Category “Conversation with a specialist” Unstable angina

Reasons for the development of pathology

Symptoms of unstable angina develop against the background of a gradual narrowing of the lumen of the coronary arteries. This phenomenon causes necrosis of cardiomyocytes. Lipid deposits on the coronary vessels lead to the formation of atherosclerotic plaques. The patient suffers from decreased blood flow in the coronary arteries.

A significant amount of lipid deposits can cause blood clots. Damaged vessels become overly susceptible to substances released by platelets. This phenomenon provokes further narrowing of the arterial lumen.

How does the disease develop?

It is at such moments that common signs of angina pectoris appear in women and men: you feel a lack of air, arrhythmia. At this time, chemical changes occur in the myocardium associated with metabolic disorders, a decrease in the synthesis of substances, and the accumulation of acids. The functions of the myocardium are gradually disrupted, and its metabolism changes.

What causes this disease? There are certain factors:

• high cholesterol levels;
• obesity when consuming excessive amounts of fats and carbohydrates;
• physical inactivity disrupts lipid volume;
• smoking causes oxygen starvation of cells and arterial spasm;
• arterial hypertension causes myocardial tension;
• anemia, intoxication contribute to oxygen starvation;
• diabetes mellitus increases the risk of ischemia;
• increased blood viscosity is a direct risk of blood clots;
• psycho-emotional stress (especially in women) worsens myocardial nutrition.

Forms of pathology

The classification of unstable angina used by cardiologists takes into account the timing of the onset of primary symptoms of the disease.

Typical signs of Prinzmetal's angina

New York cardiologist M. Prinzmetal described a type of angina pectoris in 1959, which is included in the modern classification of unstable forms of angina pectoris. In pathogenesis, great importance is attached to the increased tone of the vagus nerve.

Features of the clinic:

• occurs more often in young men;
• attacks of pain occur at rest, there are characteristic ECG changes;
• patients do not complain of pain during physical activity and tolerate it well;
• attacks often occur in the morning rather than during the day or at night;
• good effectiveness in treatment with drugs from the group of nitrates and calcium antagonists.

The prognosis of this form is unfavorable due to the high probability of transition to acute myocardial infarction.

Signs of pathology

The main symptom of unstable angina is intense pressing pain behind the sternum. The attack can last 10-15 minutes. The pain radiates to the left arm, shoulder, shoulder blade, neck and jaw. Taking nitroglycerin by the patient does not completely relieve symptoms. Over time, the frequency and intensity of attacks increase.

Manifestations of unstable angina develop against the background of:

• physical activity;
• stressful conditions;
• changeable weather;
• excessive food consumption.

Patients may experience interruptions in heart rate that occur with minimal physical activity (moving around the apartment, performing daily household chores). Later, shortness of breath joins the listed symptoms, and the person faces a lack of air.

Category “Conversation with a specialist” Unstable angina

Unstable angina is a concept under which several clinical situations are united: their common feature is the presence of attacks of pain in the chest. Recently, unstable angina has been defined as an exacerbation of coronary heart disease (impaired blood circulation in the arteries designed to provide the heart muscle (myocardium) with the necessary supply of blood), threatening the development of myocardial infarction (death of a section of the heart muscle due to impaired circulation in it) or sudden death.

Symptoms of unstable angina The main symptom of unstable angina is pain: the nature of the pain is quite strong, squeezing or pressing, often a feeling of heaviness or lack of air is felt; localization (location) of pain - behind the sternum or in the precordial region, that is, along the left edge of the sternum; pain radiates to the left arm, left shoulder or both arms, neck area, lower jaw, between the shoulder blades, left subscapular area; duration - more than 10 minutes. Factors that provoke pain: it is impossible to determine a clear connection between pain and certain physical activity or other conditions (for example, pain appears in windy weather or after eating), a painful attack often occurs at rest or with minimal physical activity (bending over, walking around the apartment); the end of a painful attack - often after repeated use of nitroglycerin; attacks occur more often than before. Heart rhythm disturbances gradually develop: increased heart rate, palpitations; heartbeats become irregular and intermittent. Shortness of breath occurs, which occurs with minimal physical activity and even at rest, and a feeling of lack of air.

