ECG change in angina pectoris. Electrocardiogram changes in angina pectoris. Doppler study of blood vessels

The main condition for the development of coronary heart disease is the presence of atherosclerosis, in which cholesterol and other harmful lipids are deposited on the walls of arterial vessels. Almost all blood vessels of the body suffer from atherosclerosis, but it is the coronary arteries located in the heart that are most susceptible to the negative impact of this pathology.

Over time, cholesterol plaques grow, reducing the lumen of blood vessels and preventing normal blood flow. If a person is calm, circulatory disturbance almost does not manifest itself, but with nervous or physical exertion, the heart increases its rhythm, and blood begins to run faster through the vessels.

Since the vessels are narrowed, the movement of blood is difficult, as a result of which the myocardium experiences a lack of oxygen. Hypoxic processes prevent the removal of unprocessed metabolic products, and this leads to the appearance of pain in the heart. This condition is called an angina attack.

A stable type of the disease can be successfully controlled - do not overload yourself physically, avoid stress, take nitroglycerin during an attack. The unstable form of the disease manifests itself in a different way.

Unstable angina can be considered a borderline condition between the usual failure of the heart and such a threatening phenomenon as myocardial infarction. This pathology, without timely medical care, can lead to the development of an acute heart attack, therefore, it requires urgent hospitalization and constant medical supervision.

Causes and risk factors

Angina pectoris takes on an unstable form when a fibrous plaque ruptures in a coronary artery, followed by the formation of a thrombus that prevents normal blood supply to the myocardium.

Fibrous plaque can collapse due to inflammatory processes, excess body fat, hemodynamic disturbances, or lack of collagen.

The main cause of unstable angina is coronary artery disease. It appears when fatty deposits accumulate on the walls of the arteries. At the same time, the lumen of the vessels narrows, the heart ceases to receive enough oxygen, which leads to pain symptoms of ischemia.

Other reasons that can cause the development of pathology are:

rupture of capillaries with subsequent hemorrhage into the plaque;
increased ability of platelets to stick together;
the release of serotonin or another vasoactive agent into the blood, in which there is a sharp narrowing of the lumen of the coronary vessels;
decrease in antithrombotic properties of endothelial cells.

Species classification

There are 4 main types of unstable angina:

Primary, in which the disease causes concern for a month.
Post-infarction, manifested by attacks in the first 2 days after a myocardial infarction, or during an acute period, which usually lasts about eight weeks.
Progressive, in which the state of health worsens and the frequency of attacks increases progressively, throughout the month.
Prinzmetal's angina, in which blood vessels constrict as a result of spasms, and not due to atherosclerosis.

It is also divided by prescription and severity:

1 degree. The disease began less than 2 months ago, is severe, progresses rapidly, manifests itself at rest.
2 degree. Refers to the subacute phase of the disease, with symptoms occurring for the first time, and pain can last more than two days.
3 degree. Pain sensations arise the last 2 days.

Depending on the factors of appearance and the clinical picture, it is divided into three classes:

1 class. The pain syndrome first appears at a high load, in the future - at a minimum. The number of seizures increases over time. The first attack - not earlier than 2 months ago. In a calm state, seizures may not appear for 2 months.
Grade 2 It is characterized by constant pain at rest. The first case of an attack was registered not earlier than 2 months ago.
Grade 3 It includes acute angina pectoris at rest, which has occurred over the past two days.

For reasons of formation, the disease is classified into three groups:

Group A - attacks occur due to diseases that are not related to the heart - thyrotoxicosis, hypoxia, anemia, acute infection.
Group B - angina pectoris develops against the background of other heart problems.
Group C - the origin of the disease is associated with a previous heart attack.

The diagnosis of unstable angina pectoris is made on the basis of its classification and looks something like this: "unstable angina pectoris, class 1 A." According to this characteristic, it can be determined that seizures appear with a slight load for 2 months already, and the patient has a disease that provokes a narrowing of the coronary vessels.

Danger and complications

If left untreated, unstable angina can cause the following problems:

acute myocardial infarction;
thromboembolism of the pulmonary arteries;
sudden fibrillation of the ventricles of the heart, followed by death;
acute heart failure, accompanied by pulmonary edema.

Clinic: signs and symptoms

It is sometimes quite difficult to identify the disease, since the symptoms of this disease can be attributed to many other cardiac pathologies.

Unstable angina is defined if the following symptoms are observed:

Change in symptoms: the frequency and duration of pain attacks have increased, nitroglycerin helps less, the pain intensifies and spreads to nearby parts of the body, attacks occur already at lower loads than before.
Attack of pain that lasts more than 10 minutes, not relieved by nitroglycerin.
Seizures began to disturb a month ago or later.
Pain in the chest during the treatment of a post-infarction condition - such a sign indicates the formation of a new blood clot in the affected vessel.
Seizures began to occur at rest.
The onset of symptoms after coronary artery bypass surgery less than three months ago.

Prinzmetal's angina has its own specific symptoms:

young men are most often subject to an attack;
pain is not associated with physical activity;
seizures are more common in the morning than at other times of the day;
high efficiency of treatment with calcium antagonists and drugs from the nitrate group.

Since this pathology poses a great danger to human life, when the first symptoms appear, you should immediately contact a cardiologist. People suffering from coronary heart disease and exertional angina need to see a doctor regularly and undergo examinations.

Diagnostics

The following types of diagnostic procedures are used to make a diagnosis:

general examination of the patient, listening to heart sounds, studying symptoms and anamnesis;
a blood test to detect inflammatory processes;
urinalysis - necessary to exclude other pathologies;
ECG - to detect complications of coronary disease;
Holter ECG - used to determine the conditions, frequency and duration of the presence;
Echo-ECG - required to study the structure and size of the heart, as well as the condition of the valves and blood circulation;
coronary angiography, which allows you to examine the blood flow in the heart vessels;
Stress echo ECG - carried out to identify areas of myocardial hypoxia under conditions of physical activity;
scintigraphy, which allows you to study the condition of the walls and cavities of the heart.

Only after collecting the full data of all examinations, they make the appropriate diagnosis.

Therapy tactics

If unstable angina is detected, emergency hospitalization with strict bed rest is prescribed, as well as drug therapy. The following are used in treatment:

painkillers - neuroleptanalgesia, nitroglycerin;
drugs that improve blood flow - antiplatelet agents and direct anticoagulants (clopidogrel, prasugrel, aspirin and others);
drugs that reduce myocardial oxygen demand - calcium antagonists, beta-blockers.

In the absence of a positive effect from drug therapy, surgical ways of treating the disease may be indicated:

Angioplasty. A stent (metal tube) is inserted into the narrowed vessel, which keeps the vessel walls from sticking together and ensures normal blood flow.
Aorto-coronary bypass. Such an operation is used if the main coronary artery, or most of the coronary vessels, has been affected. In this case, an additional channel is created, bypassing the affected vessels, which ensures the delivery of blood to the heart.

It is also important to know about the first signs of an angina attack and how to stop it - more on this in a separate article. Sometimes the treatment of angina pectoris with folk remedies can help.

Forecasts and preventive measures

The prognosis of the disease depends on the degree of its severity, the duration of development and concomitant pathologies. To prevent angina attacks, it is recommended to follow preventive measures:

to give up smoking;
fight against excess weight;
sports;
moderate drinking;
a large number of fruits, fish, vegetables, whole grains and lean meats in the diet.

In addition, diseases that cause high blood pressure and narrowing of arterial vessels should be treated in a timely manner. Taking an aspirin tablet a day can reduce the number of pain attacks and reduce the chance of developing an acute myocardial infarction.

What is the danger of unstable angina and how to treat it

Pain behind the sternum on the left is always frightening and makes you assume the worst. This symptom is caused not only by cardiac pathologies, but can also be triggered by many other reasons.

