According to ICD-10, angina pectoris is coded by codes I20-I25. Doctors know four functional classes (FC), and each of the cases is attributed to one of them. The maximum efficiency will be shown by the timely started medical course, if it is possible to identify an accurate diagnosis and begin adequate therapy without delay. It is worth remembering that angina pectoris is not just an unpleasant and painful sensation, but a life-threatening condition that can provoke various complications.
general information
Angina pectoris (in the ICD codes I20-I25) is a type of cardiac ischemia. Currently considered perhaps the most common form. As a rule, the disease is observed against the background of atherosclerosis, which violates the integrity of the vascular membranes of the coronary arteries. The pathology is popularly known under the expressive name "angina pectoris", as it manifests itself as shortness of breath, constriction in the chest and unpleasant, painful sensations.
Several types of the disease are known: increasing, primary, progressive, tension. Angina pectoris (ICD-10 encodes the disease with ciphers I20-I25) in any of these cases is distinguished by the presence of obstacles in the circulatory system, due to which the blood flow is disturbed. It is possible that both nourishing the heart can simultaneously suffer from a violation of the activity of one artery. With the disease, specific symptoms arise that suggest ischemia, that is, the heart muscle lacks vital chemical elements, primarily oxygen.
What is this about?
To understand what angina pectoris is, it is necessary to delve into the mechanisms leading to a pathological condition. The pathogenesis of the disease is a mismatch of the amount of oxygen that the heart needs with what it receives with a blood stream. This leads to metabolic disturbance, provokes foci of tissue necrosis. There are two main factors that provoke angina pectoris:
- atherosclerotic plaques leading to narrowing of the gaps of blood vessels;
- vascular spasms (sharp, prolonged).
Statistics show that in their experience they often learn what angina pectoris is, people who are forced to face increased physical exertion. With this activity, the demand of the heart muscle in oxygen molecules increases sharply, which means that the risk of underreaching becomes more significant. Against the background of physical activity, the likelihood of an angina pectoris is much higher than at rest. The load has to be considered differently - both work, and exercises, hobbies and activities. In addition, angina pectoris, heart attack can provoke severe and prolonged stress.
A feature of angina pectoris is a partial lesion of muscle heart tissue. In the general case, the consequences are not as negative as with a heart attack, but angina pectoris alone can cause it. It so happened that because of the prevalence of the disease, people often do not realize its danger, but statistics claim that an impressive percentage of cases of disability and death due to heart and vascular diseases is provoked precisely by angina pectoris. Especially at risk for people over forty years of age. According to Russian doctors, on average, every fourth woman has angina pectoris in women, and in men it is 50% of all our compatriots. The difference is explained by the specific functioning of the hormonal system: the substances secreted by the glands of the female reproductive organs protect the vessels from atherosclerosis, therefore, the risk of angina pectoris is reduced. Over the years, the hormonal system is being transformed, the risks of ischemia, heart attack, and other disorders increase.
Classifications and Types
Several functional classes (2 FC) of angina pectoris are known . Two main types of the disease: occurring with and without symptoms. Classification based on an analysis of the causes of the disease, the degree of oxygen deficiency in the heart, suggests the allocation of the following groups:
- arrhythmic, manifested suddenly, turning into a chronicle if timely assistance is not provided to the patient;
- chronic, in which shortness of breath, chest pain, especially expressed during experiences and exertion, are disturbing;
- a heart attack, that is, an illness in the acute stage, accompanied by necrotic processes in the heart muscle;
- unstable, proceeding with numerous attacks, from time to time more and more strong and long-term;
- hidden, in which there is neither pain nor discomfort;
- sudden cardiac arrest.
The last option is a complete organ failure, the blood stops flowing.
How to notice?
Symptoms of angina pectoris are diverse, a lot depends on the individual characteristics of the case. Most patients note that there is severe pain behind the sternum. Sensations describe, as if squeezing something inside, a heavy object lies on the chest. Soreness is given to the jaw from below, arm, shoulder on the left. In rare cases, patients have complained that their stomach hurts. Breathing is interrupted, unstable and irregular. Possible panic, nausea, and vomiting. One of the symptoms of angina pectoris is severe dizziness.