Forms There are several forms of unstable angina: new-onset angina (a disease manifested by discomfort or pain in the chest of a compressive, pressing nature, which is most often localized behind the sternum and can radiate (give) to the left arm, neck, lower jaw, epigastric (“under spoon") area); progressive angina (increasing intensity and/or duration of painful attacks, their occurrence with significantly less physical activity or at rest, the addition of shortness of breath, feeling of lack of air); post-infarction angina (occurring 24 hours and up to 8 weeks after the development of myocardial infarction (death of part of the heart muscle due to cessation of blood flow in this area)) or postoperative angina (within one to two months after a successful operation to restore blood flow). In practice, the Braunwald classification (1989) is often used, dividing unstable angina into three classes (the higher the functional class, the greater the likelihood of complications: Class I - new angina or worsening of existing angina within a month; Class II - resting angina in during the previous month; Class III - angina at rest during the last 48 hours. Depending on the conditions of occurrence, they are also distinguished: class A - secondary unstable angina. This group includes patients in whom unstable angina develops in the presence of factors that aggravate ischemia (anemia ( anemia), increased body temperature, infection, low blood pressure, uncontrolled hypertension, heart rhythm disturbances, emotional stress and others); class B - primary unstable angina. This group includes patients in whom unstable angina develops without extra-cardiac conditions, increasing ischemia; class C - post-infarction unstable angina. This group includes patients in whom angina develops in the first 2 weeks of myocardial infarction.

Causes The main cause of unstable angina is the rupture of the so-called unstable atherosclerotic plaque (a formation consisting of a mixture of fats (primarily cholesterol (a fat-like substance that is a “building material” for the body’s cells) and calcium), which provokes the formation of a blood clot with incomplete closure of the lumen vessel. The presence of a thrombus (blood clot) in the artery supplying the heart prevents adequate blood supply to the heart muscle, which leads to the appearance of pain and a full-blown clinical picture (set of symptoms) of unstable angina. Plaque rupture is facilitated by: the accumulation of a large amount of fat and insufficient collagen content in it (a protein that forms the basis of connective tissue); inflammation and blood “fluidity” factors.

Diagnostics Analysis of the medical history and complaints - when (how long ago) for the first time and what specific complaints appeared (pain in the heart, shortness of breath, weakness), what measures the patient took and with what results, whether he consulted a doctor, what the patient attributes the occurrence of these symptoms to . Life history analysis is aimed at identifying risk factors for the development of angina (for example, tobacco use, frequent emotional stress), dietary preferences and lifestyle are clarified. Analysis of family history - whether there are cardiovascular diseases in relatives, cases of sudden death. A medical examination - listening, tapping and palpating the area of ​​the heart - can detect signs of hypertrophy (increase in mass and size) of the left ventricle, left ventricular failure and atherosclerosis of various vascular systems. General blood test - allows you to detect signs of inflammation in the body (increased levels of leukocytes (white blood cells), increased levels of ESR (erythrocyte sedimentation rate (red blood cells), nonspecific sign of inflammation)). A general urine test allows you to detect concomitant pathologies. Biochemical blood test - it is important to determine the level of cholesterol (a fat-like substance that is a “building material” for body cells), fractions, blood sugar to assess the risk associated with vascular atherosclerosis. Study of specific enzymes in the blood. These intracellular protein enzymes, when heart cells are destroyed, are released into the blood and help prevent myocardial infarction. Electrocardiography (ECG) is a method of recording the electrical activity of the heart on paper - changes are detected in the ST segment (a segment of the ECG curve that corresponds to the period of the cardiac cycle when both ventricles of the heart are completely covered by excitation) and the T wave (reflects the cycle of repolarization (restoration) of the ventricles of the heart muscle) . Echocardiography (EchoECG) is a method of ultrasound examination of the heart that allows you to evaluate the structure and size of the working heart, study intracardiac blood flows, the condition of the valves, identify possible disorders of cardiac muscle contractility and determine a number of specific signs of myocardial ischemia. A normal EchoECG does not exclude the presence of unstable angina. Holter 24-hour electrocardiogram (ECG) monitoring – recording of an electrocardiogram for 24-72 hours; the study reveals myocardial ischemia, the conditions of its occurrence, duration, and determines heart rhythm disturbances that can aggravate the course of the disease. For the study, a portable device (Holter monitor) is used, fixed on the shoulder or belt, which allows the patient to be periodically identified and takes readings, as well as a self-observation diary, in which the patient notes hourly his actions and changes in well-being. Stress echocardiography - the method is a combination of physical activity with echocardiographic (EchoCG) research, which allows identifying areas of impaired contractility of the heart muscle caused by physical activity. Ultrasound scanning indicators are compared at rest, at load height and during rest. These data are compared with changes in the cardiogram and existing symptoms identified at maximum load. In the acute period, it is not carried out, since myocardial infarction may occur; if treatment is successful, it is carried out for 7-10 days. Myocardial scintigraphy is a method of functional visualization of the walls and cavities of the heart, which consists of introducing radioactive drugs into the body and obtaining an image by determining the radiation emitted by them. Coronary angiography, a radiopaque method for studying the condition of the coronary bed, is indicated when the issue of surgical treatment of unstable angina is discussed or in patients with prognostically unfavorable signs of the disease. The study allows you to identify blood clots (blockages) and narrowing of blood vessels.