A bit about anatomy
Varieties of angina pectoris
The main dangers of unstable ischemic manifestations
Classification of degrees of pathology
Characteristics
Circumstances of appearance
Diagnostic methods
Collection of anamnesis
ECG monitoring
Ultrasound and dopplerography
Blood test
Angiography
Treatment of the disease
Elimination of causes
Lifestyle Correction
Medical and surgical treatment

If the examination revealed signs of myocardial ischemia and diagnosed with unstable angina, then you should carefully listen to the doctor's recommendations.

This type of angina is considered the most dangerous, in most cases it leads to complications such as a heart attack, or causes other life-threatening conditions.

A bit about anatomy

For full-fledged work, the heart muscle (myocardium) needs an increased supply of tissues with oxygen and nutrients. Myocardial nutrition is carried out through two large coronary arteries and many small vessels extending from them.

Violation of vascular patency leads to the following:

spasm or mechanical narrowing of the vascular lumen by atherosclerotic plaques slows down the rate of blood flow;
in areas of the coronary vessels located behind the narrowing of the artery, there is a slowdown in blood flow;
a decrease in blood flow velocity leads to a deterioration in myocardial nutrition and its ability to conduct impulses;
ischemic processes are always accompanied by pain syndrome of varying intensity (pain can be pressing or squeezing with irradiation to the neck, shoulder or left arm).

Pain behind the sternum is the first signal that pathological changes are occurring in the heart (ischemic heart disease develops). Ignoring angina attacks, especially if they occur for the first time, is life-threatening.

Varieties of angina pectoris

There are two types of angina pectoris manifestations of coronary artery disease (ischemic heart disease):

stable;
unstable.

Stable is considered the most favorable for the patient and, subject to medical recommendations, allows you to avoid dangerous complications for a long time.

What is the difference between stable and unstable angina? To answer this question, it is necessary to compare how both forms of the disease manifest themselves.

stable

unstable

The nature of the pain	The pain syndrome almost always manifests itself in the same way, for example, pressing pain radiating to the neck accompanies almost every attack	The nature of pain is changing. Soreness behind the sternum with each appearance can change the area of manifestation, for example, if the last time there was irradiation to the arm, then with the next violation of the coronary blood flow, irradiation to the neck may occur
Duration and intensity of pain syndrome	All arising attacks last approximately the same period of time and are the same in severity of pain.	Each new attack, in comparison with the previous one, is longer, and the pain syndrome is intensified.
Relationship with external factors	The patient knows well under what circumstances he has ischemic manifestations (great physical exertion, stress or at night) and, if possible, tries to prevent the onset of symptoms	Pain manifestations are almost not associated with external factors and can appear both at rest and during physical exertion.
The action of nitrate-containing drugs (nitroglycerin, nitrosprays)	Medicines contribute to the complete elimination of painful manifestations	Medicines based on nitrates are either completely ineffective or provide a short analgesic effect.

But unstable angina is not only an independent manifestation of coronary artery disease. Under the influence of adverse factors, a stable form of ischemia may acquire signs of an unstable one.

These factors include:

bad habits (smoking and alcoholism are the most common causes of deterioration in the patency of the coronary arteries);
heavy physical work;
prolonged or frequent stressful situations;

chronic fatigue;
lack of proper rest;
non-compliance with medical recommendations;
self-treatment.

The main dangers of unstable ischemic manifestations

In addition to the progression of ischemia of the heart muscle and the deterioration of the organ, unstable angina often provokes life-threatening conditions:

myocardial infarction;
acute heart failure complicated by pulmonary edema;
pulmonary embolism;
sudden ventricular fibrillation (the most dangerous condition, which, without the prompt provision of qualified assistance, leads to cardiac arrest and death of the patient).

The type of complication and the likelihood of its development depend on the stage of unstable angina pectoris and on which parts of the myocardium the ischemic disorders occur.

Classification of degrees of pathology

Classification of unstable angina according to the main characteristics of the attack and the factors that cause pain, allows you to determine the severity of the disease and the risk of severe complications.

Most often, cardiologists use the classification table for unstable angina according to Braunwald to determine the degree of risk.

The table consists of 2 parts:

characteristics of the manifestation of an attack;
circumstances of the occurrence of pain syndrome.

Characteristics

By the nature of the course, unstable angina pectoris is divided into risk classes:

The first - along the course of the attack is considered the easiest. This includes all stable angina pectoris if there was an increase in the frequency of occurrence of pain or a change in the nature of the pain, but the patient did not have pain behind the sternum at rest. At the same time, at least 2 months have passed since the last manifestation of the disease. Class I almost always acts as a secondary complication of heart disease, accompanied by a violation of myocardial trophism.
The second - paroxysmal painful sensations are noted at rest, and no more than a month has passed since the last occurrence of the manifestation of the disease. They can develop as primary signs of coronary artery disease or be a complication of existing cardiac pathologies.
The third is the most dangerous condition, when paroxysmal intense pains were noted at rest after the last 48 hours.

Circumstances of appearance

Depending on the cause, several types of unstable angina are distinguished:

A - occurs as a complication of coronary pathologies or is caused by other causes (anemia, hypoxia or various infections). Considered the easiest.
B - a manifestation of the newly emerged coronary artery disease. The severity is determined by the degree of ischemic process in the myocardium.
C - post-infarction. It can occur in the first 14 days after a heart attack and, in most cases, ends in death.

But the division of unstable angina according to the Braunwald method is not always accurate, because it does not take into account the following factors:

age;
ECG data;
concomitant diseases (arterial hypertension, kidney pathology, etc.);
blood test data for markers of necrosis (troponin test).

To clarify the degree of risk and severity of the pathology, a comprehensive examination of the patient is always carried out.

Diagnostic methods

If signs of ischemia can be detected on the ECG during an attack, and sometimes even 2–3 days after the disappearance of pain manifestations, then it is impossible to determine whether it is stable or unstable angina only on the basis of this type of examination.

For the purpose of accurate diagnosis, they carry out:

collection of anamnesis;
ECG monitoring;
Ultrasound and dopplerography;
general and biochemical blood tests;
angiography.

Collection of anamnesis

In a conversation with the patient, the doctor specifies the following characteristics of the attack:

nature of pain;
pain duration;
causes that provoke the occurrence of soreness behind the sternum;
Do nitrate supplements help?

ECG monitoring

It is not always possible to take a conventional ECG during an attack, and daily monitoring is used to detect angina pectoris signs of ischemia.

An apparatus is attached to the patient's body, which records an ECG at regular intervals. The procedure may take 2-3 days. With the help of the data obtained, it is possible to identify the nature of angina pectoris and the most characteristic time of day for the onset of an attack.

Ultrasound and dopplerography

With the help of ultrasound, it is possible to determine the areas of myocardial ischemia, to identify the degree of patency of the cardiac vessels.

Blood test

The main indicators necessary for diagnosis:

The level of leukocytes. Unstable angina is characterized by leukocytosis.
The amount of troponin. Troponin rises strongly immediately after an attack, and then its amount decreases. The presence of troponin in the blood for a long time indicates a high risk of heart attack.

Angiography

X-ray examination of the cardiac vessels is done only if the treatment of unstable angina pectoris will be carried out by the operative method. For conservative therapy, there is no need for this type of examination.

With the help of angiography, the localization of the narrowed artery is determined, and based on the data obtained, the cardiac surgeon determines the method of surgical intervention. After confirming the diagnosis of unstable angina and determining the severity of the disease, appropriate therapy is selected.

Treatment of the disease

The process of treating unstable angina includes several stages.

Elimination of causes

The most common causes of disease progression include:

bad habits (alcohol abuse and smoking);
abuse of fatty, smoked or spicy foods;
hormonal disorders (diabetes mellitus, thyrotoxicosis);
obesity;
atherosclerosis or thrombosis of non-coronary vessels.

If these factors are not eliminated, then the ongoing therapy is ineffective, and ischemia will progress.

Lifestyle Correction

When unstable angina is diagnosed, a person needs to completely change their lifestyle to prevent complications. Patients are advised:

constantly take medications that improve the blood supply to the myocardium;
exclude harmful products from the menu;
take care of proper rest and avoid overwork;
provide the body with adequate physical activity (physical inactivity is no less harmful to the work of the heart than overload).

