupture of the wall of an atherosclerotic plaque and the formation of a blood clot that completely clogs the lumen of the affected artery. The consequence of this is the death of the area of ​​the myocardium, the delivery of blood to which is impaired. If the death of the patient did not occur immediately after this ( due to a sharp and pronounced decrease in the contractile activity of the heart), dead cardiomyocytes are replaced by fibrous tissue, that is, a scar is formed.
• Arrhythmias. Violation of the blood supply to the myocardium, as well as the presence of scars, contributes to the occurrence of arrhythmias, which can cause dizziness and fainting. The most dangerous type of arrhythmia is ventricular fibrillation, in which cardiomyocytes contract and relax separately at a high frequency. In this case, the pumping function of the heart is almost absent, which without emergency assistance ( defibrillation) leads to the death of the patient within 2 to 5 minutes.
• Heart failure. With severe atherosclerosis or as a result of many heart attacks, the heart is unable to perform its function, which leads to edema in the legs, shortness of breath, pulmonary edema and other manifestations of heart failure.
• Thromboembolism of the pulmonary artery. In some cases, when an atherosclerotic plaque ruptures, a blood clot can enter the right ventricle. With the blood flow, it is transferred to the pulmonary arteries and clog them, which can lead to acute respiratory failure and death of the patient.

• elderly age;
• the appearance of the first seizures before the age of 30;
• widespread atherosclerotic process ( if more than 3 coronary arteries are affected, the prognosis is less favorable);
• severe stenosis of the left coronary artery ( narrowing of more than 70% of its lumen);
• a pronounced decrease in the contractility of the heart;
• high blood pressure ( over 180/90 mm. rt. Art.);
• diabetes;
• concomitant respiratory failure.

Ischemic heart disease is a myocardial lesion caused by a disorder of the coronary circulation that occurs as a result of an imbalance between the coronary blood flow and the delivery of oxygen to the heart muscle. IHD is based on an organic lesion of the coronary arteries, caused in the vast majority of cases by stenosing atherosclerosis, which may be accompanied by thrombosis. Less commonly, the cause of coronary artery disease can be functional conditions of the coronary arteries (spasm or increased tone of the coronary arteries), which, ultimately, are also superimposed on existing defects in the endothelium of the coronary arteries.

The most common manifestation of coronary artery disease is angina pectoris. This is a clinical manifestation of transient myocardial ischemia, which occurs as a result of an acute discrepancy between myocardial oxygen demand and its delivery.

The most significant symptom is pain.

• The nature of the pain syndrome: paroxysmal discomfort or pressing, squeezing, deep dull pain, an attack can be described as tightness, heaviness, lack of air.
• Localization and irradiation:
• - the most typical localization is behind the sternum or along the left edge of the sternum.
• - irradiation to the neck, lower jaw, teeth, interscapular space, less often - to the elbow or wrist joints, mastoid processes
• Duration: from 1-15 minutes (2-5 minutes).
  Causes of occurrence: connection with physical and emotional stress
  Factors that eliminate the attack:
  - taking nitroglycerin
  - termination of the load

The following symptoms of angina pectoris are less common:

1. An increase in blood pressure, which in turn provokes manifestations of headache, dizziness, weakness.
2. Shortness of breath is a common symptom of oxygen starvation of the myocardium. The person begins to sweat for no apparent reason.
3. Often, angina pectoris is accompanied by interruptions in the work of the heart, a person feels well an uneven and chaotic pulsation.
4. There may be nausea, vomiting.
5. A person experiences fear, increased physical activity.

Classification of angina pectoris

Currently, the following types of transient myocardial ischemia are considered: stable angina, variant angina and silent myocardial ischemia.
1. Stable angina
Stable angina pectoris, depending on the severity, is usually divided into functional classes:
I FC"Ordinary daily physical activity" (walking or climbing stairs) does not cause angina attacks. An attack of angina pectoris occurs when performing very intense, or very fast, or prolonged exercise.
II FC"Slight limitation of usual physical activity", which means the onset of angina pectoris as a result of walking fast or quickly climbing stairs, after eating or in cold or windy weather, or under the influence of emotional stress, or in the first few hours after getting out of bed; while walking more than 200 m (two blocks) on level ground
or while climbing more than one flight of stairs at a normal pace under normal conditions.
III FC"Severe limitation of usual physical activity" - an attack of angina occurs as a result of walking a distance of one to two blocks (100-200m) on level ground or climbing one flight of stairs at a normal pace under normal conditions.
IV FC“The inability to perform any type of physical activity without the occurrence of
discomfort "- an attack of angina pectoris can occur at rest.

