According to WHO, mortality from heart disease is rapidly progressing. The most common cause of death is ischemia of the muscular layer of the heart (myocardium) followed by the formation of necrotic zones (infarction). Angina pectoris is a precursor to irreversible changes in the heart. People call angina pectoris “angina pectoris” because during an attack, patients feel severe pressing pain in the chest area.

What is cardiac angina?

Angina pectoris translated from ancient Greek means a narrow or weak heart. In medicine, angina pectoris is a manifestation of coronary heart disease, but is not classified as a separate disease. If angina pectoris is ignored and myocardial hypoxia is not treated, it can lead to acute coronary insufficiency or even death.

Angina syndrome includes several symptoms:

• painful;
• hypertensive;
• psychoneurotic;
• respiratory (shortness of breath may occur).

Classification of angina

Angina pectoris is pain in the heart area

In 1979, at the Congress of World Experts in the Field of Cardiology, the following classification of angina pectoris was adopted:

1. Angina pectoris, divided into three subgroups:

• angina pectoris that occurred for the first time;
• stable angina with determination of functional class;
• progressive angina (with and without treatment).

2. Angina at rest, this group includes Prinzmetal’s vasospastic angina.

Pathogenesis of angina

Violation of blood flow into the myocardium through the coronary arteries leads to the development of hypoxia (lack of oxygen). The heart is very dependent on ATP, the formation of which requires glucose and oxygen.

If the coronary vessels are unable to provide sufficient perfusion of heart tissue, then glucose oxidation occurs in a roundabout way, anaerobically (without oxygen). As a result of anaerobic glycolysis, it is released large number lactic acid along with under-oxidized products. The latter strongly irritate the pain receptors of the heart, which manifests itself as angina pectoris syndrome.

Reasons for development

The main link due to which angina develops is a discrepancy between the heart’s need for oxygen and the body’s ability to deliver it to the myocardium.

Angina pain occurs due to insufficient blood supply cardiac muscle in coronary heart disease

Pathologies in which angina pectoris may occur:

• atherosclerosis of the coronary vessels of the heart;
• calcification aortic valve, with involvement of the coronary sinus in the process;
• inflammation of the coronary vessels (may occur with sepsis or bacteremia);
• coronary artery thrombosis;
• coronary vasospasm (Prinzmetal's angina);
• post-infarction conditions;
• myocardial hypertrophy (insufficient vascularization of an enlarged heart).

There are a number of conditions and factors that contribute to the development of IHD (coronary heart disease) and angina in particular.

Contributing factors and pathological conditions:

• obesity;
• alcohol, nicotine and drug abuse;
• metabolic connective tissue diseases;
• diabetes mellitus and other endocrine disorders;
• hypertension;
• anomalies in the development of coronary vessels;
• arrhythmias;
• rheumatism;
• surgical interventions;
• oncological diseases.

Angina pectoris usually has the character of an attack that occurs in response to a sharp increase in the heart's need for oxygen

Symptoms and signs of angina

In the classic picture, pain develops at the peak of physical activity. When performing heavy work, the patient suddenly feels a burning or squeezing sensation chest. The peculiarity is that the pain is most often localized diffusely, in the middle. In some cases, the pain is localized on the left.

At the time of the attack, the patient experiences psychological stress; this condition is described as fear of death.

The pain can vary in intensity, it is important clinical symptom is the irradiation (spread) of pain to the following areas:

• left shoulder blade;
• left arm and hand;
• lower and upper jaw;
• into the spine;
• V atypical forms may spread to the stomach or spleen.

During an attack, the patient may experience a headache, weakness in the arms and legs, and spots or sparks may appear before the eyes. Often during an attack, a person sweats heavily and clenches his hands in the sternum area.

The pain often stops after stopping the exercise or taking Nitroglycerin.

The symptoms of angina pectoris are few, but very characteristic, and therefore they are easy to distinguish from the manifestations of other diseases

Diagnostics

The diagnosis of angina is established after collecting anamnesis, laboratory and instrumental methods diagnostics Physical exercise tests are also used to determine the class.

TO laboratory research include:

• blood test. With angina pectoris, the indicators of red blood cells, leukocytes and platelets may be unchanged or with minor deviations;
• urine diagnostics are prescribed to exclude concomitant kidney diseases;
• blood tests for glucose levels. It is very important to detect diabetes mellitus in advance, since the latter is one of the risk factors for the development of IHD (coronary heart disease);
• blood biochemistry. Levels of protein, bilirubin, troponins, ALT, AST, and other markers of myocardial damage. These examinations are necessary to determine the risk of developing myocardial infarction;
• study of hormone levels (thyroid hormones, adrenal hormones and hormones of the anterior pituitary gland).

Instrumental methods include:

• Ultrasound examination of the heart and its vessels. Heart defects or organic damage can be excluded;
• X-ray of the chest organs;
• electrocardiogram, most often the cardiogram shows an increase in the left chambers of the heart, sometimes arrhythmia can be detected;
• Holter study, which is ineffective for angina pectoris, but helps to exclude associated disorders rhythm.

To diagnose angina, it is necessary to evaluate clinical symptoms, as well as carry out a number of laboratory, instrumental studies and tests

If not stable angina often resort to a study such as coronary angiography. This examination makes it possible to accurately determine the location of the atherosclerotic plaque that blocks the blood flow.

For tests with physical activity, a bicycle ergometer or tests with dosed physical activity are used.

Treatment

The goal of angina treatment is to prevent complications and restore normal blood circulation in the myocardium.

The first step is to treat the disease that provokes angina attacks, most often this is:

• atherosclerosis of coronary vessels;
• aortic valve calcification;
• left ventricular hypertrophy.

For symptomatic therapy, drugs are used that lower blood pressure and increase blood flow in the myocardium. The most popular medications that reduce peripheral blood pressure are nitrates. Nitroglycerin is a representative of nitrates. It must be taken under the tongue during an attack at intervals of 10 minutes. The maximum dose is 6 tablets per day.

Sudden attacks of pain behind the chest, a burning sensation between the shoulder blades can be signs of angina pectoris. The disease often occurs in elderly patients and those who suffer from partial obstruction of the coronary arteries. It is important to know what other symptoms are present in heart disease in order to consult a doctor in time and begin treatment.

What is angina

A heart attack that occurs during physical and psycho-emotional stress is called angina pectoris. This disease is accompanied by unpleasant sensations in the chest (pain, burning, heaviness), which is why in the past it was called angina pectoris. According to medical statistics, people suffering from angina pectoris have a several-fold increased risk of developing coronary heart disease. In the General Medical Directory of Diseases (ICD-10), cardiac pathology is coded I20-24.

Symptoms

A characteristic sign of an angina attack is acute, pressing or burning pain. Often discomfort localized behind the sternum, in the heart area or in the center of the chest. Somewhat less frequently, patients complain of pain in the neck, jaw, legs, arms, or a burning sensation between the shoulder blades. Heart attacks are short-lived, lasting from 3 to 15 minutes. They disappear at rest or after taking Nitroglycerin tablets under the tongue.

Other symptoms include:

• difficulty breathing, feeling of lack of air;
• increased blood pressure;
• tachycardia - rapid heart rate up to 90 beats per minute or more;
• attacks of nausea, vomiting;
• feelings of fear, anxiety, panic attacks;
• sweating;
• loss of sensation in fingers;
• pale skin;
• dyspnea.

Reasons

Seizures occur due to insufficient supply of blood, nutrients and oxygen to the heart muscle (myocardium). This happens as a result of the development of atherosclerosis, when cholesterol plaques narrow or completely block the lumen of the coronary vessels leading to the heart. During physical or emotional stress, when the myocardium needs additional blood flow, but narrow vessels cannot deliver the required amount, acute pain occurs. The formation of atherosclerotic plaques is promoted by:

• eating fatty foods, smoked meats, fast food;
• smoking, alcohol abuse;
• taking certain medications;
• hormonal disorders, including menopause;
• disruption of metabolic processes in the body;
• increased coagulability blood.