This lifestyle should become a good habit, because this is the only way to maintain the health of the heart muscle.

Medical and surgical treatment

Unlike stable angina, in unstable angina, conservative therapy is ineffective, and only at an early stage in the development of the pathology can give a positive effect.

For therapeutic purposes, appoint:

blood-thinning drugs;
calcium antagonists (reduce spasm of the heart arteries);
metabolic agents that stimulate metabolic processes in the myocardium;
drugs for the treatment of concomitant diseases (diabetes, atherosclerosis, etc.).

In most cases, these medications are prescribed not as a conservative treatment, but for the prevention of postoperative complications. Surgical elimination of myocardial ischemia is carried out in several ways:

Shunting. With large narrowing of the left artery, a shunt is installed and the blood flow is redistributed between other heart vessels.
Angioplasty and stenting. An artificial expansion of the place of vasoconstriction and the elimination of a blood clot or atherosclerotic deposits are carried out.

The type of operation is determined by the surgeon, taking into account the individual characteristics of the disease.

According to medical statistics, in 60-65% of those operated on, there is a complete disappearance of signs of the disease, and in the remaining patients it is possible to transfer the disease to a stable form.

But even with the complete disappearance of all signs of the disease, a person is shown lifelong medication to prevent relapse.

An unstable form of angina pectoris is dangerous and, if not treated promptly, is fatal in 100% of cases. Do not ignore the first pain behind the sternum, it is better to immediately do an ECG - this will be enough to detect the first signs of ischemia.

09/29/2017 at 18:52

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Stable angina is angina that occurs under well-defined conditions, that is, at a certain threshold of physical activity. For example, one patient knows that if he walks quickly on a flat area of 500 meters, then there will be no pain, but if he walks these 500 meters at a faster pace, he will start to press immediately behind the sternum - this is stable angina I functional class. Or, for example, another patient knows that if he goes up to the 1st floor, then pain will appear, which will disappear after taking a nitroglycerin tablet - this is functional class III angina pectoris. And if this threshold is constant (well, of course, there is always a “plus or minus bast shoe”), then angina pectoris is called stable.

But if suddenly the usual exercise causes symptoms in the first patient, and in the second patient they begin to appear at rest and are poorly removed even with two tablets of nitroglycerin, then this condition will be called unstable angina. And from it to a heart attack one step.

Unstable also include angina pectoris, which was first identified. In both cases, the patient is shown hospitalization in a hospital on an emergency basis.

In simple terms, unstable angina is a pre-infarction condition that has only two ways, either everything stabilizes, or myocardial infarction develops.

Angina pectoris is one of the forms of coronary heart disease (CHD), caused in the initial stage by a temporary spasm of the coronary vessels that feed the myocardium. After the spasm is removed, all manifestations disappear. In diagnostics, it is important to register not only the patient's complaints, but also the objective signs of the disease.

What manifestations do doctors focus on when referring to an ECG?

The clinical symptoms of angina pectoris are well known. 75% of patients have:

paroxysmal pain behind the sternum lasting from a few seconds to 40 minutes; irradiation to the left half of the chest, shoulder, lower jaw; pressing or squeezing character; concomitant arrhythmias, dizziness, shortness of breath.

The effectiveness of nitroglycerin to relieve pain speaks in favor of angina pectoris.

For more accurate diagnosis, instrumental methods of examination are used. One of the most accessible is electrocardiographic. An ECG in angina pectoris serves as objective evidence and a sign of an imbalance between the need for oxygen in myocardial cells and its supply. Ambulances, all polyclinics, feldsher points are equipped with equipment. Doctors of all specialties are familiar with possible changes on the ECG.

Features of registration of signs of angina pectoris

At the initial stage of the development of IHD, pain manifestations in the heart occur only during increased physical or emotional stress, smoking. This type of disease is called "angina pectoris".

The method of electrocardiography fixes myocardial malnutrition, too, only against the background of the clinical manifestations of an attack. After its completion, the ECG has normal parameters, there are no deviations.

This means that typical changes can only be registered if:

long-term monitoring of the patient with subsequent interpretation of the results - the principle is used in the Holter examination, when the ECG is recorded from electrodes attached to the patient during the day; artificial provocation of an attack - tests with increased physical activity, electrical atrial stimulation, the introduction of special drugs, psycho-emotional tests are used.

In the ECG rooms there is a structure of two steps 22.5 cm high for a simple stress test

Why is it important to identify signs of angina pectoris?

Professional selection provides for the exclusion of admission of people with initial manifestations of coronary artery disease. Targeted programs to study the prevalence and causes of cardiac diseases need to examine people of different age groups and gender.

a) recording before the attack; b) changes in angina pectoris are highlighted in red; c) after the attack everything returned to normal

Working under stress is a necessary requirement for the health of people in professions related to military service, police, emergency situations, air transportation, and vehicle management. Therefore, when passing a medical commission, tests with physical activity are mandatory. In the treatment of angina pectoris, rehabilitation after a myocardial infarction or heart surgery, a cardiologist may need to control the resistance of the body and the heart muscle to physical activity. Mass studies of the population to detect early signs of coronary disease conducted within specific programs and territories. Morbidity forecasts are based on the results of such a survey. IHD therapy should be started as early as possible, therefore, any ways to detect angina pectoris at the stage of the absence of pain manifestations at rest are important. Angina pectoris is insidious in atypical symptoms. Attacks can simulate cholecystitis or biliary colic, pancreatitis, gastritis, intercostal neuralgia. Some patients are sure of a cold and sore throat. In a surgical hospital, with an emergency admission of a patient with unclear abdominal pain, they cannot do without an ECG.

What changes on the ECG

The main electrocardiographic diagnostic signs of angina pectoris are:

shift of the ST interval; changes in the T wave (flattening, downward direction, high and sharp in shape).

These changes appear on the background of an attack, rarely last from several minutes to hours after the end of the pain.

If the reduced ST interval and negative T-wave persist for longer, acute focal

myocardial dystrophy

or chronic coronary insufficiency.

The shape of the T wave indicates the depth of the ischemic area:

with a subendocardial form - T is high in amplitude, the ST segment decreases at the same time; with subepicardial localization - in addition to T, the ST segment rises and takes the form of an arc.

Against the background of an attack, rhythm and conduction disturbances are often recorded. Cases of the appearance of a negative U wave have been established.

Differential Diagnosis

The registered changes in the ST segment and the T wave are characteristic not only for angina pectoris. They are observed in dystrophic disorders of the myocardium of various causes, myocarditis, electrolyte disorders.

Drug tests help to distinguish them:

positive changes after taking Nitroglycerin indicate cardiac ischemia; improvement in the ECG picture after taking potassium-containing drugs is not typical for coronary artery disease, but confirms electrolyte changes; a positive result after taking Obzidan is more typical for myocardial dystrophy of neuroendocrine origin, but is also possible with angina pectoris.

Use of exercise tests and ECG changes

The use of dosed physical activity to detect latent pathology, an early stage of the disease is widely used in cardiology. The application of samples is carried out in the presence of a doctor with a preliminary examination and an ECG study. Pulse rate, blood pressure, oxygen consumption are taken into account.

The most commonly used dynamic Master-Oppenheimer test. They introduced the "Harvard step test" in 1929, standardized the study, and developed evaluation tables. In the modern version, the patient is asked to go up and down the stairs for 1.5 minutes (simple version) or three minutes (double test). The method is considered to be the most physiological. The use of bicycle ergometry (a bicycle ergometer is a stationary bicycle with a graduated load in units of power) is based on high sensitivity. In 80 - 95% of cases, changes during exercise indicate exertional angina. Evaluation standards provide for ECG deviations in mm and their storage in fractions of a second. A similar test is carried out with a track on a treadmill. The treadmill is driven by a motor and allows you to set different speeds. There are static tests. These include loads accompanied by muscle contraction without shortening the length of the fiber. Apply squeezing and unclenching, holding gravity with hands, feet.

