Angina pectoris: symptoms and treatment
Angina is a sharp, severe pain in some parts of the heart that occurs due to a lack of blood supply. This is because the vessels become clogged or narrowed.
When angina pectoris makes itself felt, the patient feels a compressive pain in the chest area, which can be given to the jaw, arm, neck, shoulder. Angina pain can last from thirty seconds to thirty minutes. But most often it lasts for three minutes and goes away if the patient took any medicine or just lay down to rest.
Angina pectoris is a symptom of transient myocardial ischemia. As a result, the body develops an acute discrepancy between the supply of oxygen to the myocardium and its needs for it.
In people with coronary artery disease, angina pectoris occurs in 50% of cases or even more often. Women suffer from angina attacks less often than men. At a young age, angina pectoris develops in women in 6-20% of cases, and in men in 2-15% of cases. After the age of 55, these indicators equalize, and gender ceases to matter. This is due to the fact that after menopause, the level of estrogen decreases, and hormones cease to protect the female body from various damages.
Content:
- Causes of angina attacks
- What does a person feel during an angina attack?
- Do angina attacks mean an impending heart attack?
- Classification of angina pectoris
- Diagnosis of angina pectoris
- Angina pectoris treatment
- Surgery
- Emergency care for angina pectoris
- Prevention of angina pectoris
Causes of angina attacks
With some stress on the heart, there is a lack of oxygen, this leads to sharp pains in the heart. And the reasons may be different: due to strong physical exertion, the use of heavy or spicy food, stress, hypothermia or due to heat, after drinking alcoholic beverages.
What does a person feel during an angina attack?
Symptoms that a person experiences during an attack of angina pectoris:
- Pain. It is concentrated behind the ribcage, on the left side. Sometimes the pain radiates to the neck, teeth, and lower jaw. Less often, the gap between the shoulder blades, the elbow and wrist joints, the mastoid processes hurt.
- The pain can be dull, pressing, squeezing. Sometimes a person feels heaviness in the chest, he does not have enough air.
- The attack lasts no more than 5 minutes. It often has a relationship with emotional and physical stress.
- Increased blood pressure. Its jump provokes the onset of headache, dizziness and weakness. This symptom does not always develop with angina pectoris.
- Shortness of breath, which indicates oxygen deprivation of the myocardium. A person sweats more, for no apparent reason.
- Disturbances in the work of the heart, which a person feels well.
- Nausea and vomiting.
- Feeling of fear, increased physical activity.
Do angina attacks mean an impending heart attack?
With angina pectoris, the pain is sharp and not as long as with a heart attack. In addition, with a heart attack, nausea, weakness of the body are observed. Also, pain during a heart attack does not go away after taking pills or rest.
However, if pain with angina pectoris occurs often enough and does not go away for a long time, then this may well lead to a heart attack.
One should not think that any pain in the region of the heart is a sign of the development of angina pectoris. For example, if the pain subsides in less than thirty seconds after drinking water or taking a deep breath, then this is not angina.
Classification of angina pectoris
Modern medicine distinguishes between 3 types of transient myocardial ischemia: stable angina pectoris, variant angina pectoris, painless myocardial ischemia.
Stable angina
Stable angina is exertional angina. It usually appears after severe stress or increased physical exertion.
Stable exertional angina is divided into four functional classes, which depend on the severity of the disease:
- First functional class. Carrying out normal activities does not cause an angina attack. It is about walking or climbing stairs. An attack can occur with severe physical exertion. It can be either too intense or too long.
- Second functional class. In a person, an attack of angina pectoris can happen when walking quickly, while climbing stairs quickly, after eating, while spending time in the cold or in the wind. A stressful situation can provoke angina. Sometimes attacks recur in the first few hours after a night's rest. It is dangerous for the patient to walk more than 200 meters.
- Third functional class. The patient is forced to limit physical activity, since angina attacks occur after walking a distance of 100 meters or a little more, while climbing one staircase, on the street, regardless of weather conditions.
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The fourth class of functional activity. A person loses the ability to perform many actions, since an attack can occur at any time, even when the patient is at rest.
Unstable angina
Unstable angina - resting angina. It occurs under any stress and regardless of stressful situations. It is long lasting and often manifests itself. Symptoms of the disorder develop due to the fact that the myocardium does not receive enough oxygen against the background of narrowing of the arteries, and not due to increased physical activity.
Some features of the diagnosis, course and treatment of variant angina pectoris:
- On the ECG, anginal attacks are accompanied by a transient increase in the ST segment.
