Angina pectoris is an ischemic cardiovascular disease that develops due to atherosclerosis of the arteries that feed the heart. As their lumen decreases, the blood supply to the myocardium is inhibited, ischemia develops. An attack of angina pectoris is the outcome of short-term ischemia in the heart muscle, after which the blood supply is fully restored. This condition has a common origin with myocardial infarction, but, unlike the latter, a thrombus does not form in the coronary artery, and a site of necrosis does not form in the muscle. Every patient should know how it manifests itself and how to relieve an attack of angina pectoris.
Forms of angina pectoris
According to the generally accepted classification, stable angina pectoris (CH) is distinguished, characterized by the appearance of short pain episodes, well stopped by nitrates, unstable (NS), progressive, variant and vasospastic. Unstable angina pectoris is a heart attack lasting more than 30 minutes without signs of a heart attack on the cardiogram and in the absence of a significant increase in cardiospecific enzymes.
An episodic spasm of the arteries of the heart is characterized by a vasospastic attack of angina pectoris, which makes it possible to develop it without ischemic vascular damage. Unlike vasospastic, variant angina pectoris develops in the presence of coronary artery atherosclerosis. However, it is similar to vasospastic in that it develops due to spasm of the coronary arteries.
Progressive angina pectoris (PS) is a special type of stable angina pectoris, in which the frequency of anginal pain increases, tolerance to physical activity decreases, and the time of relief decreases. With progression, an attack of angina pectoris, symptoms and emergency care are the same as with a traditional episode of anginal pain. However, in the case of an increase in seizures, hospitalization and the solution of the question of angiography are indicated.
The reason for the transformation of angina pectoris into progressive angina pectoris is an increase in the size of the atherosclerotic plaque. This significantly increases the likelihood of developing myocardial infarction. The purpose of hospitalization in PS and NS is to prevent it, while with angina pectoris, the risk is much lower.
Symptoms of angina pectoris
Traditionally, an episode of angina pectoris develops under conditions of physical exertion or with intensive expenditure of energy substrate in the heart. This phenomenon occurs when doing work, in some patients, just when walking or worrying. Often an angina attack develops at night and just before waking up. This happens due to the development of tachycardia in the REM phase, when the cardiovascular system is in good shape.
The first and most specific symptom of angina pectoris is anginal pain. It is manifested by a feeling of strong squeezing behind the sternum directly when walking or with excitement, a burning sensation in the heart. Pain sometimes appears in the left hypochondrium, but a burning sensation remains in the area of the heart. Anginal pain often spreads to the area under the lower jaw, to the neck, to the interscapular region and under the left shoulder blade, less often to the area of the left shoulder.
The nature of anginal pain
Angina pain has a constant high intensity and is accompanied by nausea in 5-10%, shortness of breath in 10-20% and constant dissatisfaction of the breath in 30-50%. This does not mean that with an attack of angina pectoris, the symptom of shortness of breath is specific. Dyspnea characterizes the appearance of signs of left ventricular failure with a heart attack. But with angina pectoris, especially in the absence of chronic heart failure, it is practically uncharacteristic. It is precisely the feeling of dissatisfaction with the inspiration that appears, although the respiratory rate does not increase.
In addition to specific anginal pains, the first signs of an angina attack can be the following: the appearance of weakness, a feeling of tightness and stiffness in the chest and heart, sweating and the appearance of perspiration on the face. Often headaches develop in the parietal and occipital region, which is a concomitant sign of arterial hypertension.
An important specific sign of anginal pain in angina pectoris is their quick (3-4 minutes) elimination after cessation of physical activity, taking nitroglycerin preparations or normalizing blood pressure after a crisis. The inability to stop the symptoms of angina pectoris lasting more than 20-30 minutes after 2 times the use of nitroglycerin every 7 minutes is a signal that the patient needs to go to the SMP due to the risk of developing acute coronary syndrome.