A person on the track walks or runs on a horizontal surface, but you can raise it and simulate climbing uphill

Psycho-emotional tests

Depending on the level of education of the patient, his physical activity, special tests can be used to establish the influence of the sympathetic nerve on the onset of an attack. For this, tests are used that require increased attention, nervous tension:

counting in the mind; memorizing a series of numbers; tasks on the computer.

Execution is time limited. A comparison is made between the initial and repeated ECG.

Electrocardiography is not the only method for diagnosing angina pectoris. It is taken into account in combination with ultrasound. If necessary, special centers carry out transesophageal atrial stimulation, radioisotope scanning, biochemical tests for blood tests. The most revealing is the angiography of the coronary vessels.

Angina pectoris is the most common manifestation of coronary heart disease. Pressing pain, burning, any feeling of discomfort in the chest should not be ignored. The body can signal life-threatening heart disease. That is why any manifestations of ischemia are subject to detailed diagnosis.

During the diagnostic study, the diagnosis of angina pectoris should be scientifically established, the severity of the disease and the risk of its complications should be determined. The choice of method and scale of treatment depends on these data: whether it will be outpatient, or hospitalization is required, how justified is surgical intervention.

Diagnostic research goes in several directions:

a detailed survey of the subject; analysis of the medical history; physical examination; instrumental and laboratory research; differential diagnosis of angina pectoris and diseases with a similar clinical picture.

Physical examination

A qualified patient survey is the first in the list of answers to the question “how to identify angina?”. The patient's complaints are carefully collected and recorded in the medical record, it turns out when the disease started, what preceded it. The conditions of life and work of the subject, hereditary pathologies, past diseases, bad habits are recognized.

According to statistics, more than half of the cases of complaints of pain in the heart area are of ischemic origin. For this reason, all symptoms are necessarily studied as possible manifestations of coronary heart disease.

Pain sensations of the patient are evaluated from the following positions:

localization; duration; the nature of the flow; associated with physical and emotional stress.

How to determine angina pectoris, the analysis of these factors will prompt. According to them, you can establish a typical pain syndrome inherent in angina pectoris. Moreover, these data are sufficient to attribute the disease to a typical, atypical angina pectoris, or to cardialgia (a pain syndrome in the chest that is not associated with pathologies of the arteries of the heart).

The patient points to the source of pain with his hand. As a rule, its focus is the chest, however, in some cases it can be localized in the lower jaw, left arm, shoulder blade, just below the ribs. Pain occurs if there is increased oxygen consumption. This happens during physical exertion, being in the cold, a tight snack, stressful situations, any cases when the heart rate increases.

An attack of pain usually has clear boundaries and lasts from 2 to 10 minutes. It quickly passes if you return to a calm state or take a nitroglycerin tablet. If the discomfort is prolonged, it may indicate a myocardial infarction.

Quite often, patients characterize chest pain as a feeling of heaviness, burning, pressure. This discomfort may be accompanied by profuse sweating, weakness, shortness of breath, palpitations, pallor, and anxiety.

Risk factors for coronary artery disease are taken into account. The doctor attributes the disease to angina pectoris with a higher probability if it turns out that the patient smokes, if in the past the respondent was diagnosed with muscle pain when walking (intermittent claudication), myocardial infarction, strokes, diabetes mellitus, and also if his parents suffer from diseases of the cardiovascular system.

The age and gender of the respondent is taken into account. So, in women diagnosed with coronary artery disease most often occurs after the onset of menopause.

Thus, the disease can be diagnosed with high accuracy if, in the course of searching for an answer to the question “how to recognize angina?” the following conditions were identified:

the pain is in the nature of an attack, its beginning and end is clearly expressed; the attack is provoked by certain circumstances, as a rule, physical and emotional stress; the use of nitroglycerin gives a good effect; other signs, such as the focus of occurrence, the nature of the manifestation, may vary within certain limits.

Differential diagnosis of angina pectoris should unequivocally distinguish and exclude from suspicion neuroses, lung diseases, intercostal neuralgia, and diseases of the digestive organs.

After a detailed survey proceed to the examination of the patient.

The basis of angina pectoris is atherosclerosis, so pay attention to the external signs of its manifestation. Numerous xanthomas and xanthelasmas testify to atherosclerosis - yellow lipid formations on the forehead, eyelids, folds of the limbs, in the abdomen and buttocks. The change in lipid metabolism is also indicated by the “senile arc” - a smoky ring along the edge of the eye iris. A vertical crease in the earlobe (Frank's symptom) is associated with coronary atherosclerosis.

Pay attention to swelling of the lower extremities, shortness of breath, swelling of the cervical veins, bluish color of the skin and mucous membranes. These are signs of insufficient blood supply due to disorders in the work of the heart.

Auscultation (listening) of the heart is performed. Heart rhythms and murmurs are assessed. Measured pulse and pressure. All symptoms of conditions that can provoke coronary artery disease are actively detected. A more accurate diagnosis of angina pectoris involves other studies.

Laboratory diagnostics

Laboratory studies identify possible sources of CAD. Mandatory tests include:

general blood analysis. Shows the status of red blood cells and hemoglobin. Based on the results, we can conclude that anemia, the consequence of which is a lack of oxygen in the tissues. This is the cause of weakness, dizziness and other symptoms; determination of blood glucose levels. Excess sugar provokes diabetes mellitus - an alarming risk factor for coronary artery disease. Increased blood viscosity leads to impaired blood supply, thrombosis. Shortness of breath, sweating, palpitations accompany angina on the background of diabetes mellitus; lipid profile analysis. Shows the level of fats and lipoproteins, which can be used to judge how a person is predisposed to cardiovascular diseases. The growth of low-density lipoproteins, and, accordingly, the accumulation of cholesterol in the vessels, leads to the formation of atherosclerotic plaques and slows down blood flow; determination of creatinine concentration. The accumulation of creatinine in the blood leads to kidney pathologies, reducing the rate of blood flow. Outwardly, this is expressed by nausea, dizziness, weakness.

Additional tests may also be ordered:

determination of troponin I in the blood. The troponin protein inherent in the cells of the heart muscle, entering the blood, indicates a violation of the myocardium. In a healthy state, its level is so low that it is practically undetectable; thyroid hormone levels. Increased production of hormones by the gland (hypothyroidism) leads to the breakdown of myocardial proteins, the replacement of heart muscle tissues with connective ones, increased stress on the heart, increased heart rate and other pathologies.

Electrocardiogram

A 12-lead electrocardiogram (ECG at rest) is performed for all subjects experiencing discomfort in the heart area. This is a generally accepted method of instrumental diagnosis of ischemia. The greatest value is an ECG taken during an attack, however, this possibility rarely occurs.

An ECG for angina pectoris is a study of cardiac activity produced using electrodes located on the chest. The ECG at rest records 12 electrical signals simultaneously and is displayed on paper. The procedure has no contraindications and is absolutely harmless.

The study allows you to evaluate the frequency, uniformity of contractions of the heart muscles, diagnose abnormal rhythms caused by cardiac pathologies. On the ECG, you can see the affected area of \u200b\u200bthe heart, measure the size of the chambers. The pumping function of the heart is not recorded reliably by the ECG.

On the ECG during ischemia, a change in the S-T segment relative to the isoline is recorded.

If the attack has already passed, then ECG signs of angina pectoris may be absent. In this case, violations can be fixed in two ways:

long-term monitoring of the condition of the subject (daily ECG); artificial induction of an attack (ECG with physical activity, atrial electrical stimulation, psycho-emotional tests).

A daily ECG involves the patient wearing a device with electrodes fixed on the skin during the day. The ECG is recorded continuously and can detect spontaneous or asymptomatic angina.

Exercise testing is an affordable procedure with over 85% sensitivity. An additional load is provided by work on special simulators. In the process, the load increases (for example, the speed on the treadmill increases), respectively, the demand of the heart for oxygen increases. During the whole process, an ECG is taken and blood pressure is measured. False test results are recorded mainly in young women with a stabbing syndrome in the chest.