- Sometimes severe heart pain can occur after physical activity that a person received in the morning. In the evening and in the afternoon, similar physical activity does not manifest itself in pain.
- To cope with anginal attacks, you can take AK and nitrates. Beta blockers are less effective. In some patients with angiospastic angina, beta-blockers can have an anti-ischemic effect.
Painless myocardial ischemia
Very often, myocardial ischemia develops without any obvious symptoms. The person does not feel the manifestations of angina pectoris. At the same time, the intensity of the attacks can be quite high, up to the development of myocardial infarction.
It is possible to detect painless ischemia during exercise tests and when performing a daily ECG.
There are 3 types of silent myocardial ischemia:
- First type. Ischemic changes in the myocardium occur without any symptoms. They appear during physical exertion, and they can also be detected during a 24-hour ECG.
- Second type. Ischemia is recorded in patients with angina attacks.
- Third type. Ischemia develops in patients without angina pectoris, but after myocardial infarction.
The third and fourth types of angina pectoris require emergency medical attention. If you ignore this recommendation, then the likelihood of developing myocardial infarction or tachycardia increases.
Diagnosis of angina pectoris
A person with angina symptoms should seek the advice of a physician or cardiologist. The doctor will listen to the patient's complaints and take an anamnesis. It is important to clarify what factors become the basis for the development of a pain attack, how long it lasts, how intense the pain symptom is. It is necessary to find out from the patient which drugs allow him to cope with the violation.
After examining the patient, the doctor will give him a referral for laboratory tests. First of all, the patient's blood is studied. It is mandatory to determine the level of cholesterol, LDL and HDL, triglycerides, ALT, AST. Blood is taken for sugar and electrolytes. It is important to consider blood clotting indicators.
Another important marker of myocardial injury is troponins. If their level is increased, then this indicates a previous heart attack.
The next stage of the examination is instrumental diagnostics.
It includes procedures such as:
- Electrocardiogram. In this case, a decrease in the ST segment and a negative T wave in some leads will be noted. Also, the doctor can diagnose myocardial conduction disorders.
- ECHO-KG. This study will determine violations in myocardial contractility, as well as its local ischemia.
- Daily ECG. In this case, the cardiogram is removed during the day. A person should write down all of his actions that he performs. Physical activity during this period should be moderate. This will allow to assess how the heart reacts to them, whether the patient has ischemic changes in the myocardium, whether the heart rhythm is disturbed. If a rapid pulse was observed before an attack of heart pain, then this is highly likely to indicate stable angina pectoris. If the pulse did not increase, then most likely the patient has spontaneous angina pectoris.
- Coronary angiography of the arteries. This diagnostic technique allows you to assess the degree of damage to the coronary arteries, as well as to select the optimal treatment method. This study is prescribed to patients with angina pectoris of functional class 3 and 4, as well as to patients with symptoms of myocardial ischemia and to people who have had episodes of sudden death from cardiac arrest in the anamnesis. Most of these patients require surgery, since conservative therapy does not allow achieving positive results.
Angina pectoris treatment
Treatment of angina pectoris involves taking medications. There are drugs that people with such a diagnosis are prescribed without fail, as they improve the prognosis of the disease.
These include:
- Antiplatelet agents: Thrombo ass, Cardiomagnet, Clopidogrel. Their reception allows you to prevent the formation of blood clots in the vessels and reduce the likelihood of developing myocardial infarction by 30%.
- Beta blockers: Bisoprolol, Metoprolol, Nebivolol. They reduce myocardial oxygen demand, expand the lumen of the coronary arteries, and reduce the number of heart contractions. Their reception allows to normalize the process of oxygen supply through narrow vessels.
- Statins: Atorvastatin, Rosuvastatin. These drugs make it possible to stabilize atherosclerotic plaques, reduce blood cholesterol levels, which reduces the likelihood of developing myocardial infarction.
- ACE inhibitors: Lisinopril, Perindopril, Enalapril. Taking these drugs reduces the likelihood of developing heart failure, which means it reduces the risk of death of the patient.
Angina pectoris requires an integrated approach to therapy. Patients are prescribed several drugs that complement the therapeutic effect of each other.
Nitrates
Drugs from the nitrate group relax the heart muscle, reduce its oxygen demand, and reduce pain in the heart caused by muscle spasm. Their reception promotes the expansion of the vessels located on the periphery, therefore, the outflow of blood increases.