Often, angina attacks occur when a person experiences extreme stress or anxiety, climbs stairs, or exercises vigorously. Somewhat less frequently, acute pain occurs when leaving a warm room due to cold, infection or allergic reactions. Other reasons include:

• spasms of the coronary arteries and coronary vessels;
• coronary heart disease;
• damage to blood vessels by viruses and bacteria (herpes virus, chlamydia, cytomegalovirus);
• thrombosis or thromboembolism;
• left ventricular hypertrophy;
• cardiomyopathy;
• tachycardia;
• abnormal development arteries or myocardium.

According to medical statistics, men are more susceptible to attacks than women. Doctors attribute this to the ability female body produce hormones that inhibit the development of atherosclerosis. In addition to men, those at risk include:

• overweight, obese people;
• street food lovers;
• hypertensive patients;
• patients with diabetes;
• people who are dependent on smoking, narcotic drugs;
• elderly patients;
• those who lead a sedentary lifestyle.

Classification

For the convenience of diagnosing the severity of the disease, doctors usually divide angina into three main groups:

• stable – the course does not worsen over time;
• unstable – characterized by atypical symptoms and causes;
• painless (silent) - the development of the disease occurs without any obvious external signs.

The stable variant is also called exertional angina, since the occurrence of attacks is directly related to physical activity, stress, strong emotions. Depending on the severity of the pathology, it is divided into several functional classes (FC):

• FC 1 – characterized by the rare occurrence of short-term attacks. Pain appears when performing physical exercise at too fast a pace, due to carrying uncomfortable heavy objects, during an emotional outburst.
• FC 2 - acute pain in the chest appears when walking quickly, while climbing stairs, after eating too fatty or high-calorie foods.
• FC 3 – discomfort in the chest occurs even with minor physical exertion, immediately after going out into the cold, or with minor emotions.
• FC 4 – attacks occur with any physical activity. A person becomes unable to perform even the slightest actions of self-care.

Unstable angina is characterized by the manifestation of atypical symptoms, when the attack lasts longer or, conversely, is shorter than usual, and is provoked by unexpected factors. In addition, the unstable type also includes a disease that changes its course over time. Currently, the following types of angina are distinguished:

• Primary – the disease occurred for the first time and lasted no longer than a month.
• Progressive – characterized sharp increase intensity, quantity, duration of angina attacks.
• Post-infarction – pain appears 10–14 days after suffered a heart attack myocardium.
• Variant or Prinzmetal's angina - sudden pain can overtake the patient during sleep, rest during the day, when the body is in a relaxed state. The reasons for the development of this disease are not atherosclerotic plaques, but spasms of the coronary vessels.

The most dangerous type considered painless or silent angina. The patient does not feel any discomfort during exercise, and the disease is detected during a preventive examination. This type of pathology is divided into 3 groups:

• Type 1 is diagnosed in patients with severe obstruction of the coronary arteries. Such people often have a distorted perception of pain.
• Type 2 is detected in patients who have recently suffered a myocardial infarction or have several risk factors for developing coronary heart disease.
• Type 3 is diagnosed in patients with coronary heart disease and arterial hypertension, diabetes mellitus or obstructive pulmonary disease.

Complications

It is important to understand that angina attacks are not just a fleeting pain syndrome, but the most important signal that the heart needs help. Over time, a section of an organ cut off from blood circulation experiences oxygen starvation, does not receive enough necessary nutrients and loses the rhythm of work. All this can lead to very sad consequences:

• myocardial infarction;
• cardiac arrest;
• thrombosis in cerebral vessels and stroke;
• lethal outcome.

Diagnostics

The doctor will first take a medical history, based on the patient’s complaints, determine the intensity of the disease and the root cause. To clarify the diagnosis, instrumental and laboratory methods diagnostics These include:

• General and biochemical analysis blood - necessary to determine the level of cholesterol in the blood and the presence of prerequisites for the development of atherosclerosis.
• Holter monitoring. To carry out the procedure, the patient must wear a special device for 24 hours that monitors heart function and monitors blood pressure. Thanks to the data obtained, doctors determine at what time the violation occurs heart rate.
• ECG (electrocardiography) during physical activity - an additional study, prescribed if the results of the previous analysis are inaccurate in a hospital setting using an exercise bike or treadmill.
• Computed multislice tomography is necessary if patients complain of pain uncharacteristic of angina pectoris.
• Scintigraphy is an analysis that helps identify abnormalities and damaged areas of the myocardium by introducing radioactive isotopes into the body.
• Coronary angiography is a method of studying the coronary arteries based on the use of X-rays. Coronary angiography helps doctors determine the condition of the vessels leading to the heart and diagnose their narrowing or blockage.
• EchoCG (endovascular echocardiography) – modern method ultrasound examination of the coronary vessels. Diagnostics helps doctors determine the size of the atherosclerotic plaque and determine the likelihood of blood clot formation.

Treatment of angina

To treat angina, doctors may resort to conservative or surgical treatments. Surgical intervention is performed only in severe cases and strictly according to indications. A person must follow conservative treatment methods throughout his life. Their action is aimed at achieving the following results:

• prevention of stroke and myocardial infarction;
• preventing disease progression;
• improving the patient's quality of life;
• reduction in the frequency, intensity and duration of attacks;
• stopping the development of atherosclerosis, cleansing blood vessels from atherosclerotic plaques;
• cupping pain syndrome.

During treatment, the patient must reduce as much as possible. physical activity, avoid stress and strong outburst of emotions. At the rehabilitation stage, the patient is prescribed physical therapy. An integral part conservative therapy is a diet with a significant restriction of fats and salt. Proper nutrition helps reduce levels bad cholesterol in the blood and relieve symptoms.

The calorie content of food should be reduced by 10–15% of your daily diet, and in patients with severe obesity by 20%. The menu should be structured so that you eat no more than 80 g of fat, 400 g of carbohydrates and 8 grams of salt per day. The amount of protein must be calculated based on your body weight: 1.5 grams per 1 kg of weight. For angina pectoris, the following products are strictly prohibited:

• ham;
• sausages;
• sausages;
• potato;
• soy sauce;
• snacks such as crackers or chips;
• mayonnaise, ketchup;
• fatty dairy products;
• fatty meats - pork, lamb, duck, lard;
• vegetable and dairy fats – butter, margarine, lard, sunflower oil, cream;
• sweet carbonated drinks;
• pickles;
• smoked meats;
• baking, fresh bread, sweets.

You need to eat often, but in small portions. Preferred cooking dishes - boiling, stewing, steaming, baking. The menu should be based on the following heart-healthy foods:

• cereals – oatmeal, buckwheat porridge, couscous, millet;
• predominantly green vegetables - cucumbers, zucchini, spinach, asparagus, cabbage;
• fresh fruits and berries - watermelon, all citrus fruits, bananas, kiwi, avocado, blueberries;
• legumes;
• seafood and sea ​​fish– salmon, mackerel, sardines, trout;
• nuts;
• rye or bran bread;
• mineral waters, herbal teas, juices.

First aid

If you notice that a loved one suddenly turns pale, puts his hand over his heart, and beads of sweat appear on his forehead, in this case, emergency help is required for an angina attack. Your actions should be as follows:

1. Try to sit or lay the victim down, open his neck by unbuttoning his collar.
2. If the incident occurs indoors, open the windows to provide fresh air.
3. Look in the first aid kit or in the victim's pockets for Nitroglycerin, Nitrolingvala, Valocordin, Validol tablets or half an Aspirin tablet and place it under his tongue.
4. Note the time. If after 2–3 minutes the patient does not feel better, call urgently ambulance.

Today some medications for emergency relief heart attack(nitrates) are released in the form of liquid aerosols. They act faster and much more effectively than their tablet counterparts. Before spraying, shake the can thoroughly 2-3 times and inject one dose of the aerosol under the tongue. Liquid nitrates include preparations under trade name:

• Isoket;
• Nitrospray;
• Nitro Mac;
• Nitrosprint;
• Nitromint.