The test ends when 85% of the maximum heart rate, characteristic of the patient's age, is reached, or with the onset of an attack. The result is considered positive if, as a result of the test, pain in the chest begins, or the ECG shows changes typical for angina pectoris.

Tests with physical activity are shown:

in the differential diagnosis of ischemia; to determine the ability to work and individual tolerance for physical exercises; to evaluate the effectiveness of the therapy; to predict the development of the disease and a possible heart attack.

A number of medications, such as beta-blockers, can reduce the value of this method.

Electrical stimulation of the atria allows you to change the number of heartbeats, keeping blood pressure unchanged. The method has a high diagnostic value. The advantage over physical stimulation is that the patient is at rest during the examination. This makes it possible to use the method for patients for whom a physical test is contraindicated, or for whom there are concomitant diseases (lack of breathing, diseases of the musculoskeletal system, and others), as well as in the presence of arterial hypertension.

Psycho-emotional tests are studies that require nervous tension. To do this, for some time the subject performs various tasks for memorization, counting, or computer tests. The ECG during these tests is compared with the ECG at rest.

echocardiography

Echocardiography is a highly informative ultrasound method for examining the heart. It makes it possible to obtain an image of the heart and blood vessels, to find out the condition of the cavities and valves, the wall thickness. EchoCG results are displayed on photographs.

With the help of echocardiography, you can evaluate heart contractions, blood flow velocity, and pressure in the chambers. Echocardiography captures pathological changes, defects, thrombosis, all areas suffering from circulatory disorders.

Echocardiography is indicated if symptoms indicate a previous myocardial infarction, if there are suspicions that the heart valves are affected, if murmurs indicate a possible narrowing of the aortic lumen.

Coronary angiography

This method is called the "gold standard" of vascular diagnostics. It is coronary angiography that is necessary when the question arises of choosing the optimal therapy: to prescribe medication or to operate on the subject. Coronary aerography accurately determines the location of the affected vessels, their boundaries and the degree of narrowing, the nature of the pathology.

Coronary angiography is indicated for the following patients:

whose physical condition does not allow them to fight the disease; having a socially significant nature of work (pilots, drivers); who have suffered sudden death; with repeated hospitalization due to chest pain; with a high risk factor for cardiovascular diseases (smoking, heredity, diabetes, and others); with suspected acute myocardial infarction; who have had a heart attack, but have angina pectoris even with minor physical exertion; with stable angina, not amenable to drug treatment; with progressive angina; before heart surgery.

The course of the examination consists in the fact that a contrast agent is injected through the femoral artery, which is carried through the vessels. At the same time, information about its movement is displayed on the screen, as a result of which the doctor can assess the patency of the arteries.

Any patient diagnosed with angina pectoris should clearly understand the essence of angina pectoris and coronary heart disease and know that by reducing the influence of risk factors, one can lead an active long life. To do this, you need to monitor weight, blood pressure, quit smoking, reduce the impact of concomitant diseases, maintain physical activity and diet. Being in good physical shape is much more likely to save life during acute heart attacks.

Electrocardiography for angina pectoris is mandatory. The disease is detected as part of IHD, but this clinical syndrome can lead to other complications of the disease. At the time of the attack, changes occur in the myocardium or blood vessels: a spasm occurs or the need for oxygen increases sharply. At the same time, small coronary vessels do not increase. This may result in damage. And the longer the spasm, the more serious damage is done to the heart.

Methodology

ECG with angina pectoris is most often performed with a load. At the time of the study, the patient is on a bicycle ergometer or treadmill, which allows specialists to compare what changes occur before and after exercise.

Note! This study belongs to a number of mandatory, as it reveals other ischemic problems that may accompany this disease. It also allows you to determine the likelihood of a heart attack or find out the localization of a past attack.

Sometimes an exercise test is prohibited by indicators or simply impossible due to comorbidities, age, or severity of angina. In this case, 24-hour Holter monitoring is carried out. During the day, all changes in the work of the muscle will be recorded, and even those attacks that did not cause symptoms and went unnoticed by the person are noted on the ECG. All data on the medical monitor comes from a portable recorder attached to the patient.

Additional Research

Along with electrocardiography, a number of other types of instrumental diagnostics are also distinguished, which can be prescribed to clarify the condition. Radiography is one of them. A study is indicated for suspected lung disease, heart defects or insufficiency. The method also reveals congestion, blood clots, increased size of the myocardium. With stable types of pathology, radiography may not be performed.

Coronary angiography is considered the most reliable of all types of diagnostic measures for angina pectoris. Not only the localization and size of the damage is revealed, but even its nature (ulcer, thrombosis, etc.). Most often, coronary angiography is performed before surgery to determine the size of the vessel lumen. It is indicated for patients with an unstable and stable form of pathology, especially if the drugs no longer have the desired therapeutic effect.

Important! In addition to these three important studies, laboratory tests are also carried out. In biological fluids, cholesterol levels are determined, as well as other indicators that indicate a disease.

The manifestation of the disease on the study

At the time of an angina attack, an ECG study captures all the changes that occur. Pathology at the very peak of development has different signs. They usually depend on the type of disease. In particular, the following abnormal phenomena are most often seen on the ECG:

Prinzmetal's angina is characterized by fluctuating position of the RS-T segment. It is located in the area above the isoline. Similar signs are inherent in short-term ischemic damage or transmural ischemia. The T tooth is undergoing changes. In particular, negativity, two-phase, amplitude reduction, isoelectricity are possible. The lowering of the same segment below the marked isoline indicates that acute ischemia is developing, as well as that the myocardium of the left ventricle is damaged. S-T segment depression. A short-term change in the T wave or RS-T segment helps to exclude the possibility of a heart attack. You can also determine the localization of a heart attack using an ECG. After angina pectoris, this condition develops in the area where the change in the RS-T segment and T wave occurred.

ECG does not always help to capture all abnormalities. This happens in the initial stages of the disease or if the attack was short-lived. With standard pathology, the voltages undergo changes in the ventricular end QRS complex. Along with pathology, signs inherent in other heart diseases are often revealed. It is often accompanied by a rhythm disorder, blockade of the legs of the bundle of His, ventricular extrasystole, atrioventricular blockade.

With chronic angina, the ECG allows you to identify those areas on the heart muscle that have scars or damage. Interestingly, the characteristic features are able to remain unchanged for a long time. But if there are changes in the coronary vessels on the ECG, this is displayed immediately.

Important! Sometimes the signs of angina pectoris are completely invisible or there are only slight deviations on the ECG. This feature is typical for young people.

After stopping the attack, all signs of the disease return to normal.

Angina pectoris is a dangerous disease, the diagnosis of which is not so difficult, but sometimes it is she who gives the answer to the question of whether it is possible to completely get rid of the disease and how dangerous the course of the pathology is at the time of the examination.

What are the diagnostic measures?

In fact, all the diagnosis of angina is reduced to the identification of four factors:

To solve these problems, modern medical science has a fairly wide arsenal of diagnostic techniques and tools. However, it is worth noting that when diagnosing any disease, the doctor should focus on the following indicators of the examination method:

Less invasive than others.
Informative.
Economically feasible.

Stages of determining the presence and extent of the disease

Diagnosis of angina pectoris, determination of the presence and severity of this disease is carried out according to the following steps:

What does angina pectoris look like on an electrocardiogram?

Angina pectoris is detected on the ECG only at the time of an attack of pain, or in a severe course of the disease.

Pain during an angina attack is associated with local myocardial ischemia. In this case, there is a violation of the functions of the heart tissue at the site of ischemia, which leads to a violation of the conduction of the electrical impulse.

This process is recorded by an electrocardiogram. Most often, such a conduction disturbance looks like a rise (elevation) of the ST segment above the isoline. An increase in the amplitude of the R wave may also be observed.

How is an EKG performed?

