The angina attack lasts. Signs of an angina attack, how to help and prevent recurrence

- a form of ischemic heart disease, characterized by paroxysmal pain in the region of the heart, due to acute insufficiency of blood supply to the myocardium. There are angina pectoris of tension, which occurs during physical or emotional stress, and angina at rest, which occurs outside physical effort, more often at night. In addition to chest pain, it is manifested by a feeling of suffocation, pallor skin, fluctuations in pulse rate, sensations of interruptions in the work of the heart. May cause the development of heart failure and myocardial infarction.

General information

- a form of ischemic heart disease, characterized by paroxysmal pain in the region of the heart, due to acute insufficiency of blood supply to the myocardium. There are angina pectoris of tension, which occurs during physical or emotional stress, and angina at rest, which occurs outside physical effort, more often at night. In addition to chest pain, it manifests itself as a feeling of suffocation, pallor of the skin, fluctuations in the pulse rate, sensations of interruptions in the work of the heart. May cause the development of heart failure and myocardial infarction.

Progressive, as well as some variants of spontaneous and new-onset angina pectoris are combined into the concept of "unstable angina".

Angina symptoms

A typical sign of angina pectoris is pain behind the sternum, less often to the left of the sternum (in the projection of the heart). Painful sensations can be squeezing, pressing, burning, sometimes - cutting, pulling, drilling. Pain intensity can be from bearable to very pronounced, forcing patients to moan and scream, to experience fear of imminent death.

Pain radiates mainly to the left arm and shoulder, lower jaw, under the left shoulder blade, to the epigastric region; in atypical cases - in the right half of the body, legs. Irradiation of pain in angina pectoris is due to its spread from the heart to the VII cervical and I-V chest segments of the spinal cord and further along the centrifugal nerves to the innervated zones.

Pain with angina pectoris often occurs at the time of walking, climbing stairs, exertion, stress, and may occur at night. The pain attack lasts from 1 to 15-20 minutes. Factors that alleviate the attack of angina pectoris are taking nitroglycerin, standing or sitting.

During an attack, the patient experiences a lack of air, tries to stop and freeze, presses his hand to his chest, turns pale; the face takes on a suffering expression, the upper limbs grow cold and numb. At first, the pulse quickens, then it decreases, the development of arrhythmias, more often extrasystoles, an increase in blood pressure is possible. A prolonged attack of angina pectoris can develop into a myocardial infarction. Long-term complications angina pectoris are cardiosclerosis and chronic heart failure.

Diagnostics

When recognizing angina pectoris, the patient's complaints, nature, localization, irradiation, duration of pain, conditions of their occurrence and factors of relief of an attack are taken into account. Laboratory diagnostics includes a study in the blood of total cholesterol, AST and ALT, high and low density lipoproteins, triglycerides, lactate dehydrogenase, creatine kinase, glucose, coagulogram and blood electrolytes. The determination of cardiac troponins I and T, markers indicating myocardial damage, is of particular diagnostic importance. The identification of these myocardial proteins indicates a microinfarction or myocardial infarction that has occurred and allows to prevent the development of postinfarction angina.

An ECG taken at the height of an angina attack reveals a decrease in the ST interval, the presence of a negative T wave in chest leads, conduction and rhythm disturbances. Daily ECG monitoring allows you to record ischemic changes or their absence with each attack of angina pectoris, heart rate, arrhythmias. An increasing heart rate before an attack makes it possible to think about exertional angina, a normal heart rate - about spontaneous angina. Echocardiography in angina pectoris reveals local ischemic changes and violations of myocardial contractility.

Myocardial scintigraphy is performed to visualize the perfusion of the heart muscle and identify focal changes... The radioactive preparation thallium is actively absorbed by viable cardiomyocytes, and with angina pectoris, accompanied by coronary sclerosis, focal zones of myocardial perfusion are revealed. Diagnostic coronary angiography is performed to assess the localization, degree and prevalence of damage to the arteries of the heart, which makes it possible to determine the choice of treatment (conservative or surgical).

Angina pectoris treatment

It is aimed at stopping, as well as preventing attacks and complications of angina pectoris. The first aid drug for an attack of angina pectoris is nitroglycerin (keep on a piece of sugar in your mouth until it is completely absorbed). Pain relief usually occurs in 1 to 2 minutes. If the attack has not stopped, nitroglycerin can be reused at intervals of 3 minutes. and no more than 3 times (due to the danger of a sharp drop in blood pressure).

Routine drug therapy for angina pectoris includes the use of antianginal (anti-ischemic) drugs that reduce the oxygen demand of the heart muscle: long-acting nitrates (pentaerythrityl tetranitrate, Isosorbide dinitrate, etc.), b-blockers (anaprilin, oxprenolol, etc., channel blockers), molsidomine channels (verapamil, nifedipine), trimetazidine, etc.

In the treatment of angina pectoris, it is advisable to use anti-sclerotic drugs (group of statins - lovastatin, simvastatin), antioxidants (tocopherol), antiplatelet agents (acetylsalicylic to-you). According to the indications, prevention and treatment of conduction and rhythm disorders is carried out; with angina pectoris of a high functional class, surgical myocardial revascularization is performed: balloon angioplasty, coronary artery bypass grafting.

Forecast and prevention

Angina pectoris is a chronic disabling heart disease. With the progression of angina pectoris, there is a high risk of developing myocardial infarction or death. Systematic treatment and secondary prevention help control the course of angina pectoris, improve prognosis and maintain ability to work while limiting physical and emotional stress.

For effective prevention angina pectoris, it is necessary to exclude risk factors: reducing excess weight, controlling blood pressure, optimizing diet and lifestyle, etc. As a secondary prevention with an already established diagnosis of angina pectoris, it is necessary to avoid anxiety and physical effort, take nitroglycerin prophylactically before exercise, prevent atherosclerosis, carry out therapy of concomitant pathologies (diabetes mellitus, gastrointestinal diseases). Accurate adherence to the recommendations for the treatment of angina pectoris, taking prolonged nitrates and dispensary monitoring of a cardiologist allow you to achieve a state of long-term remission.

At the initial stage, angina pectoris is almost asymptomatic, with the onset of pain, prevention is no longer enough, you need treatment and a qualified examination.