Preventing attacks and improving the course of pathology

Drug therapy helps reduce the intensity, duration and frequency of attacks, and prevents the development of complications. To improve the patient's condition, the following groups of drugs are used:

• Beta-adrenergic receptor blockers - Atenolol, Bisaprolol, Nebivolol. They reduce the myocardium’s need for oxygen and eliminate imbalances nutrients necessary for the functioning of the heart.
• Angiotensin-converting enzyme inhibitors (ACE inhibitors) - Lisinopril, Sonoprel, Noliprel. Medicines are prescribed to prevent and treat spasm of the coronary arteries.

Anti-sclerotic therapy

To carry out complex therapy The doctor also selects other medications from the group of antianginal drugs. They improve the course of the disease, help cleanse the blood, and prevent the formation of cholesterol plaques on the walls of blood vessels. These include:

• Statins – Atorvastatin, Simvastatin. These medications inhibit the release of pituitary tropic hormones and reduce the concentration of bad cholesterol in the blood.
• Medicines that prevent the formation of blood clots and thin the blood - Acetylsalicylic acid, Aspirin, Dipyridamole.
• Fibrates – Lopid, Bezalip, Lipantil. Drugs from this group increase the amount of high-density lipoproteins, which are actually cholesterol solvents. Chronic use of fibrates reduces the risk of death from coronary heart disease.

Surgical intervention

Surgery is prescribed only in particularly severe cases, when non-invasive methods of therapy have not brought results or an atherosclerotic plaque has almost completely blocked the lumen of the coronary artery. Among the surgical treatment methods used:

• Coronary artery bypass surgery is an operation to restore hematopoietic function in the heart by bypassing the site of vascular narrowing using shunts (special vascular prostheses). Contraindications for the procedure are serious illnesses lungs or liver.
• Balloon angioplasty is a method of stenting arteries based on the introduction into blood vessel a special cylinder, which, using inflated air, expands the narrowing area. After artificial dilatation of the vessels, a stent (metal frame) is installed in place of the formed lumen.

Medicines for angina pectoris

Like any other disease cardiovascular system, angina attacks are treated with a combination of several groups of drugs, which, interacting with each other, provide maximum therapeutic effect and prevent the development of complications. These medications must be taken regularly, strictly following the dosage and doctor's instructions.

Nitrates

Pharmacological agents based on nitrates still remain one of the most reliable means for stopping heart attacks. They reduce the myocardium’s need for oxygen, quickly relieve painful spasms of blood vessels, and promote the outflow of blood from the heart. Such products are available in the form of tablets and liquid aerosols for spraying into the mouth. This pharmacological group includes dozens of different drugs. The most popular include:

• Nitroglycerine;
• Nitrong;
• Trinitrolong;
• Erinite;
• Isolong;
• Dilasid.

Nitroglycerin quickly relieves pain. The drug is available in the form of small tablets white, solution in oil and microgranules. Action active component(nitroglycerin) is aimed at dilating peripheral veins, reducing blood flow to the right atrium and reducing vascular resistance. The medicine is taken at the time of an attack, under the tongue. While using the product, slight dizziness, dry mouth, and tachycardia may occur. Nitroglycerin is strictly contraindicated in the presence of the following diagnoses:

• cranial hypertension;
• uncontrolled hypovolemia;
• mitral stenosis;
• collapse;
• hemorrhagic stroke;
• toxic edema lung;
• closed form of glaucoma;
• violation cerebral circulation;
• pregnancy;
• arterial hypertension.

For those who don't like taking pills, drug manufacturers have developed special transdermal patches with sustained release of nitroglycerin. The Nitroderm patch has proven itself well. When applied to the skin, it ensures a continuous flow of nitroglycerin into the blood for 24 hours. The patch is glued to the anterolateral surface of the chest (left) or to the left forearm. Nitroderm is contraindicated for stroke, hypotension, and glaucoma. With prolonged use of the patch, the following are possible: side effects:

• allergic shock;
• collapse;
• pulmonary edema;
• increased intraocular pressure;
• acute disruption of cerebral blood supply.

Beta blockers

Drugs from this pharmacological group reduce the number of heart contractions, thereby reducing the myocardium’s need for oxygen. The effect of the drugs begins with increased physical activity and automatically slows down when the patient is at rest. Popular beta blockers include:

• Atenolol is a drug with a selective principle of action. It does not affect the entire body, but only the heart and the coronary vessels that feed it. The drug relieves or prevents the occurrence of angina attacks and helps the myocardium cope with the increased load. If you follow the instructions adverse reactions occur extremely rarely. Main contraindications: bradycardia, breastfeeding period, heart failure.
• Betaxolol is a long-acting tablet. You need to take the drug only once a day in a dosage of 10 mg. Betaxolol is prescribed with caution to patients with diabetes mellitus. renal failure, pregnant women. In case of accidental overdose, the following are possible: convulsions, headaches, bronchospasm.

Calcium channel antagonists

These drugs for the treatment of angina pectoris block the formation of complex proteins, due to which spasm of blood vessels is eliminated, the frequency of contractions of the heart muscle decreases, and blood outflows from the myocardium. Among the antagonists calcium channels The following drugs are most often prescribed:

• Diltiazem. The drug has a vasodilator, antiarrhythmic effect, reduces the flow of calcium ions to the myocardium, reduces smooth muscle tone. To prevent attacks, tablets are taken orally before meals according to an individual dosage. Diltiazem has an impressive list of contraindications and side effects.
• Gallopamil. The anti-ischemic drug reduces the myocardial oxygen demand, reduces the heart rate, and dilates blood vessels. The dosage of the medicine is prescribed based on the severity of the underlying disease - from 50 to 100 mg twice a day. Like its predecessor (Diltiazem), Gallopamil has a wide list of side effects. Main contraindications: pregnancy, hypotension, kidney disease, congenital heart disease.

Anticoagulants and antiplatelet agents

This group of drugs is intended to thin the blood. Anticoagulants and antiplatelet agents suppress platelet production and reduce the risk of thrombosis of veins and arteries. Popular medications include:

• Warfarin. The anticoagulant suppresses the hepatic synthesis of vitamin K, which affects blood clotting, and prevents the formation of new blood clots. The dose is selected individually for each patient. Prescribed with caution for liver or kidney diseases, diabetes mellitus, alcoholism, arterial hypertension. An overdose of Warfarin can cause uncontrolled internal bleeding.
• Dipyridamole. The antiplatelet agent dilates blood vessels, increases the oxygen content in venous blood. The drug is strictly contraindicated in case of myocardial infarction, hypotension, peptic ulcer. During treatment with Dipyridamole, tachycardia, nausea, and allergic reactions may occur.

Sedatives

For attacks of angina caused by excessive nervous excitement, sedatives are indicated. In complex therapy cardiovascular diseases they are used as sedatives. The doctor may prescribe:

• Persen is a herbal medicine based on valerian, peppermint. The herbal medicine has a sedative effect, helps relieve spasm of the coronary vessels, and eliminate the symptoms of nervous excitability. Persen rarely causes negative effects, among which the most common are allergic reactions. The drug is contraindicated in case of individual intolerance to the composition, deficiency of lactase, sucrose, hypotension.
• Tenoten – lozenges based on antibodies to brain-specific protein. The medicine improves tolerance to psycho-emotional stress and normalizes the functioning of the cardiovascular system. When used according to instructions, there are no side effects. Tenoten is prescribed with caution to children and pregnant women.

Diuretics

Diuretics help remove excess liquid from the body and thereby relax the heart muscle. Diuretics are prescribed only in combination with calcium antagonists and adrenergic blockers. Doctors often recommend the following:

• Chlorthalidone. The drug has low toxicity, quickly reduces blood pressure, and relieves swelling. For therapeutic purposes, it is taken once a day. Chlorthalidone has multiple side effects and should be used with caution when bronchial asthma, diabetes mellitus, systemic lupus erythematosus.
• Lasix is ​​a drug based on furosemide. The drug is prescribed only in cases where weaker diuretics have not brought the desired effect. Lasix quickly reduces blood pressure and promotes active removal of fluid from the body. Categorical contraindications are: anuria, lactation period, hepatic coma.