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Nitroglycerin (15-51 rubles). Nitroglycerin is one of the most effective drugs to reduce heart pain that occurs during an angina attack. The main advantage of the drug comes down to its rapid absorption by the mucous tissues.
Nitroglycerin is placed under the tongue. The effect can be felt after a few minutes: a person has less pain in the heart, since the outflow of blood from it is stabilized, and vascular dilation is normalized.
Nitroglycerin is prescribed for both therapeutic and prophylactic purposes. The doctor selects the dose on an individual basis. In many ways, it depends on the patient's pressure, since the drug helps to reduce it. It is also necessary to take into account what other diseases a person suffers from. Anemia, renal and hepatic failure, and hyperthyroidism are important.
Nitroglycerin can be addictive, so its regular use to relieve angina attacks helps to weaken the therapeutic effect. If the patient is forced to take the drug on an ongoing basis, breaks should be taken from time to time. In this case, Nitroglycerin is replaced by means with a similar effect.
Nitroglycerin allows after the first dose to reduce the intensity of heart pain. If this does not happen, you can take another pill. When the repeated resorption of the drug does not allow to stop the attack, it is necessary to call an ambulance, since there is a high probability that the patient develops a myocardial infarction.
- Nitrosorbide (28 rubles). The drug helps to reduce pressure in the pulmonary circulation, thereby unloading the myocardium. A person taking Nitrosorbide has an increased exercise tolerance. However, the drug is absorbed longer than Nitroglycerin, so it will take more time to stop an attack of angina pectoris. Nitrosorbide expands the venous wall, but it has no pronounced effect on the arteries and on the aorta. It can be taken orally, placed on the cheek or under the tongue at a dose of 10 mg. The drug accumulates in the body over time, therefore its long-term use leads to a decrease in the therapeutic effect. You should not increase the dose, it is better to stop taking Nitrosorbide for a while, replacing it with another drug from the nitrate group.
- Transdermal stickers (1550 rubles). If a person is forced to take nitrates on an ongoing basis for prophylactic purposes, then you can use a patch. It slowly supplies the body with nitrates in the correct dosage. The patch is glued to the skin. Such treatment can reduce the likelihood of developing an angina attack. The dosage of the medication depends on the size of the label.
Blockers of adrenergic receptors
Drugs in this group can reduce the need for oxygen in the heart muscle, as they reduce the heart rate. By themselves, drugs do not affect the work of the myocardium if a person is at rest. The therapeutic effect develops only with physical exertion.
- Anaprilin (17-79 rubles). In the first days, Anaprilin is prescribed in a dosage of 20 mg (the drug is taken 3 times a day). Then the dose is gradually increased and adjusted to 240 mg per day. The drug can be prescribed to patients with kidney pathologies. If a person suffers from liver disease, then the dose is selected individually. Anaprilin has a number of side effects. These include disorders in the functioning of the digestive system, allergies, migraines, insomnia. If the patient complains of a deterioration in well-being, then therapy should be reviewed.
- Betaxolol (235 rubles). The drug has a prolonged effect, so it is enough to take it once a day at a dosage of 10 ml. After 2 weeks of treatment, the dose is increased to 20 ml per day. This is done if the healing effect is too weak. The drug is prescribed with caution to patients with severe impaired renal function, patients with diabetes mellitus, people with blood pathologies. An overdose of Betaxolol is dangerous, which threatens with bronchospasm, convulsions and dizziness.
- Atenolol (48 rubles). The drug is prescribed to a patient with angina pectoris 1 time per day. It is taken in the morning after meals. The starting dosage is 50 mg. After 14 days, it is increased to 100 mg. Provided that there is no therapeutic effect, they refuse to use Atenolol. The drug has contraindications, including: heart failure, hypertension, bradycardia, pregnancy.
Adrenoreceptor blockers should be prescribed by a doctor, taking into account all possible contraindications.
Calcium channel antagonists
These drugs block the production of proteins that lead to spasm of the arteries and veins, which has a positive effect on the functioning of the heart. The number of its contractions decreases, blood outflows to the peripheral circulation. As a result, the person begins to feel better.
- Diltiazem 107 rubles). Diltiazem is a 3rd generation drug. Despite this, the drug has many side effects. It is recommended for patients with angina pectoris and vascular spasm. The maximum daily dose is 360 mg, but treatment is started with the minimum dosage (180 mg). If the patient develops side effects, then they refuse to take the drug, since the likelihood of pulmonary edema and collapse increases.
