Angina pectoris is an acute severe pain in certain areas of the heart, which appears due to a lack of blood supply. This is due to the fact that the arteries become clogged or narrowed. Emergency care at a clinic of angina pectoris, the classification of which is attached is what everyone should know.
When the disease makes itself felt, the patient feels constricting pain in the chest area, which can go to the jaw, arm, neck, shoulder. Pain can last from 30 seconds. up to 30 minutes However, it lasts most of all for three minutes and passes if the patient received a particular drug or simply went to rest. In more detail about first aid, prophylaxis and clinic of angina pectoris of IHD further.
Disease factors
With individual loads on the heart, according to the clinic of a typical angina pectoris, a lack of air appears, which leads to sudden pain in the heart. And the prerequisites have every chance to be different:
- due to significant physical exertion;
- heavy or spicy food intake;
- stress
- hypothermia or heat;
- subsequently drinking alcohol.
Symptoms of pathology
Signs that the person feels during a seizure of angina pectoris, the clinic, the pathogenesis and etiology of which is higher:
- Pain. It is concentrated behind the chest from the left edge. In some cases, pain radiates to the neck, teeth, lower jaw. Less often the gap between the shoulder blades, elbow and wrist joints, mastoid processes.
- The pain is deaf, pressing, constricting. In some cases, a person feels a heaviness in his chest, he does not have enough air.
- The attack lasts no more than 5 minutes. Often it has a connection with psychological and physiological stress.
- High blood pressure. His jump causes headaches, dizziness and powerlessness. This symptom with angina pectoris is not always formed.
- Dyspnea, which indicates oxygen starvation of the myocardium. In humans, hyperhidrosis increases for no apparent reason.
- Disturbances in the work of the heart that a person feels good.
- Nausea and vomiting.
- Feeling of fear, increased physical activity.
It is also worth classifying the disease, because there are several varieties of such a disease.
Stable
It is worthwhile to learn more about what stable angina pectoris is, clinic and prevention of coronary heart disease further. Stable is a disease of tension. As a rule, it is expressed after severe stress or intense physical exertion.
Stable angina pectoris is divided into 4 multifunctional classes, which depend on the severity of the disease:
- The implementation of simple actions does not cause a seizure of angina pectoris. We are talking about walking or climbing stairs. A seizure can occur with severe physical overload. It can be either very active or long-lasting.
- In humans, a seizure can occur when walking fast, during a rapid climb up the stairs, as well as after eating, while hanging out in the cold or in the wind. Stress can cause angina pectoris. In some cases, seizures are repeated in the first few hours after a night's rest. It is risky for the patient to walk more than 200 m.
- The patient should be limited by physical dynamism, since angina attacks occur after walking to a distance of 100 m or a little more, during the ascent to one stairwell, on the street, regardless of atmospheric circumstances.
- An individual loses the ability to carry out numerous actions, since a seizure can occur at any time, including if the patient is calm.
Unstable
The clinic of unstable angina indicates that it is a disease of calm. Appears with various weights and regardless of tense situations. It has a long appearance and often manifests itself. Signs of pathology develop due to the fact that the heart muscle lacks oxygen against the background of narrowing of the arteries, and not because of increased physical activity.
Some characteristic features of the diagnosis, course and treatment of a clinic of angina pectoris (unstable):
- On ECG, anginal seizures accompany a temporary increase in the ST sector.
- Sometimes severe heart pains have every chance of appearing after the physical exertion that the individual earned in the morning. In the evening and in the daytime, such physical activity is not expressed by pain.
- It is possible to cope with anginal seizures by taking nitrates. The result from beta blockers is not so pronounced. In some patients suffering from angiospastic angina pectoris, beta-blockers are ready to show an anti-ischemic result.
Painless myocardial ischemia
Quite often, myocardial ischemia is formed in the absence of any obvious signs. A person does not feel the manifestations of angina pectoris. In this case, the strength of the seizures can be quite high, up to the formation of myocardial infarction.
It is possible to detect painless ischemia during the period of performing tests with physical activity and during the execution of a daily ECG.
There are 3 types of clinics for angina pectoris:
- Modifications of the myocardium by ischemic appearance are performed without any signs. They are expressed during physical exertion. In addition, they can be detected during the period of the daily ECG.
- The disease is fixed in patients with seizures of angina pectoris.
- The disease forms in patients without angina pectoris, however, already after myocardial infarction.
The last two types of angina pectoris require urgent medical attention. If you ignore this recommendation, the possibility of developing myocardial infarction or tachycardia increases.
