The treatment of heart pathologies should be approached very responsibly, as they are dangerous to human life. For example, there is a kind of rest angina, such as Prinzmetal angina, which can lead to both a heart attack and sudden death. Such a condition can be prevented, if only to prepare for possible consequences.
Pathology specificity
Prinzmetal angina pectoris is one of the varieties of resting angina that occurs with coronary angiospasm. The disease got its name in honor of M. Prinzmetal, a cardiologist who first described this form in 1959. The international classification of diseases is listed under the code I20.
A similar pathology is also called spontaneous, variant and unstable vasospatic. The disease is rare, as it occurs in about three percent of patients. Most often characteristic of men from thirty to fifty years old. In some cases, stress can be observed along with angina pectoris.
The main feature of variant angina is that it is distinguished by a long and severe attack of pain that can occur at rest.
Causes of occurrence
M. Prinzmetal was the first to suggest that coronary artery spasm is the cause of variant angina pectoris, which was confirmed in further studies. The appearance of spasm of the coronary artery is noticeable during coronarography. Cramping occurs due to located endothelial dysfunction with increased sensitivity to vasoconstrictor type effects. From 70 to 90% of patients with spontaneous angina are men. It is also noted that among people with this disease there are a lot of smokers.
Spontaneous variant angina pectoris is characterized by spasm of the spacecraft, severe painful anginal attack and a significant transient elevation of the RS-T segment on the ECG.
The following studies have revealed that patients with “pure” (isolated) spontaneous angina are very rare, less than 5% of all people with angina pectoris. Often in medical practice, patients with this kind of angina may not occur even for ten years. The increased frequency of variant angina was recorded only in Japan - about 20-30%. But at present, this indicator has decreased in Japan - about 9% of the total number of cases of angina pectoris.
A concomitant pathology such as angina pectoris (“mixed angina pectoris”) has a high frequency - from 50 to 75 percent of cases, with coronary angiography in approximately 75% of patients, significant hemodynamic stenosis of the coronary arteries is determined somewhere within one centimeter of the site of spasm .
Even if patients have coronary arteries that are unchanged during coronary angiography, non-stenotic atherosclerosis is diagnosed by means of ultrasonic intracoronary examination at the site of the spasm .
In most patients, proximal narrowing is found in at least one main coronary artery. Typically, a spasm occurs no further than one centimeter from the area with exacerbation and is often accompanied by ventricular arrhythmia.
Symptoms
A distinctive symptom of variant angina is pain. They most often occur in the morning and at night, they can appear even without good reason. Such pain comes from the region of the heart, is distinguished by a cutting and pressing character, it can also be given to other parts of the body. The attack itself can be described by listing its characteristic features:
- tachycardia;
- sweating profuse type;
- hypotension;
- fainting
- headache;
- skin pallor.
In some cases, the symptoms of variant angina can be as follows: heart rhythm disturbances, ventricular fibrillation, and atrioventricular block.
Most often, attacks last no more than fifteen minutes. Very rarely, the pain can last up to thirty minutes, is very difficult to tolerate. Against the background of an attack, myocardial infarction can also develop, in connection with which, with prolonged therapy, you must immediately call an ambulance.
What signs are not characteristic of variant angina? The fact that physical activity is poorly tolerated is extremely rare.
Diagnostics
Before starting all diagnostic procedures, a specialist will collect an anamnesis of life and family. After this, auscultation is performed, where they listen to noise, and a physical examination. These manipulations are required for the differential diagnosis of variant angina pectoris, as well as determining the initial diagnosis.
Then the patient is prescribed:
- blood and urine tests to identify concomitant pathologies;
- a biochemical blood test to assess the concentration of protein, cholesterol and other elements that help determine the cause of the disease;
- ECG, which determines the main indicator of variant angina pectoris - ST-segment elevation;
- Holter ECG monitoring, detecting transient ischemia;
- provocative test accompanied by hyperventilation for angiospastic induction;
- cold and ischemic tests;
- coronarography, detecting stenosis in about half of patients;
- bicycle ergometry, which determines the level of patient tolerance of physical activity.
In addition, an MRI can be prescribed to the patient if there is a suitable modern device in the village.
Treatment
The Prinzmetal variant therapy of angina pectoris is best carried out in stationary conditions, as this can help control disease changes. The treatment is based on a combination of drug and therapeutic methods. Very rarely, the patient requires surgery.
It is not recommended to start therapy for variant IHD, vasospastic angina pectoris with alternative drugs.
Therapeutic method
The treatment methodology for variant angina is based on an absolute revision of all human life principles. The patient must abandon his bad habits, stop drinking alcohol and smoking. In addition, it is very important to make adjustments to the diet:
- limit the intake of animal fats (in total calories - up to 30%);
- limit salt intake;
- reduce the use of spices and spices;
- drink multivitamins;
- Pay particular attention to vegetables and protein products.
The patient, along with these tips, needs to engage in physical therapy, which includes cardio exercises.
Medication method
In the form of prolonged drug treatment of variant angina, patients are prescribed:
- As a long-term drug therapy, patients are prescribed: alpha-blockers; calcium antagonists; nitrates.
- To stop angina attacks, the patient must take nitroglycerin, as well as Nifedipine, under the tongue.
Surgical intervention
The operation is indicated only in the presence of a strong arterial narrowing and in cases where the development of angina pectoris occurs in the region of the heart. The following manipulations are used:
- angioplasty, in which the expansion of the vessel is carried out by means of a balloon and is fixed in this state by an awning of metal;
- coronary artery bypass grafting, which means the stitching of a patient’s vessel to the coronary artery to start blood bypassing a narrower place.
Very rarely, a disease can affect the heart in such a way that it can no longer function on its own. In this case, the intervention of the surgeon is shown to him.
Preventative measures
Prevention measures for variant angina are reduced to a number of general recommendations:
- a diet with a reduced content of salt and animal fat, increased - cereal crops and vegetables;
- the exclusion of tobacco and alcohol;
- compliance with the principles of the ratio of rest and work;
- an eight-hour healthy sleep;
- Avoiding stressful situations.
In addition, people who are at risk are advised to exercise regularly. Every six months, everyone needs to go to a cardiologist so that he examines the patient for prevention.
Complications
The most common complication of this form of angina pectoris is myocardial infarction, due to which a number of heart muscle cells die. In addition, if there is no competent treatment, the disease can lead to:
- severe varieties of tachycardia;
- arrhythmias;
- CHF;
- the most dangerous complication of the pathology is a sudden death of the heart, which can be reversible with the timely provision of qualified help.
Forecast
It is difficult to predict the course of angina pectoris, as the condition is determined by the influence of various kinds of factors: the age of the patient, the strength of the attacks, etc.
With weak heart damage, the probability of death is very low: about 0.5% per year.
If heart damage is severe, death occurs in 25% of cases.