Pains appear with angina pectoris in different directions. The pain is localized in the region of the heart, neck, under the scapula. It can be pressing, squeezing, as if in a vice, drilling or pulling. There is profuse sweating, weakness, lethargy, nausea, pallor of the skin, rapid or weak pulse.

Why is there pain?

The cause of the malaise lies in the lack of oxygen to the heart, which is supplied to it with the blood. The vasoconstriction leads to circulatory disorders, due to which the heart begins to experience a lack of oxygen and a lack of nutrients. This process from the inside looks like the formation of plaque on the walls of the arteries. They narrow the lumen and inhibit the movement of blood through the vessels. The vessels are also narrowed as a result of spasms, and pain occurs with angina pectoris.

Unbalanced nutrition and lack of the required amount of oxygen leads to the accumulation of lactic acid, which is the source of pain. And if the ducts narrow before the blood supply to the heart stops, a dangerous disease will develop - myocardial infarction.

Pain sensations with cardiac pathology are quite bright

Leading experts point out many causes of heart pain that are not associated with angina pectoris:

• alcohol abuse;
• nicotine;
• high blood pressure;
• severe stress;
• excessive physical activity;
• thick blood.

It is very important to recognize the first signs in time to avoid serious complications.

The nature of pain in angina pectoris

The attack begins on the rise, at first there is a mild mild discomfort, then the condition worsens. The nature of pain with angina pectoris:

• there is heaviness, burning, numbness of the limbs;
• further sensations intensify:
• the pain becomes dull, there is heaviness in the chest area;
• symptoms intensify;
• sweating increases ("cold sweat").

The pain is localized in the upper left side of the chest, forcing the person to fix the body in one comfortable position. An attack can occur after a dense and abundant meal, with great physical exertion, as a result high blood pressure or in a stuffy room, while the duration of pain with angina pectoris lasts from 10 minutes to 45.

Pain may appear without prior action - angina at rest

Pain intensity

At the time of the onset of the attack and until the end, the intensity of pain is varied, it all depends on the degree of angina pectoris, from mild sensations, to sharp pain that cannot be tolerated until loss of consciousness.

It must be remembered that for a typical attack of angina pectoris, manifestations of pain are characteristic of increasing, gradually and, having reached a climax, stops, you need to have time to do something, and not let it go.

The intensity and duration of a painful attack with angina pectoris will depend on:

• from the type of disease;
• other diseases of the heart, blood vessels, arteries;
• from age.

There are two types of angina pectoris, stable - easy to predict pain, it is predictable, occurs after exercise and unstable - is unpredictable and very dangerous, it is spontaneous and can lead to death.

At the time of an attack of angina pectoris, a person has a feeling of a foreign object in the sternum, he does not feel the area where the blood road is blocked by an artery blockage

Localization

The pain is usually localized in the chest area, in its upper part or in the middle. Very rarely, pain sinks lower and is felt in the left side of the chest within the second or third rib. Very rarely - to the right of the heart.

Irradiation

Displacement or irradiation of pain symptoms to the shoulder, scapula, hand is considered a very common phenomenon, but these will not always be signs of angina pectoris, but pain in the neck or in the lower jaw signals danger.

In the most rare cases, patients complain of abdominal or back pain.

With irradiation, the painful sensations vary slightly, they can be confused with an inflamed nerve in the tooth or in the neck.

There is exertional angina, sudden pain during exertion (walking, eating, climbing stairs) and stable angina, which depends on the degree of load.

Features of pain in angina pectoris

Only a specialist can assess the severity of pain, and the level can only be, since many factors, symptoms and age of the patient are taken into account.

A typical localization has one general form - pain with angina appears in the upper or middle part of the sternum with a shift to the left towards the heart

Studies of the duration of pain in angina pectoris have shown the following:

• the younger generation (20–45) in a state of attack complain of growing pain in the shoulder, under the scapula, in the neck, the pain goes away quickly;
• the older generation (50–80) in a state of spasm feel mild pain, but rather prolonged from 20 minutes to an hour.

Angina pectoris can contribute to the occurrence of neuropsychiatric disorders, because the sensations are terrible: severe anxiety, panic, a feeling of imminent death. In terms of autonomic reactions, there are: dry mouth, dizziness, thirst appears, the color of the skin changes and the pressure jumps.

How to relieve angina pain? You need to take "Validol" under the tongue or "Nitroglycerin", if it doesn't feel better, then call ambulance.

How to get rid of angina pain

Not everyone is able to recognize an upcoming attack, and if it occurs, then you want to quickly get rid of severe discomfort in the chest.

• take a sitting position, relax;
• put a tablet of "Nitroglycerin" under the tongue ("Validol"), dilate blood vessels and normalize blood flow, relieve spasm;
• drink drops to calm "Corvalol".

If the symptomatology does not go away, but intensifies, you need to call a doctor, since only qualified help will help.

Prevention

You need to undergo quality medical research to determine the extent of the disease. For prophylaxis, heal blood vessels, breathe fresh air, do not overheat in the sun. Avoid heavy emotional and physical stress in all possible ways.

Twice a year to drink vitamins, preparations for blood vessels and to improve the work of the heart, of course, after consultation and appointment.

Angina pectoris is a painful syndrome in the region of the heart caused by insufficient blood supply to the heart muscle. In other words, angina pectoris is not an independent disease, but a set of symptoms related to pain syndrome. Angina pectoris is a manifestation of coronary artery disease (CHD).

What kind of disease it is, why does it occur in people, and what basic signs and methods of treatment are effective for angina pectoris, we will consider later in the article.

Angina pectoris: what is it?

Angina pectoris is clinical syndrome, characterized by discomfort or severe pain behind the sternum, the main cause of which is a violation of the coronary blood supply to the heart muscle.

The name is associated with the symptoms of the disease, which manifest themselves in the sensation pressure or compression (narrow - stenos from the Greek.), burning sensations in the heart (kardia), behind the breastbone, turning into pain.

As a manifestation of ischemic disease, angina pectoris occurs in almost 50% of patients, being the most frequent form Ischemic heart disease. The prevalence is higher among men - 5-20% (versus 1-15% among women), with age, its frequency increases sharply. Angina due to specific symptomsalso known as angina pectoris or coronary heart disease.