Relief occurs if you relax and take nitroglycerin. Usually the attack goes away in just a couple of minutes. If the duration reaches a quarter of an hour, the help of a team of specialists is needed. There is every reason to believe that the heart muscle was seriously damaged.
Where did the trouble come from?
Angina attacks are caused by a lack of oxygen, due to lack of blood flow. It has already been mentioned above that the disease is often observed against the background of atherosclerosis and vascular spasm. As specific studies have shown, genetics also play a role: if close relatives had angina or heart attack, the likelihood of such a violation is significantly higher. On average, the risk increases 10 times.
To make sure that the disturbing manifestations are explained by myocardial angina, it is necessary to undergo a special examination in a hospital setting. The doctor will first collect the patient's complaints and examine him visually, write out directions for instrumental and laboratory studies. Based on the results of the information received, you can confirm or refute the initial diagnosis. To identify angina pectoris, it is important to consider the nature of the pain and the place of their appearance.
Technics and techology
A doctor will tell you how to treat angina pectoris if the diagnosis is confirmed. To clarify the condition, first of all, an ECG will be prescribed. This method of studying the activity of cardiac muscle tissue is used for any diseases associated with impaired activity of the most important human organ. To assess lesions of the vascular bed of the arteries responsible for the nutrition of the heart, as well as other elements of the circulatory system of this organ, endovascular echocardiography is prescribed. To clarify the reaction of muscle tissue to physical activity, the patient is prescribed a test. Most often, use a regular treadmill. During the lesson, the patient is connected to devices that allow you to control the heartbeat.
With signs of angina pectoris, an angiography of the vessels that feed the heart is mandatory. The analysis allows you to understand which of the possible treatment methods for a particular case is most suitable. Angiography is indispensable when choosing between surgery and conservative treatment.
Quite voluminous information about the case can be extracted if monitoring by Holter is done. This analysis lasts a whole day: the patient is given a special apparatus that records the activity of the heart during different periods. Continuous monitoring allows you to accurately identify signs of angina pectoris or to determine if there is another health problem.
Additional clarification can be obtained by making an x-ray. It is reflected if any parts of the heart or organ as a whole are enlarged, and localization of calcium deposits, blood stasis is also visible. Multislice CT is the last widespread method for clarifying the patient's condition. It allows you to determine the features of atherosclerosis, to localize the accumulation of calcium, defects. According to CT results, doctors can evaluate the quality of blood circulation.
First measures
About how to treat angina pectoris, the doctor can tell at the appointment. As a rule, an integrated approach is required, so it is almost impossible to independently develop a suitable course without a special education. The main objective of the treatment is to reduce the likelihood of a heart attack, increase the quality of life of the patient, reduce the frequency and duration, severity of attacks. Prescribe drugs - one or more means, taking into account the individual characteristics of the case, the tolerance of various components to patients, allergic reactions inherent in it. In no case should you neglect the advice of a doctor explaining how to be treated, what should be done. Angina pectoris is relieved by medications that block calcium channels, and therefore, prevent its accumulation in the heart. Also, additional means to activate blood flow, normalize vascular walls.
If Prinzmetal's angina is detected (like any other form of the disease), you will have to change your lifestyle and revise your diet. Cholesterol, saturated fatty structures are completely excluded. But dishes with oily fish are shown up to 10 times a month, because the product is rich in acids that stimulate blood flow.
With angina pectoris, you can’t eat too much. For excess weight, body weight adjustment is required. It should be a habit to exercise regularly, but strictly in moderation. With symptoms of angina pectoris, treatment requires smoking and alcohol. The doctor will explain the basic rules and points of the recovery program. You will have to follow them as clearly as possible - only medications can not protect against a new attack.
Leeches - effective and safe
With symptoms of angina pectoris, treatment with leeches is a long-established method. Two doctors are working on the course: cardiologist, hirudotherapist. First, use a couple of copies, gradually increase the number to eight. In some cases, the simultaneous use of a dozen leeches is allowed. The specific conditions depend on the strength of the pain, the nature of the syndrome. As soon as free sucking begins, doctors immediately remove the worms. This eliminates the negative impact of hirudotherapy.