Treatment of unstable angina Non-drug treatment: emergency hospitalization; sharp limitation of physical activity - strict bed rest. Drug therapy. Relief (cessation) of pain: nitrates (a group of drugs that relieve a painful heart attack, but do not affect the pulse and blood pressure); neuroleptanalgesia (a method of intravenous general anesthesia in which the patient is conscious but does not experience emotions). Medicines to reduce myocardial oxygen demand - beta blockers (dilate blood vessels, slow the heartbeat, relieve pain in the heart): calcium antagonists (inhibit the penetration of calcium into the muscle cells of the heart and blood vessels, dilate blood vessels, change the heart rate). Blood thinners: antiplatelet agents (drugs that reduce the ability of platelets (blood cells responsible for blood clotting) to stick together); direct anticoagulants (drugs that inhibit the activity of the blood coagulation system and prevent the formation of blood clots). Surgical treatment: coronary angioplasty with stenting - installation of a special frame in a narrowed vessel - a stent (a metal tube made of wire cells) that holds the lumen of the vessel sufficient for normal blood flow; coronary artery bypass grafting is a surgical restoration of blood supply to the heart muscle, in which a bypass vascular bed is created that delivers blood to the area of ​​ischemia (reduced blood supply). It is performed when drug therapy is ineffective and when the main coronary artery or all coronary vessels are affected simultaneously.

Complications and consequences Development of myocardial infarction (death of cardiac muscle cells due to circulatory disorders in this area). Development of various heart rhythm disturbances (tachyarrhythmia (acceleration of the heart rate), bradyarrhythmia (slowdown of the heart rate), extrasystole (appearance of extraordinary heart contractions) and others). Changes in the myocardium (heart muscle) during unstable angina also lead to the development of heart failure - a condition of the body in which the contractility of the heart muscle (myocardium) becomes weak, as a result, the heart cannot fully supply the body with the required amount of blood, which is manifested by severe weakness and rapid fatigue. The likelihood of sudden death increases.

Prevention of unstable angina The most effective prevention of coronary heart disease is to reduce the adverse effects of threat factors.

Quitting smoking and excessive alcohol consumption (allowable dose is no more than 30 g of alcohol per day). Elimination of psycho-emotional stress. Maintaining optimal body weight (for this, the Body Mass Index is calculated: weight (in kilograms) divided by squared height (in meters), the normal figure is 20-25). Regular physical activity: daily dynamic cardio training - brisk walking, running, swimming, skiing, cycling and more; each lesson should be 25-40 minutes long (warm-up (5 minutes), main part (15-30 minutes) and final period (5 minutes), when the pace of physical exercise gradually slows down); It is not recommended to exercise within 2 hours after eating; After finishing classes, it is also advisable not to eat for 20-30 minutes. Blood pressure control. A rational and balanced diet (eating foods high in fiber (vegetables, fruits, herbs), avoiding fried, canned, too hot and spicy foods). Control of cholesterol levels (a fat-like substance that is a “building material” for body cells).

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This article is taken from the source: https://lookmedbook.ru/disease/nestabilnaya-stenokardiya

Diagnostic procedures

The absence of specific symptoms does not allow the cardiologist to confirm the diagnosis during a physical examination. The doctor carries out differential diagnosis to exclude heart attack and non-ischemic heart pathologies from the patient’s history. Clinical guidelines suggest the following tests to confirm unstable angina:

• electrocardiography;
• general and biochemical blood tests;
• echocardiography;
• coronary angiography.

Cardiologists detect changes in the condition of the coronary arteries and decreased left ventricular function. Based on these data, the diagnosis is confirmed.

Possible complications

Untreated angina can cause:

• sudden ventricular fibrillation with fatal outcome;
• acute myocardial infarction;
• acute failure of the heart muscle with pulmonary edema;
• thromboembolism of the pulmonary arteries.