Symptoms of angina pectoris appear due to atherosclerosis of the coronary arteries, a disease in which cholesterol is deposited on their walls and formed. Over time, the lumen narrows, often there is a complete blockage.

Classification

Currently based on features clinical course there are three main options for angina pectoris:

Stable angina

Stable angina - means that during the previous month or longer, the patient had attacks of chest pain of approximately the same intensity. Stable angina is also called exertional angina, since the development of seizures is associated with excessively intense work of the heart muscle, which is forced to pump blood through the vessels, the lumen of which is narrowed by 50 - 75%.

Angina pectoris is divided into 4 functional classes (FC):

1. Chest pain attacks are rare, only at maximum physical and emotional overload. ECG changes are rare. The lumen of the coronary arteries can be narrowed by 50%. Perhaps only one of them is affected by atherosclerosis.
2. Second functional class causes seizures and pain when climbing steps, walking at a brisk pace, after a hearty meal. Frosty weather and wind are often provoking factors here.
3. With FC 3, a pronounced restriction of physical activity is diagnosed... Angina pectoris makes itself felt when driving quietly on a flat road for a distance of one hundred to two hundred meters, when climbing to the first floor. Attacks become frequent if the patient smokes. Such patients have angina pectoris at rest in the supine position after a nervous shock.
4. ... Often in the history of a person with this variant of angina pectoris, you can find a heart attack or heart failure in the chronic stage. Often, the angiose syndrome occurs in complete rest or even at night.

Unstable angina of the heart

What it is? Unstable angina is characterized by painful attacks of varying intensity, duration, unpredictable appearance, 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.

Unstable angina is divided into:

• First-onset angina pectoris - the first attack was no later than 30 days.
• Progressive - increases the severity, duration, or frequency of pain attacks.
• Spontaneous (Prinzmetal or vasostastic) - occurs as a result of spasm of the coronary arteries.
• Early postinfarction angina pectoris - in the period up to 14 days after a heart attack.

There is also the so-called variant angina pectoris, which most often manifests itself at night or in the early morning. Seizures occur when the patient is at rest. They last about 3-5 minutes on average. They are provoked by a sudden spasm of the coronary arteries. In this case, the walls of the vessels can be loaded with plaques, but sometimes they are absolutely clean.

To distinguish between stable and unstable angina, the following factors must be evaluated:

• What level of physical activity provokes an angina attack;
• Duration;
• The effectiveness of Nitroglycerin.

With stable angina pectoris, an attack is triggered by the same level of physical or emotional stress. With an unstable form, an attack is provoked by less physical exertion or even occurs at rest.

With stable angina pectoris, the duration is no longer than 5 - 10 minutes, and with unstable angina it can last up to 15 minutes.

Causes

Risk factors include heredity, age, and gender. Men 50-55 years old are more susceptible to the onset of the disease than women. If we talk about percentages, then at the age of 45 to 54 years, angina attacks disturb 2-5% of people, while in 65-74 years old, it increases to 10-20%.

The leading cause of angina pectoris, like ischemic heart disease, is the narrowing of the coronary vessels caused by atherosclerosis. Symptoms develop when the lumen of the coronary arteries is narrowed by 50-70%. The more pronounced atherosclerotic stenosis, the more severe angina pectoris proceeds.

The factors that contribute to the onset of angina attacks are:

Strong emotional experience, stress;

Tachycardia;

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

The most prone to angina pectoris are:

• Male persons;
• Overweight, obese;
• Addicted to smoking, alcohol, drugs;
• Fast food lovers;
• People with a sedentary lifestyle;
• People who are often stressed;
• Persons with diseases such as (hypertension).

The first signs in men and women

The most significant symptom of angina is pain. Duration: from 1-15 minutes (2-5 minutes).

The nature of the pain syndrome: paroxysmal discomfort or pressing, constricting, deep dull pain, an attack can be described as tightness, heaviness, lack of air.

Localization and irradiation:

• the most typical localization is behind the sternum or along the left edge of the sternum.
• irradiation to the neck, lower jaw, teeth, interscapular space, less often to the ulnar or wrist joints, mastoid processes.

In addition to pain, the so-called equivalents of angina pectoris can be signs. These include:

• shortness of breath - a feeling of difficulty breathing both on inhalation and exhalation. Shortness of breath occurs due to impaired relaxation of the heart
• severe and severe fatigue during exercise is a consequence of insufficient oxygen supply to the muscles due to a reduced contractile ability of the heart.

	Signs
Among women	Signs of angina pectoris in women Pain in the region of the heart. Pain in the forearm, neck, or back along with chest pain. Dyspnea. Increased sweating. Dizziness. Anxiety, fear of death. Feeling weak and tired. The following symptoms may also occur in women: Cough is a common occurrence with angina pectoris. It most often occurs at night while lying down. This is due to stagnation of blood in the pulmonary circulation. Feeling of numbness in the tips of the fingers. The presence of shallow breathing.
In men	A typical angina attack is often accompanied by the following characteristic features: feeling short of air; feelings of fear and anxiety; the patient groans and, because of the pain, presses his hand to his chest; pallor; coldness or numbness of the hands; rapid pulse; palpitations; increased blood pressure.

Angina symptoms

Typical symptoms in adults with angina pectoris:

• Painful sensations are usually localized in the upper or lower part of the sternum (much less often in the lower part), on either side of it or behind it.
• In extremely rare cases, angina pectoris declares itself as pain in the epigastric region - it can be mistaken for manifestations of an exacerbation of an ulcer or symptoms of a duodenal disease.
• The pain radiates mainly in left side body - arm, neck, shoulder, back, shoulder blade, lower jaw, earlobe.
• Pain with angina pectoris often occurs at the time of walking, climbing stairs, exertion, stress, and may occur at night. The pain attack lasts from 1 to 15-20 minutes. Factors that alleviate the condition are taking nitroglycerin, standing or sitting.

If it hurts too much moreover, the pain rolls in waves, and nitroglycerin almost does not help, it is necessary to urgently call an ambulance, since this is one of the signs of myocardial infarction.