The frequency of treatment with leeches is chosen based on the specific features of the case. If the attacks are frequent and the pain is severe, you should do up to five treatments daily until the pain subsides. As the condition improves, you will need to come to the reception every other day, each time passing through three procedures in succession. The doctor controls the patient's well-being, his response to treatment, takes into account the characteristics of the case. If Prinzmetal's angina (or another form of the disease) requires this, a therapeutic program may be repeated.
How to warn?
In order not to learn from experience what angina pectoris, it is reasonable to practice preventive measures. Their main idea is to prevent the development of atherosclerosis, and for this it is necessary to minimize the influence of risk factors on the body. It is important to adjust the lifestyle, abandon bad habits, normalize the daily rhythm and revise the diet, eliminating the fatty, cholesterol-rich menu. The risk of angina pectoris is minimal in people whose weight is approximately within the normal range and the body is exposed to moderate physical activity daily. It will not be superfluous to have a tonometer at home to control pressure. As soon as a person notices that the rate rises often, you need to go to the doctor to identify the causes. Additionally, you can drink vitamins to improve heart function. Such complexes contain potassium and magnesium important for the human body.
If cardiac ischemia is detected, the time for secondary prevention comes. Already knowing what angina pectoris is, the patient understands how important it is to prevent attacks. The doctor at the reception will explain what factors provoke them, and give a list of drugs, advise how to take them. You will have to avoid increased physical exertion.
If diabetes mellitus, abnormalities in the digestive tract are detected, it is especially important to carefully monitor the condition of the body, since these pathologies are associated with an increased risk of ischemia, heart attack.
It's curious
The term "angina pectoris" has a rather long history. The word is formed by a combination of two Greek: "narrowing" ("wall") and "heart" ("cardia"). The literal translation is "cardiac restraint." This term well reflects the essence of the condition, and also describes the symptom: it seems to the patient that everything is compressing in the chest.
Hippocrates in his works spoke of the mortal danger of pain in the chest. He noted that the more often the attacks, the higher the risks for the patient. Seneca, who lived several centuries later in ancient Rome, also indicated angina, describing its attacks. From his works it is known that the patient feels powerless, dying. The attacks themselves are short, but Seneca compared them to a storm.
Previously, the disease was called "angina pectoris." At present, this term, although used, but not among professionals - is considered obsolete by physicians. It was first applied in 1768 by Dr. Heberden of Great Britain. In his works, the doctor described the attack of the disease as an unusual, severe pain, in which the patient feels fear, suffocation. Then Geberden drew attention to the great dangers associated with this condition. He noticed that attacks come to a greater extent when the patient goes uphill, ate tightly.
Pain in angina pectoris in the description of Heberden is an extremely unpleasant sensation, intensifying with time. It seems to the patient that death is near, but it is worth stopping, as everything goes. Between seizures, the patient, as noted by Heberden, feels satisfactory.
By doctors of the past, it was found that pain in angina pectoris is localized in the sternum from above to the left, somewhat less often in the middle part, and even less often - from below. On the right, pain is also possible, but is recorded less frequently. Most often, the sensation spreads to the shoulder on the left. If a person has angina pectoris for a year or more, attacks are difficult, then restoring it is not enough just to take a break. Seizures are possible when the patient is lying. This is more characteristic of the position on the left side.
Factors and Risks
It is customary to talk about three factors that can provoke progressive angina pectoris, stable or microvascular:
- lifestyle related;
- due to physiology;
- uncorrectable.
The first two types can be modified, although this will require some effort.
The lifestyle includes:
- diet
- habits
- lack of motor activity.
There is a higher risk of angina pectoris in individuals who have yolks and caviar, pork meat, and cheese in their diet. This leads to one of the basic rules that are always clearly explained by the doctor at the consultation on how to treat the disease and what to do. Symptoms of angina pectoris will worry less if you reduce the number of these products on the menu or exclude them completely.
Physiology is:
- cholesterol concentration;
- low levels of high-density cholesterol;
- high pressure;
- excess of the amount of triglycerides in the blood plasma;
- excess weight;
- diabetes.
Uncontrollable factors include gender, age, and genetic prerequisites.