Angina pectoris for diabetes
In the text studied above, information is given that traditionally anginal pain is a specific sign of angina pectoris. This is not always the case, because with diabetic neuropathy many receptors are affected, including pain in the heart muscle. Because of this, with diabetes mellitus, the pain may not be felt by the patient, and with an attack of angina pectoris, other signs come to the fore: weakness, developing shortness of breath, discomfort in the chest. At the same time, it is impossible to speak reliably about angina pectoris without Holter ECG monitoring and verification of ischemia. A treadmill test and a bicycle ergometer test are also well suited for diagnosis. The appearance of signs of ischemia on the ECG during exercise is the most reliable criterion for the diagnosis of angina pectoris.
Pathogenesis of angina pectoris
A typical attack of angina pectoris develops in conditions of a mismatch between the intensity of blood supply in the myocardium and its energy needs. That is, in a situation where the load on the heart muscle increases, and blood flow does not increase, ischemia and hypoxia develops in the heart. This episodic coronary insufficiency underlies the development of angina pectoris. A necessary condition for depletion of blood flow in the coronary arteries of the heart is coronary spasm. It occurs when breathing cold air or in case of emotional stress, during physical exertion and smoking.
Immediately after the development of an attack of angina due to local tissue factors (vasodilators), an attempt is made to increase the intensity of blood supply to the ischemic muscle by expanding arteries. In the case of coronary spasm, this is successfully achieved in up to 5-7 minutes. But with the development of atherosclerosis of coronary arteries and calcification, their expansion in order to increase throughput is impossible. Therefore, in conditions of a higher functional load on the heart muscle and with energy starvation, episodic ischemia develops. After taking nitrates, this pain episode stops in 5-7 minutes. It can also stop on its own after a short rest.
Actions for anginal pain
The appearance of anginal pain is a symptom that is familiar to all patients with stable angina pectoris. They feel it during physical exertion, climbing stairs or simple walking, with a hypertensive crisis and severe emotional stress. It is difficult to confuse with gastric symptoms or skeletal pain with thoracalgia, intercostal neuralgia. Therefore, patients with a diagnosis immediately realize that they develop an attack of angina pectoris, which must be stopped with nitroglycerin. They are well aware that rest and cessation of work allows you to quickly stop this attack.
Relief of an attack
Help with an attack of angina pectoris is rest and taking nitroglycerin preparations. Now there are tablet dosage forms and sprays. All of them are applied sublingually: 1 tablet of nitroglycerin 0.5 mg or 1 injection of spray under the tongue. A typical episode of anginal pain after this stops within 2-4 minutes due to a decrease in preload, and, consequently, a slowdown in the consumption of oxygen and energy substrates in the myocardium.
If the attack of angina pectoris is not eliminated after a single dose of fast nitrates, then after 5 minutes they can be taken again. This is allowed with normal or high blood pressure. But if the blood pressure is less than 90 \ 60 mmHg, you should contact the NSR and refuse to use nitroglycerin due to a further decrease in pressure. If blood pressure is higher than 100 \ 60 mmHg, then nitroglycerin can be taken again.
Actions for a non-stopping attack
Relief of pain indicates a complete cessation of angina pectoris. But if after 4-5 minutes from the repeated intake the anginal pains did not stop, one should contact the NSR for the diagnosis of acute coronary syndrome: progressive or unstable angina, myocardial infarction. It is also possible that the patient himself misinterpreted his condition and interpreted pain from another source as an attack of angina pectoris.
In fact, due to the peculiarities of innervation of the abdominal organs, angina-like pain can be a symptom of a stomach ulcer or gastritis, reflux disease and esophagitis, cholecystitis and pancreatitis, appendicitis, adnexitis, ectopic pregnancy, mediastinal or abdominal tumors, aortic aneurysms and pulmonary embolism.
All these conditions require diagnosis and special treatment in a short time. But this does not mean that if the assistance provided with an attack of angina pectoris did not have an effect, then a formidable disease will necessarily develop. This only speaks of the need for consultation with specialists (employees of the NSR or doctors in the emergency room of hospital facilities) to exclude heart attack, acute diseases of the abdominal organs, and tumors.