Less commonly, the following symptoms of angina pectoris are observed:

• An increase in blood pressure, which in turn provokes manifestations of headache, dizziness, weakness.
• Shortness of breath is a common symptom of myocardial oxygen deprivation. The person begins to sweat for no apparent reason.
• Still often angina pectoris is accompanied by interruptions in the work of the heart, a person feels well an uneven and chaotic pulsation.
• There may be nausea, vomiting.
• A person experiences fear, motor activity increases.

As for the frequency of attacks, everything is individual here - the intervals between them sometimes last for long months, and sometimes they repeat 60 or even 100 times per day.

Under angina pectoris can be masked:

• Heart attack;
• Diseases of the gastrointestinal tract (peptic ulcer, diseases of the esophagus);
• Diseases of the chest and spine (osteochondrosis thoracic spine, shingles);
• Lung diseases (,).

Remember that only a doctor can determine the cause of chest pain.

Angina attack: symptoms and first aid

The main symptom of an attack of angina pectoris is a sudden pain syndrome behind the sternum, and people describe this condition in different ways. Some complain of burning and aching pain with a return to the left arm. Others feel bursting pains that radiate under the shoulder blade or in the stomach, neck, throat.

The attack usually lasts no more than 15 minutes and goes away on its own or after taking nitroglycerin. If this condition persists, it may mean that an acute heart attack has occurred.

There are many caseswhen symptoms of an angina attack appear only in the form of stomach discomfort or headaches. In this case, the diagnosis of the disease causes certain difficulties.

It is also necessary to distinguish pain attacks angina pectoris from myocardial symptoms. They are short-term and are easily removed by taking nitroglycerin or nidefilin. While the pain of a heart attack is not stopped by this drug.

In addition, with angina pectoris, there is no congestion in the lungs and shortness of breath, the body temperature remains normal, the patient does not experience excitement during an attack.

Providing emergency care for angina pectoris

Directly the first aid provided for angina pectoris before the arrival of the "ambulance" consists in the following points:

1. the patient sits down comfortably with his legs lowered at the same time, he should also be reassured, avoiding his sudden movements and getting up;
2. half of a large aspirin tablet or 1 tablet is given under the tongue;
3. to alleviate the condition, nitroglycerin is also given subsequently - 1 tablet under the tongue;
4. instead of nitroglycerin, isoket aerosol (single dose, without inhalation) or nitrolingval can be used;
5. the use of nitroglycerin can be performed at an interval of three minutes, while the use of aerosol medications produced at intervals of one minute;
6. reuse of drugs is possible only up to three times, otherwise it can provoke a sharp drop in blood pressure.

After the first necessary assistance, the patient must definitely see a doctor, who will clarify the diagnosis and select the optimal treatment. For this, a diagnostic examination is carried out.

Diagnostics

When making a diagnosis, an important role is assigned to clarifying the patient's complaints, anamnesis of pathology. Are evaluated clinical symptoms, instrumental and laboratory research in order to accurately determine the severity of the course of the disease.

Minimum list biochemical parameters in case of suspected coronary heart disease and angina pectoris, includes the determination of the content in the blood:

• total cholesterol;
• high density lipoprotein cholesterol;
• low density lipoprotein cholesterol;
• triglycerides;
• hemoglobin;
• glucose;
• AST and ALT.

Instrumental diagnostics:

• Holter monitoring. A portable recorder is attached to the patient for 24 hours, which records the ECG and transmits the obtained information to the clinic's computer.
• Testing. The reactions of the heart are checked by various loads - a bicycle ergometer has been created for this (it can be replaced with a treadmill).
• Computed multispiral tomography. It is required to differentiate angina pectoris from other ailments.
• Coronary angiography. The doctor uses this technique to determine the choice of treatment (operative or conservative).
• EchoCG. Determines the degree of damage that has affected the cardiac vessels.

Treatment of angina pectoris in adults

How is angina pectoris treated? Treatment of angina pectoris is aimed at relieving pain, preventing the development of a heart attack, as well as stopping the development of atherosclerosis and cleansing blood vessels from atherosclerotic plaques.

All methods of therapy for angina pectoris are aimed at achieving the following goals:

• Prevention of myocardial infarction and sudden cardiac death;
• Prevention of disease progression;
• Reducing the number, duration and intensity of attacks.

Drug therapy involves the use of the following medicines:

1. ACE inhibitors. Keep blood pressure normal, lower heart rate.
2. Omega-3 polyunsaturated acids, statins, fibrates. They stabilize and slow down the formation of sclerotic plaques.
3. Antiplatelet agents. Prevents the formation of blood clots in the coronary vessels.
4. Calcium antagonists. With vasospastic angina, the formation of coronary spasms is reduced. Nitrates (nitroglycerin and others). They stop seizures.
5. They are prescribed for prophylaxis before prolonged physical activity or before an outburst of emotions.

Surgery

This type of surgical treatment of the disease involves creating a bypass path for blood flow to the individual affected area of \u200b\u200bthe heart. Below the damage is a so-called shunt, this procedure is called coronary artery bypass grafting.

Such an intervention is indicated for patients, who have a severe form of angina pectoris with a reduced lumen of the cardiac vessels (70% or more).

Operational surgical intervention often used in case of previous myocardial infarction. The result of the operation is the restoration of disturbed blood flow in the arteries, which supply the heart muscle with oxygen.

Diet and nutrition

Diet for angina pectoris is aimed at slowing the progression of atherosclerosis. It is aimed at eliminating lipid metabolic disorders, reducing weight and improving blood circulation.

General principles of nutrition:

• Reducing animal fats and carbohydrates (easily digestible). When cooking, you need to cut off the fat, remove the fat melted during cooking and the skin from the poultry. The degree of restriction of fats and carbohydrates depends on the patient's weight.
• Normal protein content.
• The content of linoleic acid, lipotropic substances, dietary fiber, potassium and magnesium is increased due to an increase in the diet of vegetable oils, seafood, vegetables, fruits and cottage cheese.
• Increase in the share of products containing iodine (seaweed, mussels, sea fish, squid, shrimp).