Statins

If the patient has an increased risk of developing myocardial infarction, statins are added to therapy. This pharmacological group reduces the level of bad cholesterol in the blood and prevents the formation of atherosclerotic plaques. Commonly used medications include:

• Simvastatin is a lipid-lowering drug based on ascorbic acid. The medicine prevents the early stage of cholesterol synthesis and reduces blood clotting. While taking the pills, the doctor additionally prescribes a hypocholesterol diet. The dosage of the medicine is selected individually. Simvastatin has multiple contraindications and side effects.
• Atorvastatin is a tablet from the statin group, developed on the basis of calcium dihydrate. The drug reduces cholesterol synthesis in the liver and helps cleanse blood vessels of atherosclerotic plaque. Atorvastatin is not prescribed during pregnancy, liver failure, or lactation. Tablets can cause insomnia, chest pain, ringing in the ears, and dizziness.

Vitamins

As aids, in addition to sedatives, they prescribe special vitamin complexes. Vitamins from the following groups strengthen the walls of blood vessels, prevent the deposition of harmful cholesterol, and normalize heart function: C, E, PP, B6 and 11. They will also benefit mineral supplements with magnesium, potassium, phosphorus. Popular and effective vitamin and mineral complexes for heart patients include:

• Ascorutin;
• Vitrum Cardio;
• Cardio Forte;
• Cardiohealth;
• Hawthorn Forte.

Traditional medicine

Some herbal remedies that are often used in medicine also help with angina. folk medicine. If you are often attacked by pain in the chest, a burning sensation between the shoulder blades, prepare medicines according to the following recipes:

• At three liter jar pour in 1 liter of honey, juice from 10 lemons, 5 crushed heads of garlic. Mix the ingredients thoroughly and place in a dark place for a week to infuse. Take the medicine 2 tbsp. l. every morning on an empty stomach, slowly dissolving in the mouth. The course of treatment is 2–3 months.
• Pour 4 tbsp into a thermos. l. hawthorn. Pour the raw material with 1 liter of boiling water. Leave under a towel for 12 hours. Take the infusion instead of tea all day long. You can use the drink to prevent angina pectoris constantly.
• Brew 4 tbsp in a thermos. l. mint, 1 tbsp. l. valerian, pour the raw material with 1 liter of boiling water. Leave the drink for 4-5 hours, then filter. The entire volume must be drunk throughout the day. The course of treatment is unlimited.

Prevention

Measures to prevent the development of angina pectoris include the following rules and recommendations:

• complete cessation of alcohol and smoking;
• transition to healthy food, rich in heart-healthy vitamins and minerals;
• refusal of fatty, fried, salty foods;
• maintaining normal weight;
• active image life - swimming, light gymnastics;
• regular preventive examination by a cardiologist.

Video

If a person is worried about his heart, then this always indicates a serious problem. Angina pectoris is a common disease of the heart and its blood vessels in older people.. Let's consider effective ways treatment of angina pectoris or “angina pectoris”, as pressing pain in the chest was previously called.

Angina pectoris - can it be completely cured?

The heart muscle is supplied with blood through the coronary vessels. With age, fatty plaques appear inside these vessels - atherosclerosis. The lumen of the vessels becomes narrow, less blood flows to the heart. The heart muscle begins to experience hunger, and coronary heart disease develops. Its painful form is angina pectoris.

Promote the appearance of plaques:

• Overweight;
• Poor nutrition;
• Low physical activity;
• Smoking;
• Congenital metabolic disorder - familial hypercholesterolemia;
• Diabetes mellitus;
• Age over 50 years.

The process of plaque formation is long and constantly progressing. There are drugs that stop further narrowing of the vessel or slow it down. But we cannot say that angina is curable forever.. You can only eliminate acute attacks of pain and slow down the progression of the disease.

This will increase life expectancy and prevent severe forms of coronary heart disease:

• Myocardial infarction;
• Severe rhythm disturbances.

Depending on the severity of angina, medication or surgery may be necessary. There are different classes of medications recommended, many of which people will take for the rest of their lives.

• Lifestyle and diet;
• Medications;
• Means and methods of traditional medicine;
• Surgical interventions.

Diet and lifestyle

The basis of angina is atherosclerosis. The development of atherosclerotic plaques in blood vessels occurs due to high level cholesterol in the blood. What matters is “low density” cholesterol, which is designated in blood tests as low-density lipoproteins (LDL).

• Avoid eating fatty meats – lamb, pork;
• Consume at least 300-400 grams fresh vegetables and fruits every day;
• Eat white fish dishes – cod, hake – at least twice a week;
• Use mainly vegetable fats in food - sunflower, olive oils.

A person with angina should avoid smoking and regular drinking of alcohol. Nicotine constricts the blood vessels of the heart, which are already narrow due to plaque. The wall of blood vessels becomes very thin and brittle. This worsens the prognosis. Scientists have proven that smoking makes angina attacks more severe and frequent.

Alcohol impairs the nutrition of the heart muscle. It changes the composition of blood electrolytes. As a result, the heart does not receive the necessary elements. The heart muscle suffers, and an attack of pain occurs behind the sternum. Often, rhythm disturbances develop due to alcohol consumption. A person suffers from a feeling of interruptions in work and “fading” of the heart.

Folk remedies

Traditional methods of treatment for heart pain are not always effective enough. You can use herbs only after consulting your doctor. After all, angina is a serious, fatal pathology of the heart. And it is impossible to stop only at treatment with folk remedies.

In the absence of angina attacks, the following herbal preparations can help support the heart:

Regular medications for angina pectoris

After the diagnosis has been established, the question naturally arises of what to take for angina pectoris on a regular basis. Drugs that are created to treat angina pectoris can be divided into two large groups:

1. Medicines from which a person does not feel the effect now, but they will definitely increase his life expectancy. Such tablets improve the condition of the heart and blood vessels unnoticed by the person himself.
2. Antianginal medications that directly dilate blood vessels relieving the condition of a patient with angina here and now. They will not increase your life expectancy, but they will provide relief every day.

For people who suffer from angina, it seems that the first group is not needed at all. After all, it does not alleviate the condition right now, does not eliminate the attack of pain. But in fact, these are very important pills. They allow patients with angina to live to a ripe old age.

This includes medications such as:

• Antiplatelet agents;
• Statins;
• ACE inhibitors and beta blockers for some patients.

Antiplatelet agents

These are aspirin, clopidogrel and their drugs:

• "Plavix";
• "ThromboASS";
• "Cardiomagnyl".

Antiplatelet drugs are drugs that make the blood more fluid. Why is angina treated with blood thinners?

An atherosclerotic plaque, which is present in the vessels of the heart during angina pectoris, can rupture at any time. Platelets will begin to stick to its torn surface, and a blood clot will form. It will block the lumen of the vessel. Blood will stop flowing to the heart, the muscles will die and a heart attack will develop. Such a muscle will never be the same again; this part of the heart dies forever.

Aspirin or clopidogrel are taken daily. They are contraindicated only during an exacerbation of peptic ulcer disease. Typically, a person takes either aspirin or clopidogrel. But for a whole year after a myocardial infarction, doctors recommend taking both drugs. This therapy is called dual antiplatelet therapy.

Statins

Antianginal agents

The second group of drugs quickly helps and alleviates the patient’s condition. But these medications don't help prevent dangerous consequences attacks of angina - myocardial infarction. Antianginal drugs or coronary lytics dilate the blood vessels of the heart, improving its nutrition during the period of action of the drug:

• nitrates and nitrate-like: nitroglycerin, isoket;
• calcium channel blockers: verapamil, amlodipine;
• beta blockers: metoprolol, bisoprolol;
• metabolic: trimetazidine, mildronate.

Therapeutic exercise

Angina attacks are triggered by physical activity. Therefore, many patients stop their already meager motor activity, completely depriving yourself of exercise. But this is radically the wrong approach. The heart muscle and blood vessels need training. This is facilitated by moderate physical activity in the form of physical therapy.