2. Variant angina
Some patients with coronary artery disease experience episodes of local spasm of the coronary arteries in the absence of obvious atherosclerotic lesions; this pain syndrome is called variant angina, or Prinzmetal's angina. In this case, oxygen delivery to the myocardium is reduced due to intense vasospasm, the mechanism of which is currently unknown. Variant angina often develops at rest, the cause of ischemia in this case is a pronounced transient decrease in oxygen delivery, and not increased myocardial demand for it due to exercise. Criteria for clinical and ECG diagnosis of vasospastic angina:
- anginal attacks are accompanied by a transient rise (rather than a decrease) of the ST segment on the ECG;
- Anginal attacks can sometimes appear against the background of performing physical activity, which at other times is usually well tolerated, the so-called variable threshold for the occurrence of angina pectoris. These attacks develop after exercise performed in the morning, but not in the daytime and evening;
- anginal attacks can be prevented and stopped with AA and nitrates, the effect of BB is less pronounced; in some patients with angiospastic angina, BBs can cause a proischemic effect.

3. Painless (silent) myocardial ischemia
A fairly significant proportion of episodes of myocardial ischemia can pass without symptoms of angina pectoris or its equivalents, up to the development of painless myocardial infarction. Episodes of silent myocardial ischemia are usually diagnosed during exercise testing and 24-hour ECG monitoring, as well as during routine ECG recordings.
Painless myocardial ischemia is divided into:
- Type I - changes of the ischemic type, detected during exercise or
24-hour ECG monitoring in persons with no pain syndrome.
- Type II - painless ischemia, recorded in patients with seizures
angina.
- Type III - painless ischemia in patients with no angina pectoris after
transferred myocardial infarction.

It's important to know! With the third and fourth types of angina, very often a person needs professional medical care, since the accompanying symptoms negatively affect the condition and can provoke the development of dangerous diseases (myocardial infarction, tachycardia)

How to treat angina pectoris

Like any disease associated with a disruption in the functioning of the cardiovascular system, angina pectoris is treated with several types of drugs at once, which, interacting with each other, provide an effective therapeutic effect.

Nitrates

This group of drugs helps the myocardium to relax, which leads to a decrease in the need for oxygen and the removal of painful spasm of the heart muscle. Also, nitrates dilate peripheral vessels, which helps the rapid outflow of blood from the heart.

Nitroglycerine

Nitroglycerin is the most effective drug that quickly stops the painful attack of angina pectoris.

This is the most effective drug that quickly stops the painful attack of angina pectoris. The main advantage of this drug is rapid absorption by mucous tissues. Nitroglycerin is not chewed, but placed under the tongue and after a few minutes begins its therapeutic effect. It contributes to the rapid removal of the pain effect due to the outflow of blood from the myocardium and the normalization of vascular dilatation. Nitroglycerin is taken to relieve seizures and to prevent exacerbation of the disease. The dose of the drug is calculated individually, based on pressure indicators (the drug reduces blood pressure) and the presence of other diseases (anemia, hyperthyroidism, renal and liver failure). The drug is addictive, which is why its effect on stopping seizures weakens over time. With prolonged use, it is recommended to take breaks and take similar antianginal drugs.

It's important to know! Nitroglycerin from the first dose should relieve an attack of retrosternal pain. If the person's condition has not stabilized, you can take another ball of medicine. If the condition does not improve after the second dose, it is possible that the person develops a myocardial infarction and the victim urgently needs hospitalization.

Nitrosorbide

This drug reduces pressure in the pulmonary circulation, which contributes to the unloading of the myocardium. When taken, it helps to increase tolerance to physical exercises and stress. Unlike nitroglycerin, it has low absorption, so it takes a little longer to remove an attack. Also, the main difference between this drug and similar ones lies in the localized direction of action: Nitrosorbide expands the walls of the veins, it does not affect the arteries and aorta so effectively. The drug can be placed under the tongue, behind the puppy, or taken orally. It is taken at 10 mg during an attack, it tends to accumulate over time, which leads to a weakening of the effect. It is not recommended to increase the doses, it is better to change the medicine of this group for a while.

Transdermal stickers

This drug is ideal for those who do not like to take pills or who need to take antianginals on a regular basis as a preventive measure or therapy. The patch is a multilayer system that slowly delivers a certain amount of nitrates to the skin. Thanks to the stickers, the risk of an angina attack is reduced, and there is a preventive effect. Depending on the size of the patch, the dose of the drug delivered to the body depends.

Adrenoreceptor blockers

These drugs reduce myocardial oxygen demand by reducing heart rate. Blockers practically do not affect the work of the heart in cases where a person is at rest. With an increase in physical activity, the drugs begin their therapeutic effect.

Anaprilin

This drug is prescribed according to the scheme: the first few days the minimum dose is 20 mg 3 times a day. After a few days, the dose is gradually increased to 240 mg per day. The drug is not contraindicated in violation of the kidneys, but in liver diseases, the dose must be adjusted individually. It has a large list of side effects, including dizziness, allergic reactions to components, gastrointestinal upset, migraine headaches, and sleep disturbance. If unpleasant symptoms appear, it is recommended to replace the drug with a similar one.