Therefore, an increase in attacks and the appearance of unusual symptoms are important reasons for urgent medical attention.

When referred for inpatient treatment, refusal is considered as the patient’s responsibility for his own life.

Therapeutic measures

Conservative treatment involves prescribing several groups of drugs to the patient. Antianginal drugs relieve symptoms of angina pectoris. In acute attacks accompanied by intense pain, intravenous infusion of painkillers is performed.

Thrombolytics reduce the likelihood of blood clots. A similar goal is pursued when prescribing direct anticoagulants to a patient.

Lipid-lowering drugs remain an integral component in the drug treatment of unstable angina. They help normalize cholesterol levels in the patient’s blood. Constant use of such drugs reduces the likelihood of complications and recurrent attacks.

If conservative treatment is ineffective, the patient is prescribed surgery. The type of surgical intervention is determined by a cardiologist based on coronary angiography data. Imaging will allow us to understand the extent of damage to the coronary arteries. The most common methods of surgical treatment of angina remain coronary bypass surgery and coronary angioplasty.

Treatment

Treatment of unstable angina is carried out in an inpatient setting in a therapeutic or cardiology department.

Treatment goals:

• restore the patency of the coronary vessels as early as possible;
• stabilize clinical manifestations, relieve pain;
• prevent acute heart attack and sudden death;
• provide the opportunity for rehabilitation and adaptation to living conditions.

As first aid, the patient can take up to two Nitrogrycerin tablets. Some people prefer a spray under the tongue. It is recommended to take two Aspirin tablets to prevent thrombosis.

"Old Man" Aspirin is still in demand

In the hospital, the patient is prescribed bed rest, gradually increasing as his condition improves.

The diet comes down to frequent meals in small portions, limiting spicy and fatty foods, foods that contribute to bloating and elevation of the diaphragm.

Recommended are porridge, stewed vegetables, kefir, cottage cheese, low-fat soups, beef meat dishes, boiled chicken, and unsalted fish.

Treatment with medications

In an acute condition, nitro-containing drugs (isosorbide dinitrate, Nitroglycerin) are administered intravenously, then the dose for internal use is selected.

Anticoagulants (Heparin subcutaneously, Aspirin orally) to reduce coagulation and prevent the development of thrombosis. Modern aspirin-containing drugs can protect the stomach from harmful effects (Aspirin Cardio, Thrombo Ass, Cardiomagnyl).

A group of adrenergic blockers is prescribed in all cases except Prinzmetal's angina. These drugs are contraindicated for bronchial asthma, chronic bronchitis with respiratory failure.

Calcium channel antagonists are indicated in the absence of severe vascular damage (Cordafen, Nifidipine, Verapamil).

Symptomatic medications (painkillers, diuretics) are prescribed by the doctor on an inconsistent basis.

Causes of angina pectoris.

Angina pectoris does not occur out of nowhere; most often there is a situation due to which the heart muscle begins to experience a greater need for oxygen. These situations include:

• heart rhythm disturbance;
• high blood pressure, hypertensive crisis;
• heart defects;
• diabetes;
• obesity;
• smoking;
• frequent drinking of alcohol;
• hereditary predisposition.

Remember that an unhealthy lifestyle is as serious a reason for increasing the risk of angina as serious blood pressure and heart problems. Human health is a single system, and to preserve it it is necessary to take a responsible approach to all aspects of life.

Symptoms of angina in women and men

Pain

Most patients report the following symptoms of an angina attack. First of all, cutting, pressing pain in the chest. Many people complain that their heart “burns” or their throat “tightens.” At the same time, you instinctively want to press your hand or fist to your chest. Often the pain migrates to the left shoulder, neck, arm, and shoulder blade. It may grow or disappear suddenly. Symptoms clearly and distinctly appear during exercise, when the patient is diagnosed with IHD angina pectoris FC 2.

Pain can occur after physical exertion, stress, high blood pressure, or overeating. At night - due to stuffiness or low air temperature. Often the attack is accompanied by arrhythmia.

External symptoms and signs of angina pectoris

It is quite simple to identify an attack by its external manifestations. Pay attention to the following signs of angina: the person turns pale, sweat appears on the forehead, his face expresses suffering; fingers lose sensitivity, hands become cold; the patient breathes intermittently and rarely; the onset of an attack is accompanied by a rapid pulse.