- Gallopamil (250 rubles). This drug belongs to the second generation drugs. It is prescribed to people with angina pectoris, as well as to patients who have had myocardial infarction. The drug relieves the heart muscle, helps to relieve vasospasm. The dose is calculated on an individual basis; it can vary between 50-100 mg. The drug is taken 2-4 times a day. It is forbidden to prescribe the drug to patients with low blood pressure, pregnant women and children, as well as patients with impaired renal function.
- Verapamil (40-155 rubles). Verapamil is a first generation calcium channel antagonist. It has a positive effect on the work of the heart, stabilizes its rhythm, dilates blood vessels. In order to prevent the development of angina pectoris, patients are prescribed 320 mg of the drug per day. This dose is split four times. It is preventative. If the attack has already occurred, then the dosage is increased to 500 mg. The drug should be prescribed with caution to patients with kidney and liver diseases, as well as people with hypertension.
Diuretics
Diuretics increase urination and allow you to get rid of edema, relieve vasospasm. They are prescribed in a complex treatment regimen with blockers and antagonists.
- Chlorthalidone (200 rubles). It is a low-toxic drug that helps to reduce blood pressure. It is taken once every 24 hours. It does not flush sodium and potassium from the body, which is its main benefit. If angina pectoris has a severe course, then the dose may be doubled.
- Lasix (55 rubles). It is a powerful diuretic that is used to quickly lower blood pressure. In parallel, the patient should receive magnesium, sodium and calcium preparations. The daily dose is 1 tablet. Diuretics quickly lower blood pressure, so if a person is taking antihypertensive drugs, their dose must be strictly controlled.
Surgery
Balloon angioplasty. This operation, during which a catheter equipped with a balloon is inserted into the human body through the femoral artery. It is brought up to the coronary arteries and placed where there is a narrowing. The vessel expands, the atherosclerotic plaque is destroyed.
The volumes of the cylinder are calculated in advance. For this, the patient is shown a coronary angiography. After the operation, the study is carried out again, which allows you to control the effect of the procedure.
Angioplasty can reduce the number of angina attacks. However, there is a likelihood of re-narrowing of the vessel, or the formation of stenosis in other parts of it. The operation is prescribed for patients with unstable angina pectoris, with severe vascular stenosis, as well as in case of ineffectiveness of drug therapy.
Coronary artery bypass grafting. During the operation, a shunt is placed between the artery and the aorta. This helps to normalize blood flow to the heart. Such an intervention is performed in patients with severe angina pectoris, for example, with angina pectoris at rest.
The shunt can be installed only on large arteries, or on the trunk of the coronary vessels. If necessary, several shunts can be implanted to the patient at once. This procedure allows you to restore blood flow in all parts of the myocardium.
Emergency care for angina pectoris
Sometimes there are situations in which you need to call a medical team.
These include:
- An attack of angina pectoris develops for the first time.
- The attack lasts longer than 10 minutes, the patient becomes weak, vomiting develops.
- The attack could not be stopped by taking Nitroglycerin. Normally, the effect should develop in 5 minutes.
Until the medical team arrives, the patient needs the following assistance:
- Sit down the patient so that his legs are at the bottom.
- Don't let the person get up
- Give him an Aspirin pill.
- Give the patient a nitroglycerin tablet, which is kept under the tongue.
- After 3 minutes, give the patient another Nitroglycerin tablet.
- The drug should not be taken more than 3 times, as this will lead to a sharp decrease in blood pressure.
Prevention of angina pectoris
You need to lead an active lifestyle and constantly give your body physical activity. At the same time, one should not overwork, so as not to cause another attack of angina pectoris. The loads should be increased gradually. You also need to take nitroglycerin for prophylaxis during periods of stressful difficult situations, when a person feels that an attack may begin soon.
If a person does not suffer from angina pectoris, then to prevent the development of the disease, the following recommendations must be followed:
- Eat properly.
- Do sport.
- Donate blood for cholesterol regularly.
- Take blood pressure medications if the person is already suffering from hypertension. The pressure level must not rise above 140/90 mm. rt. Art.
- No smoking.
Once angina has developed, it is necessary to reduce the likelihood of seizures.
For this purpose, compliance with the following recommendations is shown:
- Avoid emotional stress.
- Refuse excessive physical exertion.
- Observe all medical recommendations.
- Treat other chronic conditions.
- Be registered with a cardiologist.
The author of the article: Molchanov Sergey Nikolaevich | Cardiologist
Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".