A set of exercises must be developed by a qualified doctor - a specialist in physical therapy. You will first need to consult a cardiologist with a detailed report and diagnosis. Accurate diagnosis will allow the physical therapy doctor to select exercises in accordance with the severity of the disease.

The first lessons will seem very simple. They start with breathing exercises, whose role is to improve the oxygen supply to the blood. In the future, classes will become more intense and gradually involve different groups muscles, ranging from the hands and feet to the muscles of the chest and back.

If you experience any discomfort, be it heart pain, heaviness, or simply shortness of breath, you should stop exercising and report your symptoms to your doctor. Excessive load, especially in the first days of training, can provoke an attack of angina, so physical exercise should not be forced.

Massage

The use of massage for angina pectoris is allowed only in fully compensated patients, outside periods of exacerbation. It is prohibited to conduct massage courses when diagnosing unstable angina or angina of functional classes III-IV.

The best massage is considered to be the interscapular region and the cervicothoracic spine.. Impact on these points is used as part of a restorative massage. Sessions should not last more than 20 minutes, once a day, for 7-10 days. It is recommended to repeat the courses twice a year.

A properly performed massage improves metabolism and stimulates coronary circulation. At the same time, the condition of the central and autonomic nervous systems improves, which has a beneficial effect on the innervation of the heart. After a course of massage, nutritional processes in tissues improve, and the body’s overall resistance to stress increases.

Surgeries for angina pectoris

In severe cases of angina, a person needs surgery.

This treatment is indicated for:

• Angina pectoris of III-IV functional classes, when attacks occur frequently and occur at rest;
• When vasoconstriction reaches 70% or more.

Today medicine can offer two types of effective interventions:

• Coronary artery bypass grafting;
• Coronary stenting.

The first operation is more traumatic. In this case, the chest is completely opened, leaving the person with a large scar. But it is more effective. Coronary artery bypass grafting involves creating bypasses in the blood vessels. Instead of those vessels that are heavily clogged with plaques, surgeons create new ones. They will be supplied with blood directly from large vessel– aorta.

Coronary stenting – less traumatic surgery. With it, the chest is not opened. Only a small puncture is made in the thigh. A small stent is inserted through it - a spring, which will open in the vessel affected by the plaque. This will open the vessel and blood flow will be restored.

Help with a seizure at home

During acute attack With angina pectoris, a person feels a strong, pressing pain behind the sternum. It can radiate into the arm, usually the left, but also under the left shoulder blade and into lower jaw. If the attack is not stopped, the heart muscle will begin to die - myocardial infarction will develop.

Therefore, it is important that every person knows how to relieve an attack at home and what to do if nitroglycerin does not help:

1. Stop, sit down. If there are people nearby, tell them about your condition, about your illness.
2. Take one dose of nitroglycerin medications. Wait 5 minutes.
3. If during this time the attack has not passed, take another dose of nitroglycerin. Wait another 5 minutes.
4. If the attack does not go away after the second dose of nitroglycerin, then a dangerous condition begins to develop. You should take a third dose of nitroglycerin, chew an aspirin or clopidogrel tablet and call an ambulance.
5. The emergency dispatcher should provide your address and your symptoms.: pain behind the sternum that does not go away from taking nitroglycerin. This will allow the dispatcher to recognize a possible heart attack and send a special cardiology team.

If an ambulance detects the development of a blood clot in a vessel, it may consider it necessary to perform thrombolysis. It's dangerous, but very effective procedure. A drug is injected into a vein to completely dissolve the blood clot. The heart muscle will begin to feed on blood again, and the development of myocardial infarction will be avoided.

Good day, dear readers!

In today's article we will look at a heart disease such as angina, as well as its symptoms, causes, types, diagnosis, treatment, medications, folk remedies and prevention of angina. So…

What is angina?

Angina pectoris – clinical syndrome characterized by discomfort or severe pain in the chest, main reason which is a violation of the coronary blood supply to the heart muscle.

Other names for angina - "angina pectoris"(obsolete name).

Angina pectoris is included in the classification, being clinical manifestation(symptom) of this disease. It is often accompanied by cardiac arrest, for example - in which the heart rate increases to 90 or more beats per minute, shortness of breath,.

Pain during angina appears suddenly, more often during physical exertion or stressful situations, less often when the person is at rest. In terms of time, the attack can last no more than 10-15 minutes, but disappears after removing the provoking factor, as well as when taking nitroglycerin (under the tongue).

The main cause of angina in most cases is the appearance and development of atherosclerotic plaques in the coronary arteries. The presence of plaques, which are based on cholesterol deposits, narrows the lumen of blood vessels, and sometimes even blocks them, thereby disrupting blood flow and, accordingly, the nutrition of the organ cut off from the blood supply. In our case, nutrition is limited by the “human engine” - the heart, which, with a lack of oxygen and other substances supplied with the blood, begins to hurt. Pain in the heart under such circumstances is angina.

It is also important to understand that a section of the heart cut off from blood circulation begins to starve after a few minutes, then dies and develops, a complication of which can be cardiac arrest and even death. That is why discomfort and pain in the heart should be taken extremely seriously, especially if angina attacks periodically make themselves felt.

Development of angina

As we have already said, the main cause of angina is a violation of the blood supply to the heart muscle (myocardium) due to the presence of atherosclerotic plaques in the coronary vessels of the heart.

Before looking at plaque formation, let's take a quick look at what it consists of.

The point is that for normal functioning The body, for its cells, in particular their protection, requires cholesterol. Cholesterol itself cannot spread throughout the body, so this role is played by transporter proteins - apolipoproteins, which deliver it through the blood and blood vessels to all organs.

Depending on the “goal” where cholesterol needs to be delivered, various types apolipoproteins - high density (HDL), low density (LDL), very low density (VLDL) and chylomicrons.

The cause of the formation of atherosclerotic plaques is low-density lipoproteins (LDL), because. they have the bad property of precipitating, sticking to the walls of blood vessels along the way. Over time, cholesterol deposits accumulate in the walls of blood vessels, reducing the lumen of the bloodstream at the site of accumulation, and sometimes even blocking it. The following images perfectly illustrate this pathological process:

An area or organ cut off from the blood experiences starvation, because along with the blood, it receives both oxygen and nutrients necessary for their normal functioning.

Moreover, in this case there is another dangerous condition - the formation of a blood clot. Indeed, over time, in the place where cholesterol deposits accumulate, the wall of the blood vessel can break through, and a dense clot in the form of a plaque with other substances is thrown into the riverbed. The thrombus, moving through the vessels, reaching the point of narrowing, clogs the bloodstream, thereby causing a sharp cessation of blood supply to subsequent parts of the organs.

The most dangerous is the formation of blood clots in the vessels of the brain, provoking the development of the brain, as well as blood clots in the area of ​​the heart muscle, causing myocardial infarction and sometimes cardiac arrest.

In fact, angina attacks are the “first bell” that tells us about developmental processes in a person, especially if pain in the heart area appears during physical exertion and emotional experiences. After all, when running or under stress, a person’s heart begins to work faster and, accordingly, needs a larger portion of blood and oxygen. If it doesn't get enough necessary nutrition, we will definitely find out about this.

Of course, the above model of angina development is very superficial. After all, there are other causes of an attack of angina, for example, spasm of the coronary vessels of the myocardium, but this is more rare occurrence, and I think I was able to describe the main thing in a simple form accessible to every person.

Angina pectoris - statistics

The prevalence of angina pectoris is increasing from year to year, which is primarily due to the deterioration in the quality of modern food, as well as the deterioration of the psycho-emotional state of many people.

A sharp increase in angina attacks has been observed in adults aged 45 years and over, especially in men, approximately 1 to 2, sometimes to 3. This is due to the characteristics of the female body, which produces hormones that inhibit the development of atherosclerosis and its consequences.

If we talk about percentages, then at the age of 45 to 54 years, angina attacks affect 2-5% of people, while among 65-74 year olds, it increases to 10-20%.

Angina pectoris - ICD

ICD-10: I20;
ICD-9: 413.