A man needs potassium, daily rate which is about 300-3000 mg. This trace element normalizes heart rhythms, improves functioning endocrine system and heart muscle. Potassium is found in the following foods:

• mushrooms;
• seafood;
• a fish;
• black currant;
• cocoa;
• dairy;
• tomatoes;
• potatoes;
• parsley;
• apricot;
• prunes;
• raisins.

Products from which you need to refuse or reduce their intake:

• Fats of animal origin, since they have a lot of cholesterol, and it contributes to the appearance of cholesterol plaques in the vessels and, as a result, causes atherosclerosis. This includes fatty meats such as pork and poultry (duck, goose).
• Flour and confectionery products, as they are rich in carbohydrates that provoke obesity.
• It is necessary to limit salt intake, as it slows down the process of removing fluid from the body. You can replace salt with herbs in which, moreover, there are many vitamins (A, B, C, PP) and minerals ( folic acid, phosphorus, potassium, calcium, iron).
• Drinks containing caffeine (coffee, strong tea), as they have a diuretic effect and remove a lot of fluid from the body.

Folk remedies

Before using folk methods from angina pectoris, be sure to consult a cardiologist.

1. Take fresh motherwort herb juice 40 drops for 2 s. l. before meals for a month. For winter storage, mix the juice with the same amount of vodka. Take 1 tsp. 3 times a day.
2. Mix valerian roots, licorice rhizomes, dill fruits, string herb, woolly panzeria, marigold inflorescences (1: 2: 1: 2: 2: 2). A tablespoon of the mixture is brewed in a glass of boiling water, insisted in warmth for at least an hour, filtered and drunk by a third of the glass three times a day.
3. In the folk treatment of angina pectoris, a mixture of garlic and honey is used. Scroll 5 lemons through a meat grinder, you can with a peel, squeeze the juice. Add 5 chopped garlic heads and 0.5 liters of honey to it, mix. Store in a cool place for a week. Take 2c l. every day for two weeks.
4. Hawthorn tea - brings relief from heart pains after a short time of daily use. Method of preparation: 3-4 tablespoons of dried hawthorn are taken for 1 liter of boiling water. To preserve the properties of the medicinal plant, it is brewed in thermos.

Prevention

Primary prevention (for those who do not have angina):

• Correction of nutrition.
• Moderate physical activity.
• Control of cholesterol and blood sugar once a year.
• In the presence of hypertension - constant intake of antihypertensive drugs with blood pressure keeping at a level below 140/90 mm Hg.
• To give up smoking.

Secondary prevention (for those with angina pectoris, it can reduce the frequency and duration of attacks, improve the prognosis):

• Avoid severe stress and excessive physical exertion.
• Before physical activity, you can take 1 dose of nitroglycerin.
• Regularly take medications prescribed by your doctor to improve the prognosis of the disease.
• Treatment of concomitant diseases.
• Observation by a cardiologist.

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One of the most common clinical manifestations is angina pectoris. It is also called "angina pectoris", although this definition of the disease has recently been used very rarely.

Symptoms

The name is associated with the signs of the disease, which are manifested in feeling of pressure or squeezing (narrow - stenos from Greek), burning sensations in the heart (kardia), behind the breastbone, turning into pain.

In most cases, pain comes on suddenly. In some people, the symptoms of angina pectoris are pronounced in stressful situations, in others - during overexertion when performing hard physical work or sports exercises. In still others, attacks make you wake up in the middle of the night. Most often, this is due to stuffiness in the room or too low ambient temperature, high blood pressure. In some cases, an attack occurs when overeating (especially at night).

areas of typical pain irradiation in angina pectoris

The duration of pain is no more than 15 minutes. But they can give in the forearm, under the shoulder blades, neck and even the jaw. Often an attack of angina pectoris manifests itself as unpleasant sensations in the epigastric region, for example, heaviness in the stomach, stomach cramps, nausea, heartburn. In most cases, painful sensations disappear as soon as a person's emotional arousal is removed, if he stops while walking, takes a break from work. But sometimes, to stop the attack, it is required to take drugs of the nitrate group, which have a short effect (a tablet under the tongue).

There are many cases when the symptoms of an angina attack appear only in the form of discomfort in the stomach or headaches. In this case, the diagnosis of the disease causes certain difficulties. It is also necessary to distinguish painful attacks of angina pectoris from. They are short-term and can be easily removed by taking nitroglycerin or nidefilin. While the pain of a heart attack is not stopped by this drug. In addition, with angina pectoris, there is no congestion in the lungs and shortness of breath, the body temperature remains normal, the patient does not experience excitement during an attack.

Often this disease is accompanied by heart disease. External signs of angina pectoris and cardiac arrhythmias are manifested in the following:

• Pallor of the skin of the face (in atypical cases, redness is observed);
• Beads of cold sweat on the forehead;
• On the face - an expression of suffering;
• , with loss of sensitivity in the fingers;
• Breathing - shallow, rare;
• The pulse at the beginning of the attack is fast, towards the end its frequency decreases.

Etiology (causes of occurrence)

The most common causes of this disease are coronary vesselsand. Angina is thought to be caused by a decrease in oxygen supply to the coronary vessels and the heart muscle, which occurs when the blood flow to the heart is inadequate. This causes myocardial ischemia, which, in turn, contributes to the disruption of the oxidation processes occurring in it and the appearance of an excess of metabolic products. Often, the heart muscle requires an increased amount of oxygen when expressed. The reason for this is diseases such as dilated or hypertrophic, aortic,.

Very rarely (but such cases have been noted), angina pectoris occurs against the background of infectious and allergic diseases.

Disease course and prognosis

This disease is characterized by a chronic course. Attacks can be repeated when doing hard work. They often occur when a person is just starting to move (walking), especially in cold and humid weather, on sultry summer days. Emotional, mentally unbalanced people who are exposed to frequent stress are prone to attacks of angina pectoris. There have been cases when the first attack of angina pectoris was fatal. In general, with a correctly chosen method of treatment, following the recommendations of doctors, the prognosis is favorable.