The procedure for taking an electrocardiogram (ECG) is not complicated and does not take much time. To do this, the patient is placed on the couch. Depending on the type of apparatus, special electrodes are applied.

In most devices that are common in our country, the electrodes are 4 double brackets, which are applied in a certain order to the limbs.

Also, 6 chest electrodes, which look like suction cups, are additionally applied to the chest.

Places of attachment of both limb electrodes and chest electrodes are necessarily treated with a special conductive gel or saline solution in order to avoid increased resistance at the skin-electrode contact points.

There are also devices, disposable, sticky electrodes of which are attached directly to the human body. Such devices are widely used in places where long-term ECG monitoring is necessary, for example, in intensive care units and intensive care units, in the cardiology department in patients with an unstable rhythm.

In diagnostics, such devices have not gained popularity due to the need for preliminary preparation of the skin (shaving hair, etc.) and because of the price of disposable electrodes.

After the correct installation of all electrodes on the surface of the human body, the recording of the electrocardiogram starts.

In modern society, the growth rate of diagnosing heart pathologies is increasingly observed, while the male half of the population is in the lead in this “race”. Signs of coronary heart disease in men can be pronounced, blurred or asymptomatic, but in any manifestation they can lead to death.

Cardiologists diagnose in their patients different forms of this cardiac pathology, which differ little in the manifestations of symptoms, and the factors that provoke the symptoms of coronary disease in any of its manifestations are the same.

The main forms of the disease

The main signs and symptoms of ischemic failures in the cardiac system are considered by specialists to be forms of one coronary disease.

Cardiologists refer the following diseases to the forms of cardiac ischemia:

stable and unstable forms of angina pectoris;
primary and repeated myocardial infarction;
postinfarction cardiosclerosis;
heart failure of varying severity.

Signs of coronary disease in patients of either sex are manifested against the background of a violation of myocardial oxygen supply. These pathological processes, as a rule, arise and develop against the background of:

atherosclerosis of the coronary arteries with subsequent narrowing of the lumen;
spasm of arteries not affected by atherosclerosis;
disorders of blood microcirculation in the myocardium itself;
increased blood clotting activity.

Given the factor that atherosclerosis develops in waves, but steadily, then the symptoms of coronary disease are unstable and alternately increase and decrease the degree of manifestation. The risk of increasing pathological symptoms increases with increasing physical activity and exposure to a nervous strain factor.

Risk factors for the development of pathology

Symptoms of coronary heart disease, according to statistics, are much more common in men than in the female half of the population. Therefore, the first important factor that provokes manifestations of coronary disease is the so-called gender aspect: in men, this disease is diagnosed twice as often as in the female half of the population. Experts attribute this to the fact that women have enough hormones in their bodies that block the development of atherosclerosis.

In addition, experts include the following factors in the occurrence of manifestations of coronary heart disease:

age category over 45 years;
hereditary predisposition to diseases of the heart and blood vessels;
nicotine abuse (smoking more than 10-20 cigarettes per day);
persistently high levels of cholesterol in the blood for several months or years;
symptoms of arterial hypertension;
diabetes mellitus insulin-dependent form;
overweight;
sedentary lifestyle.

Factors provocateurs of coronary heart disease can act separately, but they can also overlap each other, thereby increasing the possibility of the onset and manifestation of the pathological process.

General characteristic signs of the disease

Experts identify common symptoms and signs of coronary heart disease in men, the prognosis of the course of the disease and the outcome of the disease depend on the manifestations and severity of symptoms.

Stage of pathology

Symptoms

Asymptomatic	Missing	The appearance of cholesterol deposits in the heart vessels (the lumen remains wide) The process is irreversible
angina pectoris	Pressing pains in the chest radiating to the arm, shoulder, neck Symptoms of shortness of breath during brisk walking and climbing stairs Jumps in blood pressure	Growth of cholesterol plaques in blood vessels Closing the lumen to half Changes in the structure of the heart muscle The first manifestations of heart failure
arrhythmic stage	Sharp increase in heart rate severe shortness of breath Malfunctions in the work of cardiac activity	Expansion of the heart cavities Thinning of the heart muscle Sharp pathological narrowing of the arteries
	Severe and pressing pain in the chest Inability to relieve pain spasm with medications	A sharp deterioration in the work of the heart Congestion in the lungs Atrial fibrillation Persistently high blood pressure

At any of these stages, the patient may experience a sharp deterioration in the general condition, and even cardiac arrest is possible. Myocardial infarction is also possible at any of these stages, the development of coronary heart disease, especially in men, occurs in any case, regardless of the manifestations of symptoms. In the event that ischemia has already been diagnosed in a patient, then any attack can provoke an acceleration of its course.

The first harbingers of a pathological condition

Despite the fact that the asymptomatic stage of the disease is considered the initial and primary, experts warn of its serious danger. Most often, this form is diagnosed in men, since physiologically they have a higher pain threshold. The main factors in the development of ischemic pathology in men at an early stage are:

systematic hard physical labor;
alcohol abuse.

The danger of the course of the pathological process in the so-called "silent" ischemia does not decrease, despite the absence of symptoms. On the contrary, in some cases, the causes of death from ischemia or angina pectoris in men lie precisely in the fact that there are no visible signs of "terrible" cardiac ischemia.

Features of the patient's condition at the asymptomatic stage

There are other important aspects of the symptomatology, indicating that in men, ischemic pathology goes through the first “silent” stage.

Symptoms of "pathological" fatigue accompany the patient almost constantly, intensify against the background of physical overstrain.
The patient periodically experiences shortness of breath, the appearance of which can be explained, but previously it was not diagnosed in the patient.
The patient often complains of symptoms of "indigestion" of the stomach: heartburn, pain "in the pit of the stomach", nausea, heaviness in the stomach.
Discomfort accompanies the patient only against the background of physical activity, disappears immediately after the person has a rest.

Over time, the symptoms intensify, spreading throughout the body and taking on pronounced signs of cardiac obstruction.

An important aspect at this stage is the timely diagnosis of diseases already at the asymptomatic stage. The majority of “silent” ischemias are diagnosed in men at a preventive examination, thanks to which it is possible to avoid the progression of the pathological process with the transition to severe congestive forms of the disease.

Symptoms of aggravation of pathology

With untimely diagnosis of the asymptomatic course of ischemia, the disease progresses and in men this manifests itself, first of all, in cardiac obstruction. The most common diagnostic form of ischemia is angina pectoris, in the old days called "angina pectoris".

The symptoms of this common form of cardiac ischemia manifest themselves depending on the factors that caused the pathology.

Type of angina

Symptoms

stable	Nicotine abuse Significant physical activity hypothermia	Pressing chest pain Pain in the left arm and forearm, radiating to the jaw, back, under the shoulder blade
unstable	Emotional or physical overstrain Stress factors	pathological fatigue Frequent shortness of breath, shortness of breath Pain in the left side of the sternum
progressive	Frequent nervous breakdowns Physical surges Alcohol abuse Arterial hypertension	Shortness of breath, suffocation. Attacks of tachycardia

An unstable form of pathology is considered the most dangerous due to the fact that the transition of the disease to an asymptomatic course is possible. The patient feels absolutely healthy, only occasionally complains of fatigue and malaise. However, the disease progresses sluggishly, threatening the patient with myocardial infarction and sudden cardiac arrest, even against the background of minor stressful provocations.

Self-diagnosis of the type of angina pectoris

Doctors consider it necessary for each person to be able to independently recognize the symptoms of cardiac obstruction in order not to confuse heart disease with pulmonary or gastric pathologies.

Considering that aggravated cardiac ischemia manifests itself in three types of pathological condition, the patient should independently navigate in understanding what is happening to him.

The symptomatology of a stable form manifests itself in the same way, has the same frequency against the background of an even stable load.
The increase and increase in the manifestation of symptoms even with small loads and an increase in the duration of the attack over time signal an unstable form of pathology, more dangerous and requiring urgent consultation with a doctor. As a rule, these attacks are not stopped by medicines.
A wave-like increase in intense symptoms, which manifests itself for more than a quarter of an hour, a sharp fluctuation in blood pressure and heart rate indicate a progressive form of the pathological process that threatens to turn into acute myocardial infarction.