Betaxolol

The drug of prolonged action, is taken once a day, 10 ml. After 14 days, the dose can be doubled if the therapeutic effect is insufficient. It is necessary to take medicine with caution for people with kidney failure, diabetes and blood diseases. In case of an overdose, it can provoke convulsions, dizziness, bronchospasm.

Atenolol

This drug is taken once a day, in the morning after meals. The initial dose to be followed for 2 weeks is 50 mg. Further, the dosage can be doubled - up to 100 mg in one or two doses. If the drug does not stop angina attacks at the maximum dose, further administration of atenolol is considered inappropriate.

The drug has absolute contraindications, which should be taken into account: heart failure, bradycardia, hypertension, the period of bearing a child.

It's important to know! This group of drugs should be prescribed by a doctor after examining the patient's medical history, since blockers have quite a few contraindications.

calcium channel antagonists

Due to the blockade of complex proteins that contribute to the spasm of arteries and blood vessels, with the help of drugs in this group, a beneficial effect on the functioning of the myocardium is exerted. The heart muscle contracts less, there is an outflow of blood to the peripheral circulation and the human condition improves.

Diltiazem

This drug belongs to the modern third class of antagonists and has a fairly wide list of side effects. It is prescribed for angina pectoris and hypertension due to vasodilating properties. The dose of the drug is selected individually, the maximum daily dose is 360 mg, the minimum is 180. With any negative symptoms, the drug should be discontinued, since exceeding the dose can provoke collapse or pulmonary edema.

Gallopamil

This is a second generation drug, prescribed for angina pectoris or to prevent recurrent myocardial infarction. Effectively unloads the myocardium, dilates blood vessels, ensures the normal movement of blood through the peripheral vessels. The dose is prescribed based on the severity of angina attacks - from 50 to 100 mg 2 times a day. If desired, a large dose of the drug can be divided into 4 parts. Main contraindications: hypotension, impaired renal function, pregnancy, childhood, some cardiac pathologies.

Verapamil

This drug belongs to the first group of antagonists. Effectively affects the myocardium, promotes vasodilation, normalizes the heart rhythm. For the prevention of angina pectoris, the daily dose of the drug is 320 mg, which must be divided into 4 doses. For the treatment of angina pectoris, the dose of the drug is significantly increased - up to 500 mg, especially if the disease has a dangerous stage.

Take with caution to people who have a history of impaired kidney and liver function or are prone to pressure surges.

Diuretics

These drugs are diuretics, which allows you to quickly remove swelling from the walls of spasmodic vessels and arteries. They are prescribed in a complex, together with antagonists and blockers.

Chlortalidone

The word "angina" is of Greek origin: "steno" means narrowing, tightness, and "cardia" - the heart. Literally - "shyness of the heart." The concept of angina pectoris is associated with the concept ischemic heart disease (CHD)- heart disease, in which blood supply to the heart muscle is stopped or reduced due to pathological processes in the coronary (coronary) arteries that feed the heart. The decrease in blood flow leads to disruption of the heart, which requires a sufficient amount of oxygen carried in the blood to perform its functions. In conditions of lack of oxygen, attacks of retrosternal pain periodically occur - angina pectoris.

As a disease, angina pectoris has been known for a very long time. The famous ancient Greek physician, the "father of medicine" Hippocrates (460 BC - 357-356 BC) pointed to the danger, sometimes fatal, of frequent bouts of sudden chest pain. The Roman Stoic philosopher, poet and statesman Lucius Annaeus Seneca (4 BC - 65 AD) wrote about an attack of angina pectoris: - dying, because the pains, although short, are strong, like a storm. "Angina pectoris" is an old 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 pains in the chest are very strong and unusual ... accompanied by suffocation and a feeling of fear ... then they represent a serious danger, and they can be called ...“ angina pectoris ”... Most often they occur when walking (especially uphill) and shortly after eating in the form of painful and extremely unpleasant sensations in the chest, which are getting worse and do not go away. It seems to the person that he is about to die, but when he stops, the feeling of tightness in the chest disappears, 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 lasts 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 pectoris 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 spasm, there is a discrepancy between myocardial oxygen demand 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 the vessels.

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

In recent 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 features:

• increased level of total cholesterol in blood plasma (normally it should be 3.6-5.2 mmol / l);
• high blood pressure;
• low levels of “good” cholesterol (HDL cholesterol);
• elevated plasma triglyceride levels (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;
• burdened family history of atherosclerosis.