Symptoms of angina

Main symptom of angina- sharp, squeezing, pressing, sometimes with burning pain behind the sternum. Its location is shown in the picture on the right. The pain associated with angina pectoris is short-term in nature - from 3 to 15 minutes. Very often, the painful effect radiates (gives) to left hand, shoulder, shoulder blade, half of the neck, rarely - in the jaw.

Other signs of angina

• Feeling short of air, difficulty breathing;
• Feelings of anxiety, fear, similar to a panic attack;
• , confusion;
• - increase in heart rate to 90 beats per minute or more;
• Rarely - and.
• A characteristic feature is also the effect of nitroglycerin, which, when used, helps to abruptly stop an attack of angina.

Important! If the chest pain does not go away for more than 15 minutes, even when using nitroglycerin, immediately call an ambulance, because Possible more serious damage to the heart, for example, myocardial infarction.

Complications of angina

• Heart failure;
• Lethal outcome.

The main cause of angina attacks is, the mechanism of development of which we partially discussed at the beginning of the article. In short, the cause of angina is damage to the coronary vessels by atherosclerotic plaques that reduce or completely block the lumen of the bloodstream. At the same time, the heart (myocardium) does not receive enough required quantity blood, and along with it oxygen and nutrients, this is especially expressed during loads on the heart muscle, when it especially needs an additional portion of blood.

Other causes of angina include:

• Spasms of the coronary or coronary vessels;
• Anomalies in the development of the coronary vessels of the heart muscle;
• Thrombosis and thromboembolism of the coronary arteries;

Factors that contribute to the occurrence of angina attacks are:

Strong emotional experience;

Tachycardia;

Exit from a warm room into cold, cold and windy weather.

The reasons for the development of atherosclerotic plaques are:

• Consumption of low-use and - lemonades, fast food, unnatural food with a large number of substitutes (food additives - E***);
• Bad habits – smoking, alcohol;
• Hyperlipidemia ( increased level lipids and lipoproteins in the blood);
• Dysfunction of the endothelium (the inner wall of blood vessels);
• Hormonal imbalance (, etc.);
• Violation of metabolic processes in the body;
• Increased blood clotting;
• Damage to blood vessels by infection - herpes virus, cytomegalovirus, chlamydia;
• Drug abuse.

Those most prone to angina attacks are:

• Males;
• Overweight persons;
• Hypertensive patients;
• Addicted to smoking, alcohol, drugs;
• Fast food lovers;
• People with in a sedentary manner life;
• People often exposed to stress;
• Persons with diseases such as,.

Angina is divided into 2 main groups – stable and unstable angina.

1. Stable angina (angina pectoris)

Angina pectoris usually develops during a person’s physical exertion, strong experiences, stress, i.e. in cases where the heartbeat quickens and the heart muscle needs increased quantity blood, oxygen.

Depending on the level of physical activity at which a person experiences chest pain, exertional angina is divided into 4 functional classes (FC):

Angina pectoris FC 1 (FC I)– characterized by rare attacks of pain, mainly with significant or excessive physical stress on the body;

Angina pectoris FC 2 (FC II)– characterized by frequent attacks of pain during minor physical exertion – climbing stairs to the 1st floor, brisk walking of about 300 meters or more. An attack can also begin in the first hours of a person’s wakefulness, when, turning on from a resting state to normal mode, the heart rate increases, blood circulation increases and antifibrinolytic ability decreases (circadian rhythm of angina).

Angina pectoris FC 3 (FC III)- characterized by frequent attacks of pain with minor physical exertion - climbing the stairs to the 1st floor at the usual slow pace, brisk walking of about 150 meters or more.

Angina pectoris FC 4 (FC IV)– characterized by frequent attacks with minimal physical activity of a person or a state of rest (rest).

2. Unstable angina

Unstable angina is characterized by painful attacks of varying intensity, duration, and unpredictable occurrence, for example, at rest. Pain syndrome is more difficult to relieve when taking nitrates (nitroglycerin). The risk of developing myocardial infarction is higher, in contrast to the stable form of this pathology. Due to its properties, unstable angina has been divided into several different types:

2.1. New-onset angina (AF)- development repeated attack occurs 30-60 days after the first manifestation of pain.

2.2 Progressive angina (PA)– development occurs more often against the background of a stable form of angina, with an increase in the functional class (FC).

2.3. Early post-infarction, postoperative angina– the development of pain syndrome occurs in the period from 3 to 28 days after myocardial infarction (according to the classification of domestic doctors), or from 1 to 14 days (NYHA classification).

2.4. Spontaneous angina (vasospastic, variant, Prinzmetal)– characterized sudden attacks pain behind the sternum for no apparent reason, most often at rest. Typically, vasospastic angina is not associated with atherosclerotic lesions of the coronary vessels. Its cause is predominantly spasms of the coronary vessels.

Diagnosis of angina pectoris

Diagnosis of angina pectoris includes following methods examinations:

• Anamnesis;
• Measuring blood glucose levels (determination of glycemia);
• at rest and during physical activity;
• Daily monitoring of heart function using ECG;
• Echocardiography (EchoECG) at rest and during exercise;
• Scintigraphy during physical or pharmacological stress.
• Coronary angiography (in some cases, at the discretion of the doctor).

How to treat angina? Treatment of angina pectoris is aimed at relieving pain, preventing the development of myocardial infarction, as well as stopping the development of atherosclerosis and cleansing blood vessels of atherosclerotic plaques.

Treatment of angina pectoris includes the following therapy methods:

1. Limitation of human physical activity;
2. Drug treatment (drugs for angina):
2.1. Pain relief;
2.2. Maintenance therapy;
2.3. Anti-atherosclerotic therapy;
3. Diet;
4. Surgical treatment;
5. Compliance with preventive measures.

1. Limiting physical activity

As we have repeatedly mentioned in this article, any physical activity of a person, including strong emotional experiences, makes the heart work faster, the pulse increases and the heart begins to pump blood faster for normal functioning, and accordingly in more need blood. If there are obstacles in the blood vessels to normal blood flow, in our case - the presence of atherosclerotic plaques in the coronary vessels, the heart begins to experience a lack of oxygen and nutrients. In this case, the person feels a pain attack.

To prevent such situations, the patient needs rest, and the higher the functional class (FC) of angina, the more you need to protect yourself from physical activity and stressful situations.

Physical activity is necessary and prescribed by the attending physician at the rehabilitation stage, after additional examination of the patient.

2. Drug treatment (drugs for angina pectoris)

Important! Before using any drugs or medications to treat angina, be sure to consult your doctor!

2.1. Pain relief

Relief (relief) of pain caused by angina pectoris is carried out by the following groups of drugs:

Nitrates– drugs with antianginal and vasodilating effects. There are short, medium and long acting. Assigned depending on the functional class.

To quickly relieve an attack of angina, Nitroglycerin is used under the tongue. If the remedy does not help, it is necessary to examine the person for myocardial infarction or non-cardiac pain.

During the treatment period, if a person has to exercise, depending on the functional class (FC), nitrates are prescribed 5-10 minutes beforehand.

Angina pectoris 1 FC is prevented with nitrates short acting(less than 1 hour) - “Nitroglycerin”.

Angina pectoris 2 FC is prevented with the help of short-acting (less than 1 hour) or medium-acting nitrates (from 2 to 6 hours) - “Nitroglycerin”, “Isosorbide dinitrate”.

Angina pectoris FC 3 is prevented with the help of long-acting nitrates (more than 6 hours) - “Isosorbide mononitrate”.

Angina pectoris grade 4 is prevented by joint use long-acting nitrates (“Isosorbide mononitrate”) and other antianginal drugs (β-blockers, etc.). This combination is also used in the evening, before bed.

β-blockers (beta blockers)- contribute to a decrease in heart rate (HR) and, accordingly, the heart’s need for an increased amount of blood and oxygen. Thus, beta-blockers relieve angina pain.

Among the β-blockers we can distinguish: bisoprolol (Biprol, Cordinorm), carvedilol (Dilatrend, Coriol), metoprolol (Betalok, Vazocardin, Egilok).

Calcium channel blockers– have an antianginal effect, which is why they are often prescribed for the treatment of angina pectoris. They are divided into 2 groups - dihydropyridine derivatives and non-dihydropyridine derivatives.

