Microvascular angina pectoris is a pathological inheritance, it is characterized by symptoms of myocardial ischemia, they are formed due to the absence of coronary artery atherosclerosis and epicardial coronary artery spasm on coronarography.
A sensation of pain occurs in a person at a time when the necessary amount of blood along with oxygen does not enter the heart. Further, the disease develops from damage to large vessels. With the formation of arteriosclerotic plaques, the vessels begin to harden, becoming stiff. A manifestation of the disease is shortness of breath, pain in the heart, rapid heartbeat. In ICD-10, microvascular angina is listed under code I 20.
Who is most affected by this disease?
Microvascular angina pectoris syndrome occurs in patients:
- Having chest pain.
- A stress test which has a positive result.
- The epicardial coronary arteries of which are normal, their spasm is absent.
- Systemic arterial hypertension is absent along with left ventricular hypertrophy. There are also no violations of the systolic function of the left ventricle at rest.
There are cases when patients with a diagnosis of angina pectoris form a blockade of the left leg of the bundle of His with further development of dilated cardiomyopathy. It is important to note that in the absence of changes in the coronary arteries during angiography, an occlusive pathology of the distal vessels is observed.
This symptom is considered to be one of the clinical stages of coronary heart disease, because myocardial ischemia implies all cases of an upset oxygen demand and need for it, regardless of the reasons that they provoke.
When diagnosing, it is worth highlighting the method of antiography, which assesses the condition of the coronary bed and microvascular, and so, the evaluation possibilities are limited. Based on this, we can conclude that the anti-graphic invariable coronary arteries indicate the absence of a gap between atherosclerotic plaques in the epicardial arteries. Judging by the anatomical features, the arteries remain angiographically invisible.
Causes
Until now, the exact causes of the onset of the disease are not completely known. To date, only some pathophysiological processes that contribute to the progression of the disease have been established. Such causes of microvascular angina pectoris include:
- Increased sympathetic activation.
- Endothelial dysfunction.
- Structural changes.
- Metabolic changes.
- Increased perception of intracardiac pain.
- Strong arterial stiffness.
Other reasons
At the moment, there are many assumptions that help establish the ailment. The first assumption suggests that the disease occurs due to anatomical or functional abnormalities in the vessels that cannot be established through coronary angiography. The second theory confirms the presence of metabolic changes that provoke a violation of the synthesis of energy substrates. The third option speaks of an ailment that appears due to an increase in sensitivity to pain symptoms for all organs, including the heart. After conducting a series of thorough studies, scientists were not able to more accurately determine the causes of the disease.
It is only known that middle-aged people suffer the disease, often these are women. At the same time, half of the patients show pain in the chest area. A pulling pain appears, which can last from several minutes and last up to several hours.
Symptoms of the disease
The main symptom of this disease is one - pain in the chest area, and most often it occurs during a person’s physical activity. Also, symptoms can provoke a severe cold, emotional upheaval. Nitroglycerin does not help eliminate pain, on the contrary, it aggravates the situation.
Microvascular angina itself passes as a vegetative-vascular dystonia. Very often, angina pectoris is diagnosed to suspicious persons whose life is in constant stress and anxiety. Sometimes patients are advised to undergo a mental recovery course from a psychologist.
How to recognize pain
It is worth talking about the first symptoms and signs of an angina attack. When determining the diagnosis, look at the following criteria:
- Characteristic pain in the chest area, the behavior becomes depressive.
- Coronary disease in a transitional form proceeds without complications.
- Ergometrine test has a positive indicator, there is a decrease in cardiac output.
- Atherosclerosis is not observed.
- A large amount of lactate during ischemia, as shown by a blood test.
- With myocardial scintigraphy , ischemic disorders are observed.
When microvascular angina occurs, the symptoms are very similar to stable angina pectoris. But with this disease, attacks do not occur regularly. In some cases, attacks of angina pectoris are observed.
For a correct diagnosis, some points must be excluded:
- Do not take into account people with spasm of the coronary arteries.
- Exclude patients with extracardiac causes of pain in the chest. For example, this group includes:
- everything related to musculoskeletal diseases: osteochondrosis of the cervical spine;
- neuropsychiatric disorders: depression, anxiety;
- problems with the gastrointestinal tract: ulcer, pancreatitis, high cholesterol, cramping;
- lung diseases: pleural overlays, tuberculosis, pneumonia;
- rheumatological diseases, infections such as syphilis.
Diagnostics
To correctly determine the ailment, an analysis of the medical history and complaints of the patient is carried out, a survey and examination of the patient are performed. From diagnostic procedures: blood and urine tests; blood chemistry; coagulogram; electrocardiography; echocardiography; Holter electrocardiogram monitoring; test with physical activity under the supervision of an ECG; transesophageal pacing; drug stress tests; stress echocardiography; radioisotope loading tests; coronary angiography; multispiral computed tomography.
On the result of the ECG, angina pectoris will look as follows.
The main electrocardiographic diagnostic properties of angina pectoris are:
- gap offset ST;
- changes in the T wave (alignment, focus down, high and sharp in shape).
These changes are expressed against the backdrop of an attack, it is extremely rare to last from several minutes to hours after the pain is completed. If the reduced ST interval and negative T are stored longer, it is possible to allow a sharp focal myocardial dystrophy or chronic coronary insufficiency.
The shape of the T wave indicates the depth of the site of ischemia.
Treatment
After the cause of the disease is established, treatment is carried out. But, unfortunately, to date, the syndrome of microvascular angina is not yet fully understood. It is often difficult to determine the treatment, both for doctors and for the patients themselves. The effectiveness of treatment is to establish the pathological process of the disease, and only then decide the patient’s participation in therapy. Typically, patients with angina pectoris need an integrated approach to treatment.
What is used for therapy
Various options may be involved for treatment: ACE inhibitors; antianginal drugs; angiotensig receptor antagonists; statins psychotropic drugs.
In turn, antianginal agents, for example, calcium antagonists and beta-adrenergic blockers, are used in patients with diagnosed myocardial ischemia or with impaired myocardial perfusion. If you take sublingual nitrates, they help half of the patients with microvascular angina pectoris. According to preliminary data, the efficacy of nicorandil, which has a bradycardic effect, was clarified; prazoline alpha-blocker; L-arginine; ACE indicators: perindopril and enalapril; cytoprotectors - trimethisadine.
Recommendations for microvascular angina
It is recommended to use lipid-lowering treatment with statins to improve and accelerate therapy, they help reduce cholesterol in the body. Such therapy is simply vital, regardless of the chosen treatment methodology.
Physical activity in angina pectoris aggravates the patient’s condition, as it increases pain.