The combination of several risk factors significantly increases the likelihood of developing atherosclerosis and, as a result, coronary artery disease and its form - angina pectoris. Today, coronary artery disease is the main cause of death in the population. According to the GNITs (State Research Center) of preventive medicine in Russia, about 10 million of the able-bodied 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. At the same time, about 40-50% of these people are aware of their disease, while 50-60% of cases remain unrecognized and untreated. It is for these reasons that it is very important to recognize angina pectoris in time and seek medical help.

Symptoms of angina pectoris

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

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

Pain can be triggered by:

1. brisk walking, climbing stairs, carrying heavy loads;
2. increased blood pressure;
3. cold;
4. plentiful food intake;
5. emotional stress.

First aid for angina pectoris:

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

• increased pain in the region of the heart;
• severe weakness;
• difficulty breathing;
• cold profuse sweat;

you should call an ambulance, because there is a risk of myocardial infarction.

Prevention of angina pectoris

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

1. impact on modifiable risk factors;
2. drug treatment;
3. surgical methods.

The second and third fusions are carried out only with the help of a specialist doctor, but each person can influence the risk factors.

The recommendations of the American College of Cardiology provide a list of activities, the usefulness and effectiveness of which in order to prevent angina and coronary artery disease has been proven and is not in doubt among experts. These activities include:

1. Treatment of arterial hypertension, while the target pressure level is below 130/80 mm Hg. Preference is given to such groups of drugs as β-blockers, calcium antagonists, ACE inhibitors. Medical treatment is selected by a doctor!
2. To give up smoking. In smokers, the risk of developing myocardial infarction (acute coronary heart disease) is 2 times higher than in non-smokers, and the risk of sudden death is 2-4 times higher. An interesting fact: the risk of developing coronary artery disease caused by smoking is completely eliminated after 2-3 years, after a person stops smoking.
3. Treatment (adequate compensation) of diabetes mellitus. Uncompensated diabetes mellitus, as a concomitant disease, accelerates the progression of coronary atherosclerosis and, as a result, angina pectoris. Type 2 diabetes increases the risk of death by 2 times in men and 4 times in women. And in type 1 diabetes, this risk increases by 3-10 times, so the need for optimal hypoglycemic therapy is generally recognized.
4. 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 exercising for 30 minutes at least 4 times a week, and even better every day. Swimming, jogging, Nordic walking, gymnastics, aerobics, and cycling are considered the best sports that have a beneficial effect on the entire body. Remember: the best medicine for the heart is to train its endurance.
5. Lipid-lowering therapy (therapy aimed at lowering blood lipids) is prescribed by a doctor and is an important component of the treatment of coronary artery disease.
6. Reducing excess body weight in the presence of arterial hypertension is an important part of the treatment of patients with coronary artery disease. It is important to follow a low-calorie diet with enough fiber-rich plant foods.

A very interesting dependence of the risk of coronary artery disease on alcohol was discovered by experts after an analysis that combined the results of 34 studies from different countries (USA, England, Japan, Germany, Russia, France, Australia and many others). The researchers concluded that moderate alcohol consumption reduces mortality from coronary artery disease. The experts described the so-called U- or J-shaped curve of the relationship between the level of alcohol consumption and mortality from coronary artery disease.

Rice. 2.J-curve of coronary artery disease risk versus alcohol.

1 - a group of people who abuse alcohol;

2 - a group of people who drink alcohol moderately;

bold line - not drinking 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 refers to no more than 1 fluid ounce (28.41 ml) of 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 coronary death by 20-30%. This phenomenon has been called the "French paradox", because in France, heart disease is relatively less common (the death rate from cardiovascular diseases 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 is consumed on average 5-10 grams, and relatively safe doses at 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 coronary heart disease remains controversial. The book of Ecclesiastes teaches: "Envy and anger shorten life." Much convincing scientific evidence suggests that hostility, anger, and anger may be associated with the risk of CHD, but definitive conclusions have not yet been made. The connection between coronary artery disease and stress can be traced in the fact that, being in frustrated feelings, a person smokes a lot, drinks, overeats, quits sports - and all this directly increases the risk of coronary artery disease. Therefore, to prevent the development of coronary artery disease, relaxation and psychotraining are recommended as a method of reducing chronic stress.

Conclusion

Ischemic heart disease is a formidable disease that ranks first in the structure of mortality. Angina pectoris is a clinical syndrome of ischemic heart disease, which over time becomes a clinical form of ischemic heart disease and becomes a disease. The health of a person 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.

Own health is in the hands of each person, we ourselves largely determine whether we get sick or not, and if we get sick, then with what. It is much more effective and cost-effective to prevent a disease than to treat it. This also applies to angina pectoris. The need to lead a healthy lifestyle is not empty words. Lifestyle change in favor of maintaining health is quite possible, realistically achievable and uncomplicated. All that is required of a person is his desire. It is difficult to imagine that desire can not be.

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

Be healthy!