Symptoms of an acute form of an ischemic process

The acute stage of ischemia is provoked, first of all, by significant physical overstrain and emotional experiences. Against this background, blood stops flowing to one of the sections of the heart, tissue hypoxia is provoked. The pathological condition itself can last from several minutes to several hours, it is this condition that becomes the main provocateur of the formation of blood clots in the heart vessels, cell death against the background of hypoxic hunger.

The main symptoms indicating a pathological process in the cardiac system, experts consider:

severe severe pain in the left side of the chest and from the back in the center;
dizziness;
severe nausea, vomiting;
sharp pain cramps in the abdomen;
asthma attacks and difficulty in breathing.

Experts believe that the problem of the course of this form of ischemia is that the severe symptoms of an acute process can pass almost without a trace after a few hours, leaving behind only severe weakness and excessive sweating. In such cases, only on the ECG, the doctor subsequently diagnoses post-infarction changes indicating the presence of a fused scar.

That is why doctors pay attention to the need to contact doctors in a timely manner in the event of the appearance of the first complex signs indicating respiratory spasms and symptoms of gastric upset, accompanied by severe left-sided pain in the extremities and under the shoulder blade.

Prevention of pathological insufficiency of cardiac tissues

The well-known main provocateur of ischemia is oxygen starvation of the tissues of the heart muscle against the background of coronary insufficiency. Accordingly, the failure itself develops with deformation of the arteries and coronary vessels.

Experts have developed a number of factors that a person can independently work out and determine the degree of risk of the onset and development of a pathological condition.

A combination of several factors with a risk degree of "high" or "above average" causes the development of pathology in more than half of the patients. Doctors recommend that patients with a hereditary predisposition to develop cardiac ischemia monitor and self-diagnose themselves for a possible increase in risk.

monitor your own weight;
control the level of cholesterol in the blood;
reduce the impact of the consequences of bad habits on the body, avoiding the abuse of alcohol and tobacco smoking;
control the impact on the nervous system of stress loads;
observe the regime of work and rest;
follow a regimen of optimal physical activity.

Subject to the correct diet, the risk of occurrence and development of cardiac pathology.

For men over 45, experts recommend minimizing spicy, salty, fatty and smoked dishes on the menu.
You should also limit the consumption of confectionery, sugar, chocolate and carbonated drinks.
The amount of fluid consumed per day should be based on the individual characteristics of the body.
You should saturate your diet with grains, fish dishes, fruits.
You should be careful about salt intake and reduce its intake to a minimum.

Compliance with all the recommendations of specialists and regular preventive examination of the work of the cardiovascular system will help to avoid "terrible" cardiac ischemia and its consequences. Prevention is considered especially relevant for men over the age of 45 and with a history of genetic and hereditary pathology risk.

Ischemic pathology of cardiac activity is not a sentence if the patient responds in a timely manner to the manifestations of symptoms and adheres to the recommendations of the attending doctor.

Forecast of life with coronary artery disease or how long they live with coronary heart disease

For many years, diseases of the cardiovascular system have been confidently leading the sad list of mortality of the population, but so far not one, even the best, specialist will take the responsibility to say how many people live with coronary heart disease. The disease does not spare either the old or the young, we are talking about a real epidemic. The insidiousness of pathologies is hidden in the implicit beginning and gradual deterioration of the condition. Many patients for a long time do not even realize that inside them is a time bomb with an unknown duration.

Ischemic heart disease: what is it and the main causes

This diagnosis means a complete or partial disruption of blood supply to any part of the heart muscle. As a result, the tissues do not receive the full amount of oxygen, and there is a failure in the work of the heart of varying severity. Distinguish between internal and external factors in the development of the disease.

The first group includes:

heart disease (malformations, impaired cardiac conduction, myocardial disease);
internal organs or systems (lungs, thyroid gland, blood);
hypertonic disease.

The second group includes:

bad habits (alcohol, smoking, drugs);
irrational nutrition (overeating, inclusion in the diet of fatty, salty, preservative-rich foods);
chronic stress;
sedentary lifestyle;
excessive physical activity (especially in untrained people).

The impact of both internal and external factors gradually leads to atherosclerosis of the coronary arteries. The disease is characterized by the deposition of cholesterol plaques on the vascular walls. As they grow, the lumen of the vessel narrows more and more, the volume of oxygen supplied by the blood decreases, and ischemia develops. When the lumen of the vessel is completely closed, necrosis occurs, in which necrosis of the tissues of the heart muscle occurs.

IHD: varieties, symptoms and consequences

Classic coronary heart disease in most cases occurs gradually and develops over many years.

During this time, it goes through several stages:

Asymptomatic.
stable angina.
Unstable angina.

There are such forms of the disease as sudden coronary death, cardiac arrhythmia, microvascular ischemia.

Angina pectoris manifests itself in the form of periodic attacks lasting no more than 5 minutes, during which a person is disturbed by uncomfortable sensations behind the sternum with irradiation to the left shoulder blade, shoulder or arm. The patient does not experience pain as such, but there is a burning sensation or squeezing, the exact localization of which is difficult to determine, so the person continues to live with this disease.

For unstable angina pectoris:

attacks disturb more and more often;
their duration increases;
lowering the threshold of physical activity;
decrease in the effectiveness of the drugs taken.

Depending on the ability to tolerate physical activity, angina pectoris is divided into four functional classes (I, II, III, IV).

With myocardial infarction, the flow to the heart muscle abruptly stops, due to which the nutrition in the myocardium is interrupted, and the tissues begin to die. Sudden coronary death occurs due to a sharp spasm of the coronary arteries.

A heart attack is accompanied by:

Unconscious state.
Cardiac and respiratory arrest.

In this case, it is necessary to immediately provide assistance, because the life of the patient will depend on the timeliness of resuscitation.

Patients with coronary artery disease may develop complications:

postinfarction cardiosclerosis;
arrhythmia;
cardiogenic shock;
acute and chronic heart failure.

Methods of treatment and prognosis

In the initial stages of the disease, drug therapy aimed at eliminating or attenuating the factors that cause coronary artery disease has a good effect. In the absence of effect or the threat of complications, surgical intervention is performed.

Modern methods of restoring blood flow in the arteries:

stenirovanie (a thin mesh tube inserted into the vessel prevents the walls from collapsing);
atherectomy (dissection of a blood clot);
brachytherapy (radiation therapy inside a diseased organ);
coronary artery bypass grafting (introduction into the bloodstream of the internal mammary artery instead of the affected part of the vessel);
indirect laser revascularization of the heart muscle (point laser action on the myocardium in order to form a new vascular network).

The effectiveness of treatment and patient survival depends on many factors, including:

IBS stage.
Location and degree of vascular damage.
condition of the heart muscle.
The severity of atherosclerosis of the coronary arteries.
Presence of cardiac arrhythmias.
The number of affected arteries.
Functional class of ischemic disease.
Patient's age.
The presence of comorbidities or complications.

For this you need:

regularly take medications prescribed by a specialist;
control blood pressure;
periodically take a blood test to determine the level of sugar and cholesterol;
using ECG and other research methods to determine the performance of the heart muscle;
periodically visit specialists (cardiologist, therapist);
undergo specialized spa treatment.

The main emphasis is on the desire of the patient himself to maintain physical, psycho-emotional and social well-being at an acceptable level. It is in the power of each person to learn to control the manifestations of the disease, to cope with them in time and maintain a satisfactory quality of life.

Prevention of coronary heart disease

It has been known since time immemorial that many diseases are easier to prevent than to cure. Ischemic heart disease is no exception.

The rules can significantly reduce the risk of developing coronary heart disease:

To give up smoking.
Maintain optimal weight.
Preventive medical examinations.
Compliance with the regime of work and rest.
The principles of proper nutrition.