Dihydropyridine derivatives (“Amlodipine”, “Nifedipine”) have a prolonged antianginal effect, often used in combination with β-blockers to increase the effectiveness of treatment.

Non-dihydropyridine derivatives (Verapamil, Diltiazem) are used in cases of contraindications to taking beta-blockers - in the presence of severe atherosclerosis of the lower extremities, chronic obstructive pulmonary disease (COPD).

Angiotensin-converting enzyme (ACE) inhibitors– block the conversion of angiotensin II from angiotensin I, thereby preventing spasms of blood vessels. In addition, ACE inhibitors normalize and protect the heart muscle from pathological processes.

Among the ACE inhibitors are: Captopril, Lisinopril, Enalapril.

2.2. Maintenance therapy

Maintenance therapy is aimed at improving the course and preventing subsequent attacks of angina, as well as the development of myocardial infarction.

Anticoagulants– protect blood vessels from thrombosis, inhibit the development of existing blood clots and the formation of fibrin threads.

Anticoagulants include: Heparin.

Antiarrhythmic drugs- help normalize heart rate, improve respiratory function, alleviation of angina pectoris, coronary heart disease and many others.

Among antiarrhythmic drugs can be distinguished: “Ajmalin”, “Lidocaine”, “Novocainamide”.

Sedatives– calm the nervous system, which is especially important during strong emotional experiences leading to angina attacks, as well as during pain syndrome, when a person begins to be attacked by fear.

Among the sedative drugs one can highlight: “Valerian”, “Persen”, “Tenoten”.

2.3. Anti-atherosclerotic therapy

Anti-atherosclerotic therapy is aimed at stopping and preventing the development of atherosclerotic plaques in blood vessels.

Statins And fibrates– have a hypocholesterolemic (cholesterol-lowering) effect. These groups of drugs lower the level of “bad” cholesterol in the blood, thereby reducing the amount of cholesterol deposits and, accordingly, the “building material” for the formation of atherosclerotic plaques. To achieve maximum effect, statins and fibrates are taken simultaneously.

Fibrates increase the amount of high-density lipoprotein (HDL) in the blood, which actually counteracts low-density lipoprotein (LDL), which actually precipitates cholesterol. Fibrates are also used to treat coronary heart disease (CHD) and dyslipidemia. These drugs minimize the number of deaths from coronary artery disease.

Among the fibrates, one can highlight Fenofibrate.

Statins, unlike fibrates, directly lower the level of low-density lipoprotein (LDL) in the blood.

Statins include Atorvastin, Lovastatin, and Rosuvastin.

Total blood cholesterol levels should be reduced to 4.5 mmol/L (175 mg/dL) or lower, and LDL cholesterol levels to 2.5 mmol/L (100 mg/dL) or lower.

Antiplatelet agents- prevent the gluing of red blood cells and platelets, as well as their sedimentation on the inner walls of blood vessels (endothelium), thereby improving blood flow (blood circulation) in the body.

Antiplatelet agents include: Dipyridamole, Clopidogrel.

Diet for angina pectoris is an important and integral part of the course of treatment. After all, the level of cholesterol in the blood, the presence of atherosclerosis and its derivative cardiovascular diseases largely depend on the quality of food.

Key points of the diet for angina pectoris:

• The calorie content of food is 10-15% less than your daily diet, and in case of obesity - 20%;
• The amount of fat is no more than 60-80 g per day;
• The amount of protein is no more than 1.5 g per 1 kg of human body weight per day;
• The amount of carbohydrates is no more than 350-400 g per day;
• The amount of salt is no more than 8 g per day.

What not to eat if you have angina

• Spicy, fatty, fried, salted and smoked foods - ham, sausages, sausages, fatty dairy products, mayonnaise, ketchup and other unhealthy foods;
• Animal fats, large quantities of which are found in fatty meats (pork, domestic duck, goose, carp and others), lard, butter, margarine;
• High-calorie foods, as well as foods rich in easily digestible carbohydrates - cakes, pastries, chocolate, candies, marmalade, marshmallows, jams.

What can you eat if you have angina?

Food of animal origin - lean meats (lean fish, chicken), low-fat dairy products, egg whites;

• Cereals – oatmeal, buckwheat;
• Vegetables and fruits – mostly green vegetables and orange fruits;
• Bakery products - rye or bran bread;
• Drink - mineral waters, unsweetened tea,...

However, not all vitamins are useful in our case, so if you have angina, you need to limit your use.

4. Surgical treatment

Surgical treatment (operation) of angina pectoris is prescribed only in cases where non-invasive therapy has not led to the desired result, as well as in cases where the coronary vessel has too small a lumen or a blood clot has formed in it.

Among the surgical methods of treating angina pectoris are:

Coronary artery bypass grafting (CABG)– “reconnection” of the coronary vessel with another section of the blood vessel, below its blockage;

Balloon angioplasty– the operation is based on the introduction of a special balloon into a blood vessel, at the site of its narrowed lumen, which is then inflated, thereby expanding the lumen of the bloodstream. Next, the balloon is deflated and removed from the vessel. For a longer and more reliable effect, a stent is installed in place of the vessel lumen expanded by the balloon. This method called vessel stenting.

5. Compliance with preventive measures

Prevention of angina pectoris is aimed not only at preventing pain, but also at relieving possible complications given pathological process, which is why such things as quitting smoking, alcohol and other measures are mandatory for the patient. We'll talk about prevention in more detail a little later, but now let's look at traditional methods and anti-angina medications.

Important! Before using folk remedies for angina, be sure to consult with your doctor!

Lemon. While following the diet that we talked about just above in the article, before each meal, eat thoroughly washed peel.

Garlic, lemon and honey. Put 1 liter of juice from 10 lemons and 5 heads (not cloves) squeezed through a garlic press into a 3-liter jar, mix everything thoroughly, close the jar with a lid and leave for 7 days to infuse in a dark, cool place. You need to take 2 tbsp. spoons in the morning, 1 time per day, on an empty stomach, slowly dissolving the product for a couple of minutes. The course of treatment is until the prepared product runs out.

Hawthorn. Pour 4 tbsp into a thermos. spoons and pour 1 liter of boiling water over it, leave the product to infuse overnight. Drink the infusion throughout the day as tea.

Mint and valerian. 4 tbsp. spoons and 1 tbsp. add a spoonful to a thermos, pour 1 liter of boiling water over the plants and leave to steep for a couple of hours. The infusion should be drunk throughout the day.

To increase the effectiveness of the product, you can also add a couple of teaspoons of fruits, which will add a portion to the drink that directly counteracts the formation of atherosclerotic plaques.

Fir oil. To relieve pain in the heart area, you need to rub it into this place 6-7 drops of fir oil.

Prevention of angina pectoris includes compliance with the following rules and recommendations:

• Complete cessation of smoking and alcoholic beverages;
• Minimizing the consumption of unhealthy and unhealthy foods, including fatty, fried, spicy, salty, smoked foods;
• Eating foods enriched with and;
• Move more;
• Watch your weight, don't let it happen;
• Avoid stressful situations, if necessary, change your place of work;
• Don't leave it to chance various diseases, especially the cardiovascular system, so that they do not become chronic.

Angina pectoris – doctor

Angina - video

Angina is the main form of coronary heart disease. Therefore, it is considered the most frequent illness in persons over 55 years of age. The figure is average, since for women it is about 60, and for men - 55. And if up to 65 years of age the proportion of angina pectoris in the stronger sex is approximately 2-2.5 times higher, then after 70 women are more likely to get sick. Perhaps this is due to longer duration life. In any case, angina pectoris is one of the most important medical and social problems of our time.

Show all

Causes and pathogenesis

Angina - one from forms of coronary heart disease. Accordingly, its causes lie in chronic oxygen deficiency of the myocardium. It occurs as a result of pathologies of the coronary vessels.