Diagnosis of the clinic of angina pectoris
A person with signs of angina pector must go to a therapist or cardiologist for advice. The doctor will listen to the patient’s claims, will make an anamnesis. The main thing is to find out what conditions become the reason for the formation of a pain seizure, how long it has, and to what extent the pain symptom is intense. It is necessary to find out from the patient what substances enable him to overcome the violation.
After examining the patient, the doctor will provide him with a referral for laboratory tests. First of all, the patient's blood is examined. In the mandatory mode, the degree of cholesterol, LDL and HDL, triglycerides, ALT, AST is established. They take blood samples for sugar, electrolytes. It is important to take into account the characteristics of blood coagulability.
Another significant marker of myocardial damage is troponins. If their level is too high, this indicates a heart attack.
The next stage of the examination is instrumental diagnosis.
It contains operations such as:
Cardiogram. At the same time, a reduction in the ST sector and an unfavorable T wave in individual leads will be noted. In addition, the doctor is able to recognize pathologies of myocardial conduction.
ECHO-KG. This study will make it possible to establish pathology in myocardial contractility, as well as its local ischemia.
Daily ECG. In this case, the cardiogram is removed throughout the day and night. A person is obliged to record all his operations without exception, which he carries out. Physiological overload in this period should be moderate. This will provide an opportunity to assess how the heart reacts to them, whether the patient undergoes ischemic changes in the myocardium, or if the heart rate is disturbed. In the event that a more frequent rhythm was observed before paroxysm of heart pain, then this with a significant degree of probability indicates a stable angina pectoris. If the pulse did not increase, then, most likely, the patient has unexpected angina.
Coronary angiography This diagnostic technology makes it possible to assess the degree of damage to the coronary arteries, to choose the best method of treatment. This method is prescribed for patients with angina pectoris 3 and 4 of a functional class, patients with signs of myocardial ischemia and people who have a history of sudden cardiac arrest. A larger number of such patients require surgery, since conservative therapy does not make it possible to achieve positive results.
Angina treatment
Therapy of angina pectoris involves the use of pharmaceuticals. There are substances that people with a similar diagnosis are prescribed without fail, as they improve the scenario of the disease.
They include:
- Antiplatelet agents: "Thrombo ass", "Cardiomagnyl", "Clopidogrel". Their adoption makes it possible to prevent the development of blood clots in the vessels and to reduce the possibility of the formation of myocardial infarction by 30%.
- Beta-blockers: Bisoprolol, Metoprolol, Nebivolol. They reduce the need for myocardium in oxygen, make it possible to increase the gap of the coronary arteries, and reduce the number of heart contractions. Their adoption makes it possible to restore the flow of air through cramped vessels.
- Statins: Atorvastatin, Rosuvastatin. These therapeutic agents provide an opportunity to balance atherosclerotic plaques, reduce blood cholesterol, which reduces the possibility of myocardial infarction.
- ACE inhibitors: Lisinopril, Perindopril, Enalapril. Acceptance of these pharmaceutical medicines reduces the possibility of heart failure, therefore, reduces the risk of death for the patient.
Angina pectoris will require a unified approach to therapy. Patients are prescribed a pair of pharmaceuticals that expand the therapeutic result of each other.
Nitrates
Substances from the category of nitrates relax the heart muscle, reduce its need for oxygen, and reduce pain in the heart due to muscle spasm. Their adoption contributes to the expansion of the vessels located in the periphery, for this reason the decrease in blood increases.
Nitroglycerin is one of the most effective substances that reduce the heart pain that appears on the background of an attack of angina pectoris. The main advantage of a pharmaceutical preparation is its rapid absorption by mucous tissues.
Nitroglycerin is placed under the tongue. The result can be felt in a couple of moments: a person has a pain in the heart, as the decrease in blood from him is stabilized, and the expansion of the arteries is normalized.
Nitroglycerin is prescribed for both therapeutic and preventive purposes. The doctor selects the dose in person. In many ways, it depends on the pressure of the patient, since the medication helps to lower it. In addition, you should take into account what other diseases a person suffers from. Anemia, renal and hepatic insufficiency, hyperthyroidism are significant.
Nitroglycerin can be addictive, for this reason its systematic use for the relief of angina attacks helps to mitigate the therapeutic result. If the patient must take the drug in a stable dose, from time to time it is necessary to pause. At the same time, it is replaced with drugs with a similar result. Nitroglycerin makes it possible after the first dose to reduce the saturation of heart pain. If this does not happen, it is possible to take another pill. If the second resorption of the substance does not make it possible to localize the seizure, an ambulance should be called, as the likelihood of the patient developing myocardial infarction is increased.