Unstable angina, symptoms, treatment and everything connected with it

Description of the disease

Causes and risk factors

Angina pectoris takes on an unstable form when a fibrous plaque ruptures in a coronary artery, followed by the formation of a thrombus that prevents normal blood supply to the myocardium.

Fibrous plaque can collapse due to inflammatory processes, excess body fat, hemodynamic disturbances, or lack of collagen.

Other reasons that can cause the development of pathology are:

rupture of capillaries with subsequent hemorrhage into the plaque;
increased ability of platelets to stick together;
the release of serotonin or another vasoactive agent into the blood, in which there is a sharp narrowing of the lumen of the coronary vessels;
decrease in antithrombotic properties of endothelial cells.

Species classification

There are 4 main types of unstable angina:

Primary, in which the disease causes concern for a month.
Post-infarction, manifested by attacks in the first 2 days after a myocardial infarction, or during an acute period, which usually lasts about eight weeks.
Progressive, in which the state of health worsens and the frequency of attacks increases progressively, throughout the month.
Prinzmetal's angina, in which blood vessels constrict as a result of spasms, and not due to atherosclerosis.

It is also divided by prescription and severity:

1 degree. The disease began less than 2 months ago, is severe, progresses rapidly, manifests itself at rest.
2 degree. Refers to the subacute phase of the disease, with symptoms occurring for the first time, and pain can last more than two days.
3 degree. Pain sensations arise the last 2 days.

Depending on the factors of appearance and the clinical picture, it is divided into three classes:

1 class. The pain syndrome first appears at a high load, in the future - at a minimum. The number of seizures increases over time. The first attack - not earlier than 2 months ago. In a calm state, seizures may not appear for 2 months.
Grade 2 It is characterized by constant pain at rest. The first case of an attack was registered not earlier than 2 months ago.
Grade 3 It includes acute angina pectoris at rest, which has occurred over the past two days.

For reasons of formation, the disease is classified into three groups:

Group A - attacks occur due to diseases that are not related to the heart - thyrotoxicosis, hypoxia, anemia, acute infection.
Group B - angina pectoris develops against the background of other heart problems.
Group C - the origin of the disease is associated with a previous heart attack.

Danger and complications

If left untreated, unstable angina can cause the following problems:

acute myocardial infarction;
thromboembolism of the pulmonary arteries;
sudden fibrillation of the ventricles of the heart, followed by death;
acute heart failure, accompanied by pulmonary edema.

Clinic: signs and symptoms

It is sometimes quite difficult to identify the disease, since the symptoms of this disease can be attributed to many other cardiac pathologies.

Unstable angina is defined if the following symptoms are observed:

Change in symptoms: the frequency and duration of pain attacks have increased, nitroglycerin helps less, the pain intensifies and spreads to nearby parts of the body, attacks occur already at lower loads than before.
Attack of pain that lasts more than 10 minutes, not relieved by nitroglycerin.
Seizures began to disturb a month ago or later.
Pain in the chest during the treatment of a post-infarction condition - such a sign indicates the formation of a new blood clot in the affected vessel.
Seizures began to occur at rest.
The onset of symptoms after coronary artery bypass surgery less than three months ago.

Prinzmetal's angina has its own specific symptoms:

young men are most often subject to an attack;
pain is not associated with physical activity;
seizures are more common in the morning than at other times of the day;
high efficiency of treatment with calcium antagonists and drugs from the nitrate group.

Diagnostics

The following types of diagnostic procedures are used to make a diagnosis:

general examination of the patient, listening to heart sounds, studying symptoms and anamnesis;
a blood test to detect inflammatory processes;
urinalysis - necessary to exclude other pathologies;
ECG - to detect complications of coronary disease;
Holter ECG - used to determine the conditions, frequency and duration of the presence;
Echo-ECG - required to study the structure and size of the heart, as well as the condition of the valves and blood circulation;
coronary angiography, which allows you to examine the blood flow in the heart vessels;
Stress echo ECG - carried out to identify areas of myocardial hypoxia under conditions of physical activity;
scintigraphy, which allows you to study the condition of the walls and cavities of the heart.

Only after collecting the full data of all examinations, they make the appropriate diagnosis.

Therapy tactics

If unstable angina is detected, emergency hospitalization with strict bed rest is prescribed, as well as drug therapy. The following are used in treatment:

painkillers - neuroleptanalgesia, nitroglycerin;
drugs that improve blood flow - antiplatelet agents and direct anticoagulants (clopidogrel, prasugrel, aspirin and others);
drugs that reduce myocardial oxygen demand - calcium antagonists, beta-blockers.

In the absence of a positive effect from drug therapy, surgical ways of treating the disease may be indicated:

Angioplasty. A stent (metal tube) is inserted into the narrowed vessel, which keeps the vessel walls from sticking together and ensures normal blood flow.
Aorto-coronary bypass. Such an operation is used if the main coronary artery, or most of the coronary vessels, has been affected. In this case, an additional channel is created, bypassing the affected vessels, which ensures the delivery of blood to the heart.

It is also important to know about the first signs of an angina attack and how to stop it - more on this in a separate article. Sometimes the treatment of angina pectoris with folk remedies can help.

Forecasts and preventive measures

to give up smoking;
fight against excess weight;
sports;
moderate drinking;
a large number of fruits, fish, vegetables, whole grains and lean meats in the diet.

Under acute coronary syndrome (OKS) understand, as already mentioned, acute forms of coronary artery disease, namely: unstable angina, STEMI, STEMI and, finally, sudden cardiac death. There are no strict boundaries between the listed clinical forms. The cause of ACS is usually stenosis of the coronary arteries, which gradually progresses, can be complicated by tearing of an atherosclerotic plaque and hemorrhage into it and the formation of a thrombus on it.

Differentiation of the listed coronary syndromes, including using ECG, allows you to clarify the diagnosis and prescribe effective treatment (i.e. achieve myocardial reperfusion).

Unstable angina refers to acute coronary syndrome (ACS) and is caused by stenosis of the coronary arteries.

In typical cases, patients complain of compressive retrosternal pain, which acquires new qualities or appears more often and is more intense than usual.

The ECG often shows ST segment depression and a negative T wave in leads V5 and V6.

Treatment is the same as for stable angina pectoris, manifested by seizures, if serum troponin is absent, otherwise (when serum troponin appears), the tactics are the same as for STEMI.

Blood test results for markers of myocardial necrosis are usually negative.

Unstable angina is part of the OC. Patients with unstable angina present the same complaints as patients with rest angina, however, as noted in the definition, with unstable angina, the pain acquires a new color, becomes more intense, occurs more often and with less exertion, and even at rest. Change in duration and intensity of pain.

At the heart of the pathophysiological mechanisms of unstable angina is coronary artery stenosis associated with hemorrhage into the atherosclerotic plaque and subsequent thrombus formation, which causes partial blockage of the artery lumen.

ECG should be removed whenever possible when the patient first seeks medical attention. If an attack occurs again, an ECG must be recorded again. She may still be normal. ST segment depression greater than 0.5 mm in leads V5 and V6 indicates an increased risk of MI.

shallow negative T wave, recorded only in leads V5 and V6, apart from its dynamic inversion, has no pathological significance. The P wave and the QRS complex are not widened, the PQ interval is not changed. Elevation of the ST segment with this picture of the disease is observed very rarely.

As a further surveys it is recommended, first of all, to re-take an ECG so that one can judge the dynamics of changes in the ST interval. The more leads in which pathological ECG changes are recorded (for example, a distinct decrease in the ST segment and a negative T wave), the greater the area of myocardial ischemia and the worse the prognosis.

An important role in survey a patient with unstable angina pectoris has a determination of serum troponin concentrations, since the choice of treatment tactics depends on the result of this analysis. However, blood tests for markers of myocardial necrosis (creatine kinase activity and troponin concentrations) are often negative. In the absence of troponins in the blood serum and a normal ECG, further tactics are the same as in stable angina pectoris.

In this case favorable prognosis. If troponins are detected in the blood serum, it is recommended to proceed as in NSTEMI.