Then, before the arrival of the NSR, you should take a comfortable position (sitting or lying down), refuse to drink fluids, eat food and medications, and smoke. The staff of the NSR should tell in a concrete and objective form the details of the worsening state of health. When describing your condition, you need to abandon subjective facts, indicate the time of the onset of an angina attack, provide the medical documents on hand, extracts and epicrisis from hospital facilities, cardiograms.
Angina pectoris first appeared
According to the results of the Framingham study, signs of an angina attack are the first manifestations of coronary disease in 40.7% of cases among men, and in 56.5% of cases in women. This means that before the appearance of anginal pain, patients may not pay attention to a decrease in exercise tolerance. But when there is a burning pain in the heart, it becomes too late to ignore. Despite this, the diagnosis of chronic coronary artery disease slows down, and treatment begins later. As a result, its effectiveness remains insufficient, and therefore chronic heart failure develops much faster.
If an attack of anginal pain occurs for the first time and has not been seen before, then you need to follow the above recommendations. That is, stop it with nitroglycerin preparations, take “Metoprolol 25 mg” or “Anaprilin 40 mg” with a frequent pulse, lower captopril blood pressure if it was high at the time of the onset of pain. "Nifedipine" should not be used for angina pectoris, since it will increase pain due to the development of the "robbery" syndrome.
Actions after stopping the first arising angina
As soon as emergency care was given for an attack of angina pectoris, diagnostic measures are needed to clarify the stage of chronic ischemic disease. In addition, after the first attack, since there are atherosclerotic plaques in the narrowed coronary arteries, new episodes of anginal pain will constantly occur. This will significantly affect the patient's ability to work and limit his functional abilities.
The presence of a plaque in the coronary artery, the size of which and the degree of occlusion are not clear, is a risk factor for the development of acute myocardial infarction. A heart attack prior to a heart attack can be characterized in the same way as an attack of angina pectoris. Symptoms of these conditions are initially similar, since they include anginal pain. However, with a heart attack, they can be stronger, never completely stopped by taking nitroglycerin, often accompanied by shortness of breath due to left ventricular failure.
For comparison: stopping an attack of angina pectoris occurs within 2-4 minutes after taking nitrates or 5 minutes after taking them again. Myocardial anginal pains do not stop after taking nitroglycerin, although they can somewhat weaken. To prevent the development of myocardial infarction, as well as reduce the number of angina pectoris episodes, you need to see a physician.
Also, during the period when outpatient clinics are closed, the patient with the first angina pectoris should contact the emergency room of the hospital or the ambulance. The first occurrence of angina pectoris is regarded as a condition preceding myocardial infarction, and is treated with the use of anticoagulants, antiplatelet agents, statins, beta-blockers and antihypertensive drugs in a hospital.
Summary
Symptoms arising from an attack of angina pectoris are the first signs of an atherosclerotic plaque in the coronary artery of the heart. With a psychophysical load, when the heart needs a more intense energy supply than alone, ischemia occurs in the myocardium, which is accompanied by pain in the heart. Ischemia is a reversible phenomenon, which can be stabilized with drugs that stop an attack of angina pectoris. Preparations: tablets "Nitroglycerin 0.5 mg" - 1 tablet under the tongue or spray, "Metoprolol 25 mg" or "Anaprilin 40 mg" - 1 tablet inside, antihypertensives.
Only “Nitroglycerin” is obligatory for administration, while “Metoprolol” and “Anaprilin” drugs should be taken with a high pulse rate (above 90 per minute) and no history of bronchial asthma. “Captopril 25 mg” can be used as a means to lower blood pressure if blood pressure during an attack is higher than 150/80 mmHg. In the absence of the effect of repeated administration of "Nitroglycerin 0.5 mg" or a spray, as well as after stopping the first angina pectoris, it is necessary to seek medical help.