It is especially important to know what to do with the symptoms of angina pectoris, seizures, and people who are characterized by a combination of several of these factors - in such a situation, the risk of developing a pathological condition is much higher. Doctors focus on this for a reason. According to statistics, ischemia (angina pectoris is one of its forms) is almost the leading cause of death. On average, about 10 million people become victims of ischemia in Russia annually. Up to half are aware of the disease, but every second does not even suspect the presence of impaired functioning of the heart, blood vessels.
What to do and what not to do?
A symptom of angina pectoris is pain. More often, an attack occurs when you overeat, lift heavy objects, or go out into the cold. Perhaps a worsening condition when a person climbs a ladder or simply walks quickly, has experienced severe nervous tension. Angina pectoris can trigger a jump in pressure. What to do in such a situation? The algorithm is as follows:
- Sit in a comfortable position.
- Take a tablet of nitroglycerin under the tongue, the pain barely started.
- Take the pill again if after five minutes the pain persists. Repeat no more than those times.
- To alleviate the headache provoked by nitroglycerin, use Citramon, Validol, or Sydnopharm.
- For tachycardia, take Anaprilin sublingually.
It is necessary to urgently seek help from a team of doctors if taking medication does not alleviate the condition, additionally observed:
- weakness;
- cold sweat;
- dyspnea;
- increased pain.
It is highly likely that the disease progressed to a heart attack.
Wellness Activities
Treatment for angina pectoris is possible with medical and surgical. In addition, all risk factors that can be affected will have to be adjusted.
If angina is accompanied by high blood pressure, measures are taken to control this indicator. Stable values should be achieved below the border of 130/80 units. The most effective are medicines from the class:
- beta-blockers;
- calcium antagonists;
- depressing PAF.
The choice of funds is up to the doctor. The doctor evaluates the patient's condition, indications and contraindications, individual characteristics, intolerance.
It is known that when smoking, the likelihood of attacks of angina pectoris and heart attack is twice as high as in people who do not suffer from this dangerous habit. The risk of sudden death for smokers is estimated to be four times higher in comparison with other groups. If you stop smoking, the risks associated with this factor will be able to level over approximately a three-year therapeutic course.
In diabetes mellitus, it is possible to minimize the likelihood of an attack of angina pectoris and acute forms of ischemia if compensatory treatment is started. In the absence of a correctly selected program, coronary atherosclerosis progresses much faster than in non-diabetics, which means that the prognosis for angina pectoris worsens. In the second type of disease, the probability of a fatal outcome doubles for men, four times for women. In the first type of diabetes, the probability of sudden death is estimated to be 3-10 times higher compared to other persons.
Measures and results
With a sedentary lifestyle, the likelihood of almost any pathological process is much higher than that characteristic of people who are physically active in everyday life. Doctors rated the likelihood of developing angina attacks with a predominantly sedentary lifestyle as twice as high as that characteristic of the second category. The optimal disease prevention program is half-hour classes up to four times a week, and even better - daily. Those sports that simultaneously have a positive effect on the entire human body will benefit:
- swimming;
- easy run;
- Walking
- bicycle rides;
- gymnastics;
- dancing;
- aerobics.
Training for cardiac endurance is perhaps the best medicine available to everyone, regardless of lifestyle and social status, income.
Additionally, you should change the diet to reduce the intake of fats. Hypolipidemic therapy is prescribed by a doctor, may include the use of special drugs (statins). If you are overweight, you will have to start a course to get rid of it. The doctor will select a diet that is minimally saturated with calories, controlling that a sufficient amount of fiber enters the patient's body.
Nuances and diagnoses
It is known that angina pectoris is more often observed in men than in women, but only up to the age limit of 50-55 years. Around this period, most women experience menopause, menopause begins, hormones change, the likelihood of atherosclerosis rises sharply, and as a result, symptoms of angina pectoris appear. What you need to do with them, the doctor will tell you at the reception, explaining how the menopause manifests itself, what unpleasant consequences are associated with a change in the hormonal background.
Statistical studies have shown that more often angina attacks worry residents of the Scandinavian countries. But representatives of the black race suffer from atherosclerosis and its consequences several times less.
Early angina pectoris often develops in those whose male-related relatives suffered a heart attack before reaching the age of 55. Among blood-related people on the female side, sudden death of people under 65 years of age can indicate a hereditary factor.