Angina

Angina (synonym: angina pectoris, coronary artery disease is a disease, the main manifestation of which is the attack is chest pain.
The etiology and pathogenesis. The attacks of angina occur when the amount of blood flowing through the coronary (coronary) arteries to the heart muscle becomes insufficient. Failure coronary arteries (coronary insufficiency) may be caused by organic amendments and functional disorders. Most often angina occurs with atherosclerosis of coronary arteries. Organic changes as a result of atherosclerosis lead to bouts of angina pectoris at sharply increased workload (brisk walk, physical stress, and so on). In these conditions, the myocardium needs more significant flow of blood nutrients that in due measure cannot be carried out through sklerozirovanie and narrowed arteries. In other cases, angina not directly linked to increased heart attacks her appear at night because of the prevalence of tone wandering nerve during the night. Functional disorders in the form of spastic narrowing of the coronary arteries (koronarospazm) caused by disorders of the nervous regulation of coronary blood flow (the appearance of attacks in the excitement). Among the reasons contributing to the emergence of attacks of angina pectoris, we should mention the influence of cold, agitation, Smoking. The violation of the nervous regulation of the coronary arteries may be due to reflex influences in zhelchnokamennoy disease, the disease of stomach hernia hiatal (reflex angina).
Angina may occur as a result of inflammatory changes of coronary arteries with syphilitic meteorite, panarteritis, obliterating endarteritis, nodular the nodosa, rheumatism. Often angina combined with essential hypertension (see).
The clinical picture. The main clinical symptom of angina is a pain in the sternum, at least - in the apex of the heart. The pain spreads to the left shoulder, interscapular space, and sometimes in the right direction.
Pain occurs under certain conditions: when walking, especially fast, and other physical effort (angina voltage). Especially typical for angina pain after the release of the patient from a warm house in the cold. More is clearly observed in autumn and winter, especially if the person goes against the wind. The patient must stop, and then the pain after a few minutes stops. Pain also occur after a meal, at intestines swelling, high standing of the diaphragm. When the excitement aches and out of touch with the physical stress, and can be very intense. Attacks of pain can appear during the night (angina rest): the patient wakes up from reschili pain, sits up in bed with a sense not only as a sharp pain, and fear (sometimes fear of death). Pain in breast toad sometimes accompanied by headache, dizziness, vomiting. The duration of pain from several seconds to several is 20-30 minutes. Characteristic of attacks of angina pectoris is very fast disappearance of pain after taking nitroglycerin.
During an attack of angina pectoris the patient remains stationary, "stops". The person of the patient focused, expresses suffering, pale and covered with cold sweat. Sometimes with the end of the attack, a large amount of urine. Force attack vary; sometimes it ends in death.
During the attack has been slow rhythmic pulse, and sometimes tachycardia, arrythmia, blood pressure rises. In the study of the heart can be noted irregularities, if not developed expressed atherosclerotic cardiosclerosis (see) .IN some cases, the pain slightly expressed, the patient may experience only uncertain pressure in the chest or a feeling of pressure, heaviness in the heart; sometimes the pain is localized only in the shoulder, left arm, or in podlojecna area. When electrocardiographic examination during the attacks often find signs of violations of the coronary circulation.
Typical attacks of angina pectoris are not diagnostic difficulties. To differentiate pain in the chest toad pain during a heart neurosis is not easy. "Neurotic pain in the heart are usually long, stabbing, aching, not associated with walk, are located in the heart region, not in the chest, do not pass from taking nitroglycerine, hold days of irradiation them less constant. Often neurotic pain observed in young women, without any signs of organic diseases of the heart and blood vessels. Especially carefully it is necessary to differentiate breast toad from myocardial infarction (see), as a wrong diagnosis in these cases may cost the life of the patient.
The disease is chronic. The attacks can be rare (once a week and less often), to go for a few months and even years or become more frequent and severe. Attack of angina pectoris, lasting more than 0,5-1 hours, you may finish with the development of myocardial infarction. In patients, long-suffering from angina pectoris, develops cardiosclerosis, disturbed cardiac rhythm, symptoms of heart failure. The prognosis depends on the duration of the disease, the frequency of attacks, the degree of atherosclerosis of the coronary arteries, a condition of myocardium.


Treatment. During an attack of angina pectoris, it is necessary to stop physical effort, to lie or sit, stay warm (hot-water bottles to the arms and legs). To take one of the fast-acting vasodilators. The most effective means is the nitroglycerin. Give under the tongue 1-2 drops of 1% alcohol solution on a piece of sugar or 1 tablet (0.0005 g) nitroglycerin; its effect occurs in 1-2 minutes nitroglycerine can be repeated many times a day. Patients should be advised always to have at itself. For pain relief you can also apply a yellow card and leeches on the heart. During the attack you can apply validol (5 drops on a piece of sugar), but it is weaker and less reliable. If these funds attack is not cropped, then injected subcutaneously 1- 2 ml of 2% solution of morphineor 1 ml of 2% solution of omnopon, or 1 ml of 1% solution of morphine necessarily with 0.5 ml of 0.1% solution of atropine. Well relieves pain breathing mixture of nitrous oxide (50%) with air (50%).
With frequent attacks of angina pectoris, and after a severe bout (first or repeated) the patient should be put to bed on time from several days to 2 weeks, assign sedatives (Valerian, motherwort, trioxazin, Elenium and others) in conjunction with vasodilating means. The latter include: the drugs nitroglycerin prolonged action - dithranol, nitropentane (1 tablet 3 times a day), sodium nitrite (0,5% solution of 1 table. L. 2-3 times a day), purine bases - theobromine (0.3 g 2-3 times a day), diuretic (0.5 g 2-3 times a day) and aminophylline (0.1 g 2-3 times a day inside, and with more severe and persistent attacks it is injected into a vein 5-10 ml of 2.4% solution in 10-20 ml of 40% solution of glucose), Hungarian drug no-Spa (1-2 tablets 2-3 times a day), and papaverine (0.06 g 3 times a day) and hloratsizin (0.015 g 3-4 times a day, a course in 10-20 days).
In patients with persistent attacks of angina pectoris used anticoagulants of indirect action - neodikumarin (0.1 g 2-3 times a day) and others, they should be used only under strict medical supervision. Alcohol and Smoking are strictly forbidden.
Of great importance in the treatment of angina pectoris have physiotherapy and dosed walking. If angina voltage physiotherapy can be applied when loosening and reduced occurrence of seizures, chest toad rest - after decommissioning. Patients angina pectoris shows the treatment in the sanatoriums of the cardiological profile.
Koronarospazm able to temporarily remove procaine blockade: substernal, paravertebral, cervical (see Blockade procaine). For amplification collateral blood supply of the heart and to facilitate its work were suggested: cardiopediatrician - introduction in the pericardial cavity talc and other substances that cause adhesive pericarditis with the development of blood vessels in spinach heart with pericardium; amendolagine - podselenie seal to the heart; anastomosis between the aorta and coronary sinus, or between internal thoracic and coronary arteries; abdominalnaya heart - the imposition of the holes of the pericardium cavity, abdominal - all without a guarantee of success.
Prevention of angina pectoris is the fight against diseases such as atherosclerosis, hypertension. Individual prevention patients suffering from angina pectoris in the initial stage, often leads to the cessation of the further development of the disease. It includes: 1) the correct mode of the working day and rest; 2) rational use of the day off to relax during the long stay in the air; 3) ensuring adequate sleep 8 hours or more); 4) Smoking cessation; 5) rational nutrition. Should prohibit hearty meals, especially at night; the last meal should be 4-5 hours before sleep.