In first place is atherosclerosis (deposition of lipids in the walls of blood vessels). It begins to develop in every person’s youth. Therefore, an option is considered when the atherosclerotic plaque reaches a size sufficient to create obstructions to blood flow. And this only happens if there are a number of factors:

• cholesterol metabolism disorder;
• smoking;
• arterial hypertension;
• alcohol abuse;
• stress;
• diabetes mellitus

Atherosclerosis

Less common is spasm of the coronary vessels without any changes in their wall. If the spasm time and relaxation time coincide and are no more than 1-2 seconds, this does not lead to pathological changes in the myocardium. But with a spasm that exceeds the relaxation time of the vessel by at least two seconds and is repeated for 2-5 minutes, various disorders heart muscle. If this continues for a month, coronary heart disease develops.

Regardless of the cause, the pathogenesis of angina lies in one mechanism. Lack of oxygen due to increased oxygen consumption leads to metabolic changes in cardiomyocytes. Cells switch to an oxygen-free path, which leads to the accumulation of lactic acid and its metabolic products. They irritate the chemoreceptors of the heart muscle. A nerve impulse is formed, which is processed in the brain and converted into pain.



Symptoms of angina pectoris

All signs of angina pectoris are associated with the main pathogenetic factor: a deficiency between the myocardial need for oxygen and the possibilities of its delivery.

There are typical and atypical symptoms. The first group occurs in the vast majority of patients. It corresponds to the classic course of the disease.

Typical symptoms of angina consist of three signs:

• pain;
• emotional component;
• decreased physical activity.



Pain

Pain is a common and sure symptom of angina pectoris. Lasts up to 5 minutes and is localized behind the sternum. The classical type of pain is considered to be squeezing and pressing. In most cases, it begins from the depths of the chest and quickly covers the entire space behind the chest. Very often pain radiates (gives) to the following areas:

• in the chest;
• under the left shoulder blade or below;
• V left shoulder(in the joint and upper half of the arm);
• left forearm up to the palm in the area of ​​4-5 fingers;
• celiac region (epigastrium).

Most patients describe this irradiation as a constant aching pain that gradually fades (as it moves away from the heart area).

An angina attack is called atypical when the pain is localized outside the heart. Based on these differences, the Soviet cardiologist of the middle of the last century Tetelbaum divided all attacks into several groups:

• Retrosternal painful form of attack. This is the typical form.
• Precordial. The pain is localized near the lower third of the sternum, but is felt not behind it, but somewhat to the left. Does not produce irradiation.
• Left-scapular form. Pain is present only in the area of ​​the left shoulder blade.
• Left-handed form. Pain sensations are localized in various parts left hand.
• Upper vertebral. Feelings concern cervical spine spine. A person perceives them as pain in the neck area, closer to the back of the head.
• Mandibular. Feeling of pain in the lower jaw.
• Abdominal. Localization - epigastrium.
• Ear. Unpleasant sensations are localized in the area auricle. Patients often complain that the pain comes from within. It resembles a tooth.
• Pharyngolaryngeal form. Patients rarely call the sensation pain. Most often they talk about a feeling of shortness of breath in the throat.



Intensity pain slightly lower than during a heart attack. But if it is there, the patient cannot help but notice them. During an attack, pain with maximum intensity lasts 1-2 seconds. Then it decreases somewhat, but within 1-2 minutes its intensity remains at the same level. Pain relief occurs within 10-30 seconds.



Emotional component of the attack

It has wide variability: from vivid emotions and a strong sense of fear to complete apathy. The leading factor here is not the intensity of the pain, but the nature of the patient’s psyche.

Only one thing remains clear: pain always affects physical condition.

Decreased activity

An important symptom of pain during an angina attack is complete immobility. The patient freezes for several minutes. Only less than 10% of all patients can maintain any physical activity. Almost all of them require willpower.

From the moment the pain stops, the patient begins to move.

Factors provoking an attack

For angina, in addition to pain, characteristic feature are the conditions for its development. It is always caused by stress, physical or emotional. Most often, an attack occurs while walking. There is a so-called intermittent claudication syndrome. A patient with angina pectoris gets dirty for 1-2 minutes during each attack, after which he continues on his way as if nothing had happened. Important has blood pressure. Its increase often provokes an attack.

Another option is a morning attack. It occurs due to stress: during the morning rise, the myocardial need for oxygen increases.

Atypical attack and pain equivalents

In a number of patients (this is especially true diabetes mellitus) an attack of angina is not accompanied by pain. Here we must take into account the emergence of so-called equivalents. This is sudden weakness, a feeling of fear or lack of air. The duration of these sensations does not exceed 1-2 minutes.

Sometimes equivalents develop in places typical for pain irradiation. Patients report various unpleasant sensations. Most often this is tingling, “pins and needles”, numbness, severe weakness in one area or another.

Diagnosis of angina pectoris

To make a diagnosis, a doctor needs only a carefully collected anamnesis (data on the course of the disease and a detailed consideration of complaints). To confirm the diagnosis, examination and some laboratory and instrumental studies are important. Blood and urine are not important for diagnosis. An exception is a biochemical analysis for the amount of cholesterol and other lipids.

During an attack there is often a frightened expression on the face, dilated pupils, rapid breathing, pallor skin. Sometimes the facial expressions of patients mean nothing. But in any case, the patient freezes during the attack.

Outside of an attack (especially in the first year) external inspection allows only to suspect atherosclerosis:

• The presence of xanthelasmas - small yellowish tubercles on the upper eyelid.
• Inconsistency between age and appearance.
• Early gray hair.
• Tortuosity of blood vessels at the temples.
• Systolic murmur at the apex of the heart.

It is important to consider the presence of risk factors. A man over 55 years of age who has smoked for more than 20 years most likely suffers from angina. In women of the same age without bad habits the likelihood of illness is low.

Among instrumental diagnostic methods, Holter monitoring and bicycle ergometry are important. They show changes in the electrocardiogram in response to stress.

Classification of angina

The concept of “functional class of angina” has been used in clinical practice for decades, as it allows one to clearly determine the severity of the disease. And this has implications for choosing a treatment strategy. These classes are:

• I class. Habitual loads are well tolerated by patients. The attack is triggered by severe stress or heavy physical labor.
• II class. The patient tolerates normal loads just as well. But if they last more than 10 minutes, seizures may develop. Previously, there was a “step test”: if an attack develops while walking a distance of 500 meters at an average pace, climbing two floors, then the patient belongs to this class.
• III class. Seizures are caused by ordinary exertion when they last less than 5 minutes: when climbing one floor or walking less than 100 meters.
• IV class. Minimal loads already cause seizures.

All these classes are applicable only to the stable form. If the frequency of attacks increases against the background of previous loads, the intensity of pain increases, then angina is considered unstable. Such patients are advised to rest and immediately be hospitalized in the emergency cardiology department.

Treatment of angina

Treatment of stable angina involves the following program:

• Diet and exercise regimen.
• Drug therapy for ischemic disease and accompanying conditions.

A diet for angina pectoris involves limiting salt and fats of animal origin. The physical activity regime means regular exercise and activity. The European Heart Association recommends walking (at a moderate pace!) up to 4 kilometers daily.

Drug therapy includes treatment of the underlying disease and all associated conditions. Particular care must be taken to treat those pathologies that aggravate the course of coronary heart disease. Folk remedies can only be useful as a concomitant treatment for a number of diseases, but they should not replace medications. You cannot self-medicate.

Patients are advised to take antiplatelet agents, statins and antianginal drugs for life. The latter can be useful in providing first emergency aid during an attack. These include, for example, nitroglycerin. This drug should always be on hand for patients with angina pectoris. Thanks to him, the pain attack goes away much faster. It also allows you to distinguish at home a true attack of angina from other causes that cause pain in the heart. Only for this disease, taking nitrates causes relief within 0.5-1 minutes (rarely it takes 2-3 minutes). In all other cases, pain relief either does not occur at all, or occurs after more than 10-15 minutes. Long-acting (acting for several hours) anitangian drugs are prescribed to prevent attacks in some patients.

Sometimes it is necessary surgical treatment. The decision to perform it is made only by the cardiac surgeon after the recommendations of the attending physician.