Treatment

To eliminate attacks of angina pectoris are used:

1. Conservative methods of treatment, including drug (drug) and non-drug therapy;
2. Surgery.

Treatment of angina pectoris with drugs is carried out by a cardiologist. It includes the following:

№	Medications	The result to be achieved
1	ACE and f-channel inhibitors, b-blockers	Maintaining normal blood pressure, reducing heart rate and myocardial oxygen consumption, increasing exercise tolerance
2	Lipid-lowering drugs: omega-3 polyunsaturated fatty acids, fibrates, statitis	Slowing down and stabilizing the processes of atherosclerotic plaque formation
3	Antiplatelet agents (antiplatelets)	Prevention of thrombus formation in coronary vessels
4	Calcium antagonists	Prevention of coronary spasms in vasospastic angina
5	Short acting nitrates (nitroglycerin, etc.)	Relief of an attack
6	Sustained release nitrates	Prescribed as a prophylactic agent before increased and prolonged stress or a possible surge of emotions

Non-drug treatments include:

• Use aimed at reducing;
• Bringing body weight in line with its growth index;
• Development of individual loads;
• Treatment by means of alternative medicine;
• Elimination bad habits: smoking, alcohol consumption, etc.

Surgical treatment includes atherotomy, rotoblast, in particular - with, as well as a complex operation -. The method of treatment is chosen depending on the type of angina pectoris and the severity of the disease.

Classification of angina pectoris

The following classification of the disease is accepted:

• Due to the occurrence:
  1. Exertional angina pectoris caused by physical exertion;
  2. Rest angina, attacks of which overtake the patient during a night's sleep, and during the day, when he is in the supine position, without obvious prerequisites.
• By the nature of the course: Prinzmetal's angina was identified as a separate type.
  1. Stable. Attacks of the disease appear with a certain, predictable frequency (for example, every day or two, several times a month, etc.). It is divided into functional classes (FC) from I to IV.
  2. Unstable. Newly arising (VVS), progressive (PS), postoperative (early), spontaneous (variant, vasospastic).

Each species and subspecies has its own characteristic signs and features of the course of the disease. Let's consider each of them.

Stable exertional angina

The Academy of Medical Sciences conducted research on what types of physical work can be performed by people with cardiovascular diseases. vascular systemwithout experiencing discomfort and attacks in the form of heaviness and chest pain. At the same time, stable exertional angina was divided into four functional classes.

I functional class

It bears the name latent (secretive) angina pectoris. It is characterized by the fact that the patient can perform almost all types of work. He easily overcomes long distances on foot, easily climbs the stairs. But only if all this is done measuredly and within a certain time. With the acceleration of movement, or an increase in the duration and pace of work, an attack of angina pectoris occurs. Most often, such attacks appear under extreme loads for a healthy person, for example, when resuming sports, after a long break, performing unbearable physical activity, etc.

Most people suffering from angina pectoris of this FC consider themselves to be healthy people, and do not seek medical help. However, coronary angiography shows that they have moderate vascular lesions. Conducting a bicycle ergometric test also gives a positive result.

II functional class

People with angina pectoris in this functional class often experience seizures at certain times, such as in the morning after waking up and getting out of bed abruptly. In some, they appear after climbing the stairs of a certain floor, in others - while moving in bad weather. The correct organization of work and the distribution of physical activity contributes to a decrease in the number of attacks. Executing them at the optimal time.

III functional class

Angina pectoris of this type, inherent in people with strong psychoemotional arousal, in whom attacks appear when moving at a normal pace. And climbing the stairs to their floor turns into a real test for them. These people are often exposed to rest angina. They are the most frequent patients hospitals with a diagnosis of ischemic heart disease.

IV functional class

In patients with angina pectoris of this functional class, any kind of physical activity, even minor, causes an attack. Some are not even able to move around the apartment, without painful sensations in the chest. Among them, the largest percentage of patients who experience pain at rest.

Unstable angina

Angina pectoris, the number of attacks of which may increase or decrease; their intensity and duration at the same time also changes, is called unstable or progressive. Unstable angina pectoris (NS) is distinguished by the following features:

• The nature and severity of occurrence:
  1. Class I. initial stage chronic angina pectoris. The first signs of the onset of the disease were noted shortly before going to the doctor. In this case, the exacerbation of ischemic heart disease is less than two months.
  2. Class II. Subacute course. Pain syndromes were noted during the entire month preceding the date of the visit to the doctor. But they were absent for the last two days.
  3. Class III. The current is sharp. Angina attacks were observed at rest during the last two days.
• Conditions of occurrence:
  1. Group A. Unstable, secondary angina. The cause of its development is the factors that provoke coronary artery disease (, uncontrolled hypertension, infectious diseasesaccompanied by a febrile state, etc.)
  2. Group B. Unstable, primary angina pectoris. It develops in the absence of factors that enhance the course of ischemic heart disease.
  3. Group C. Early postinfarction angina pectoris. Occurs in the coming weeks, after suffering an acute myocardial infarction.
• Against the background of ongoing therapeutic treatment:
  1. It develops with a minimum of medical procedures (or not carrying them out).
  2. With a medication course.
  3. Development continues with intensive treatment.

Rest angina

Patients diagnosed with stable angina pectoris IV functional class almost always complain of pain at night, as well as in the early morning when they just woke up and are in bed. The examination of the cardiological and hemodynamic processes of such patients, through continuous daily monitoring, proves that the precursor of each attack is an increase in blood pressure (diastolic and systolic) and an increase in heart rate. In some people, the pressure was high in the pulmonary artery.

Rest angina is a more severe course of exertional angina. Most often, the onset of an attack is preceded by a psychoemotional load, which causes an increase in blood pressure.

It is much more difficult to stop them, since eliminating the cause of their occurrence is fraught with certain difficulties. Indeed, any reason can serve as a psycho-emotional load - a conversation with a doctor, family conflict, troubles at work, etc.

When an attack of this type of angina occurs for the first time, many people feel panic fear... They are afraid to move. After the pain passes, the person experiences a feeling of extreme tiredness. Beads of cold sweat appear on his forehead. The frequency of seizures is different for everyone. For some, they can manifest themselves only in critical situations. Other attacks are visited more than 50 times a day.

One of the types of rest angina is vasospastic angina. The main reason for the onset of seizures is a spasm of the coronary vessels that occurs suddenly. Sometimes this happens even in the absence of atherosclerotic plaques.