Adrenergic blockers
Substances in this category make it possible to reduce the need for heart muscle in oxygen. They reduce the heart rate. By themselves, pharmaceutical preparations do not affect the functioning of the myocardium if a person is in a state of calm. The medical result is formed only with physical overload. The following drugs can be distinguished:
- Anaprilin. In the initial time, "Anaprilin" is prescribed in a dose 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 diseases, then the dose is selected in a separate order. Anaprilin has a number of contraindications. These include pathologies in the work of the digestive system, allergies, pain, insomnia. If the patient complains of a change in health, then the therapy must be changed.
- Betaxolol. The medicine has a prolonged property, for this reason it is enough to take it once a day at a dose of 10 ml. After 2 weeks of treatment, the dose is increased up to 20 ml per day. This should be done when the medical result is very weak. A medication with caution is prescribed to patients with impaired renal function, diabetes mellitus, people with blood pathologies. An overdose of Betaxolol is dangerous, it threatens bronchospasm, convulsions and dizziness.
Adrenoreceptor blockers must be established by the doctor, taking into account absolutely all possible contraindications.
Calcium Channel Antagonists
These substances will block the production of proteins, which lead to spasm of arteries and veins, which is positively displayed on the work of the heart. The number of its contractions decreases, blood decreases to the peripheral blood circulation section. As a result, a person begins to feel much better. Here is a list of drugs:
- "Diltiazem" - a medicine of 3 generations. Despite this, the medication contains a lot of useful properties that positively affect the entire body. He is advised to receive patients with angina pectoris and spasm of the arteries. The maximum daily portion is 360 mg, however, treatment begins with lower dosages (180 mg). In case the patient develops side effects, abstain from taking the medication, as the possibility of pulmonary edema and collapse increases.
- "Gallopamil" - this remedy belongs to the substances of the 2nd generation. It is prescribed for people with angina pectoris, patients who have survived myocardial disease. The medication unloads the heart muscle, helps to remove contraction from the arteries. The dose is calculated in a personal schedule, it is able to fluctuate between 50-100 mg. Take this substance 2-4 times a day. It is forbidden to prescribe a remedy for patients with low blood pressure, pregnant women and children, patients with impaired renal function.
Diuretics
Diuretics increase urination and make it possible to get rid of edema, remove spasm from arteries. They are prescribed in the general treatment regimen with blockers and antagonists:
- Chlortalidone. This is a low-toxic medication that helps to reduce blood pressure. It is taken 1 time per day. It does not leach sodium and potassium from the body, which is considered its main advantage. If angina pectoris has a serious development, then the dose can be increased by 2 times.
- Lasix. This is a powerful diuretic medicine, it is used to rapidly reduce blood pressure. At the same time, the patient must receive substances of magnesium, sodium and calcium. Daily Serving - 1 pill.
Diuretics rapidly reduce blood pressure, for this reason, if a sick person takes antihypertensive substances, their portion should be checked accurately.
Balloon angioplasty
This procedure consists in the introduction of a catheter equipped with a balloon through the femoral artery. It is brought to the coronary arteries and placed in the area where there is a narrowing. The reservoir expands, the atherosclerotic plaque collapses.
The cylinder volumes are calculated preliminarily. For this purpose, the patient is prescribed the implementation of coronary angiography. After the procedure, the study is carried out one more time, which makes it possible to control the result of the operation.
Angioplasty makes it possible to reduce the number of angina attacks. But there is the possibility of a secondary narrowing of the reservoir or the formation of stenosis in its other zones. The procedure is prescribed for patients with unstable angina, with manifested vascular stenosis, as well as in case of ineffectiveness of pharmaceutical therapy.
Coronary artery bypass grafting
During the procedure, a shunt is placed between the artery and the aorta. This makes it possible to restore blood flow to the heart. Such an invasion is made by patients in whom the disease has a severe extension, for example, with rest angina pectoris.
. , . .
, .
These include:
- .
- 10 . , .
- "". 5 .
:
- Set the patient so that his legs are located below.
- Do not let stand up.
- Give an Aspirin tablet.
- Give the patient "Nitroglycerin", which is held under the tongue.
- After 3 minutes, provide the patient with another 1 tablet of Nitroglycerin.
- More than 3 times the medication is forbidden to take, as this will cause a sudden decrease in blood pressure.
As can be seen from the emergency clinic for angina pectoris, these actions are quite simple. But they really can save the life of the patient.