Many older people are characterized by spontaneous angina pectoris, which occurs in the early morning hours, at rest or when they change their body position. At the same time, there are no visible prerequisites for seizures. In most cases, their occurrence is associated with nightmares, a subconscious fear of death. This attack may last a little longer than other types. It is often not stopped by nitroglycerin. All this is angina pectoris, the symptoms of which are very similar to those of myocardial infarction. If done, it will be seen that the myocardium is in a stage, but at the same time there are no clear signs of a heart attack and enzyme activity indicating it.

Prinzmetal's angina

To a special, atypical and very rare species Coronary artery disease refers to Prinzmetal's angina. It received this name in honor of the American cardiologist who first discovered it. A feature of this type of disease is the cyclical occurrence of seizures that follow one after another, with a certain interval of time. They usually form a series of attacks (from two to five), which always occur at the same time - in the early morning. Their duration can be from 15 to 45 minutes. Often this type of angina is accompanied by severe arrhythmia.

It is believed that this type of angina is a disease of young people (up to 40 years old). It rarely causes a heart attack, but it can contribute to the development of heart rhythm disorders that are life-threatening, for example.

The nature of pain in angina pectoris

Most people with angina pectoris complain of chest pain. Some describe it as cutting, while others feel it as squeezing the throat or burning the heart. But there are many patients who cannot accurately convey the nature of the pain, since it radiates to various parts of the body. The fact that this is angina is often evidenced by a characteristic gesture - a clenched fist (one or both palms), applied to the chest.

Pain in angina pectoris usually follows one after another, gradually intensifying and growing. Having reached a certain intensity, they disappear almost immediately. For angina pectoris, pain occurs precisely at the time the load is performed. Pain in the chest, appearing at the end of the working day, after completing physical work, has nothing to do with coronary heart disease. Do not be concerned if the pain lasts only a few seconds and disappears with a deep breath or a change in position.

Video: Lecture on angina pectoris and coronary artery disease at St. Petersburg State University

At-risk groups

There are features that can provoke the occurrence of various types of angina pectoris. They are called risk groups (factors). The following risk groups are distinguished:

• Unmodified - factors that a person cannot influence (eliminate). These include:
  1. Heredity (genetic predisposition). If someone in the family in the male line died before the age of 55 from heart disease, then the son is at risk of angina pectoris. On the female side, the risk of disease arises if death frowned from heart ailments before the age of 65.
  2. Racial affiliation. It is noted that the inhabitants of the European continent, in particular the northern countries, have angina pectoris much more often than those of the southern countries. And the lowest percentage of the disease is in representatives of the Negroid race.
  3. Gender and age. Before the age of 55, angina is more common in men than in women. This is due to the high production of estrogens (female sex hormones) during this period. They are reliable protection of the heart from various diseases... However, during menopause, the picture changes and the risk of angina pectoris in representatives of both sexes becomes equal.
• Modified - a risk group in which a person can influence the causes of the development of the disease. It includes the following factors:
  1. Overweight (obesity). When losing weight, the level of cholesterol in the blood decreases, blood pressure decreases, which invariably reduces the risk of angina pectoris.
  2. Diabetes. By keeping the level close to normal values, you can control the frequency of coronary heart disease attacks.
  3. Emotional stress. You can try to avoid many stressful situations, which means that you can reduce the number of angina attacks.
  4. High blood pressure (hypertension).
  5. Low physical activity (physical inactivity).
  6. Bad habits, in particular smoking.

Emergency care for angina pectoris

People who are diagnosed with progressive angina (and other types) are at risk for sudden death and myocardial infarction. Therefore, it is important to know how to quickly cope with the main symptoms of the disease on your own, and when the intervention of medical professionals is required.

In most cases, this disease is manifested by the occurrence of sharp pain in the chest area. This happens due to the fact that the myocardium is experiencing oxygen deprivation due to a reduced supply of blood during exercise. First aid during an attack should be aimed at restoring blood flow.

Therefore, every angina patient should have a fast-acting drug for vasodilation, for example, nitroglycerin. In this case, doctors recommend taking it shortly before the alleged onset of an attack. This is especially true if an emotional outburst is foreseen or hard work is to be done.

If you notice a person walking on the street who suddenly froze, turned very pale and involuntarily touches his chest with his palm or a clenched fist, this means that he was overtaken by an attack of coronary heart disease and urgent help is required for angina pectoris.

In order to provide it, you must do the following:

1. If possible, seat the person (if there is no bench nearby, then directly on the ground).
2. Open his chest by unbuttoning the button.
3. Look for a life-saving nitroglycerin tablet (valocordin or validol) and put it under his tongue.
4. To catch the time, if within one or two minutes he does not feel better, then you need to call an ambulance. At the same time, before the arrival of doctors, it is advisable to stay close to him, trying to involve him in a conversation on abstract topics.
5. After the arrival of the doctors, try to clearly explain to the doctors the picture of what is happening since the onset of the attack.

Today, fast acting nitrates are produced in different formswhich act instantly and are much more effective than tablets. These are aerosols called Nitro poppy, Isotket, Nitrospray.

The way to use them is as follows:

• Shake the can
• Direct the spray device into oral cavity sick,
• Make him hold his breath, inject one dose of aerosol, trying to get under the tongue.

In some cases, you may need to re-inject the medicine.

Similar assistance should be provided to the patient at home. She will take off acute attack and may be salutary, preventing the development of myocardial infarction.

Diagnostics

After providing the first necessary aid, the patient must necessarily see a doctor who will clarify the diagnosis and select the optimal treatment. For this, a diagnostic examination is carried out, which consists in the following:

1. A medical history is compiled from the patient's words Based on the patient's complaints, the doctor establishes the preliminary causes of the disease. After checking blood pressure and pulse, measuring heart rate, the patient is sent for laboratory diagnostics.
2. Blood tests are carried out in the laboratory. It is important to analyze for the presence, which are prerequisites for the onset of atherosclerosis.
3. Held instrumental diagnostics:
   • , during which the patient wears a portable recorder during the day that records the ECG and transfers all the information received to the computer. Thanks to this, all disorders in the work of the heart are revealed.
   • Stress tests to study the reaction of the heart to different kinds loads. According to them, the classes of stable angina pectoris are determined. Testing is carried out on a treadmill (treadmill) or bicycle ergometer.
   • To clarify the diagnosis for pain, which are not fundamental factors in angina pectoris, but are inherent in other diseases, a multispiral computed tomography is performed.
   • By choosing the optimal treatment method (between conservative and operative), the doctor can refer the patient to.
   • If necessary, endovascular echocardiography is performed to determine the severity of cardiac damage.

Video: Diagnosis of elusive angina

Preparations for the treatment of angina pectoris

Medicines are needed to reduce the incidence of seizures, reduce their duration and prevent the development of myocardial infarction. They are recommended for anyone who suffers from any type of angina. The exception is the presence of contraindications to taking this or that drug. A cardiologist selects a medicine for each specific patient.

Video: The opinion of a specialist on the treatment of angina pectoris with an analysis of the clinical case

Alternative medicine in the treatment of angina pectoris

Today, many are trying to treat various diseases with alternative medicine methods. Some are carried away by them, sometimes reaching fanaticism. However, we must pay tribute that many traditional medicines help to cope with attacks of angina pectoris, without side effectsinherent in some medicines... If treatment with folk remedies is carried out in combination with drug therapy, then the number of seizures that occur can be significantly reduced. Many medicinal plants have a calming and vasodilating effect. And you can use them instead of regular tea.

One of the most effective remedies that strengthens the heart muscle and reduces the risk of heart and vascular disease is a mixture that includes lemons (6 pcs.), Garlic (head) and honey (1 kg). Lemons and garlic are chopped and covered with honey. The mixture is infused for two weeks in a dark place. Take a teaspoon in the morning (on an empty stomach) and in the evening (before bedtime).

You can read more about this and other methods of cleansing and strengthening blood vessels.

No less healing effect gives breathing exercises according to the Buteyko method. She teaches you to breathe correctly. Many patients who have mastered the technique of performing breathing exercises, got rid of surges in blood pressure, and learned how to tame the attacks of angina pectoris, having regained the opportunity to live normally, play sports and physical labor.

Prevention of angina pectoris

Everyone knows that the best treatment disease - its prevention. To be always in good shape, and not to grab your heart at the slightest increase in load, you must:

1. Monitor your weight, trying to prevent obesity;
2. Forget about smoking and other bad habits forever;
3. Timely treat concomitant diseases that may become a prerequisite for the development of angina pectoris;
4. With a genetic predisposition to heart disease, devote more time to strengthening the heart muscle and increasing the elasticity of blood vessels, visiting a physiotherapy room and strictly following all the advice of the attending physician;
5. Lead an active lifestyle, because physical inactivity is one of the risk factors in the development of angina pectoris and other diseases of the heart and blood vessels.

Today, almost all clinics have physiotherapy rooms, the purpose of which is the prevention of various diseases and rehabilitation after complex treatment... They are equipped with special simulators and devices that monitor the work of the heart and other systems. The doctor who conducts classes in this office selects a set of exercises and a load that is suitable for a particular patient, taking into account the severity of the disease and other characteristics. By visiting it, you can noticeably improve your health.

Video: Angina pectoris - how to protect your heart?

Acute chest pain is a frequent companion of ischemic heart disease and atherosclerotic coronary artery disease. The main reason for this condition is the discrepancy between the need for oxygen in the myocardium and its real amount that gets to the cardiomyocytes with blood. Therefore, all patients and their close relatives suffering from pathologies of the cardiovascular system should know how to relieve an attack of angina pectoris at home.

It is necessary to help the patient before the ambulance arrives, in addition, the correct actions in most cases can save a person from serious complications.

There are several types of this disease:

• Exertional angina (stable and progressive). Symptoms usually occur on the background of intense physical activity, in a stressful situation, during sex. In severe cases, the attack begins after the habitual climbing stairs or with a sharp temperature drop.
• Rest angina... It manifests itself already against the background of far-reaching diseases of the cardiovascular system, with a constantly increased blood pressure, stenosis of the aorta, atherosclerotic growths, narrowing the lumen of the coronary vessels. The onset of an attack is difficult to predict, the symptoms occur abruptly, at any time of the day, although more often this happens at night.

Without emergency, cardiac muscle hypoxia progresses, which with a high degree of probability can end acute heart attack myocardium.

You can recognize an attack of angina pectoris by the following symptoms:

• Pain. It has a sharp, diffuse character, localized behind chest and gives it to the left arm, leg, lower jaw. The sensations are so strong that the patient has to take a forced position, bending and pressing his hand to his chest.
• Dyspnea. The feeling of lack of air makes the patient breathe more deeply, but trying to take a deep breath only makes the chest pain worse.
• Tachycardia, a feeling of "fluttering" of the heart behind the sternum, pulsation "gives" to the ears.
• Numbness of the fingers, often they acquire a bluish tint.
• Pallor.
• Discharge of cold, clammy sweat.
• Low or, conversely, high blood pressure.

The main difference between myocardial infarction and an angina attack, which can be removed at home, is the relief of symptoms with Nitroglycerin tablets within 1-3 minutes.

The risk of developing a stable and progressive form of the disease increases with smoking, drinking alcohol, diabetes mellitus, overweight, increased blood clotting and physical inactivity.

In addition, doctors note that angina attacks are more common in males.

For traditional drug treatment diseases doctors offer a number of drugs:

• anticoagulants, the most common are acetylsalicylic acid (Aspirin), Clopidogrel, Marcumar;
• β-blockers (Anaprilin, Betalol, Nebivolol, Egilok) are prescribed to almost all patients with ischemic disease hearts;
• lipid-lowering agents (Rosuvastatin, Tulip, A nicotinic acid, Lipanor, Exlip) stop the progression of atherosclerosis by lowering the level of cholesterol and low density lipoproteins;
• aCE inhibitors (Anaprilin, Lisinopril, Captopril) are an alternative to β-blockers, but are sometimes prescribed in combination with them;
• calcium antagonists (Verapamil, Diltiazem) are often used for angina pectoris with intolerance to nitrates, in a post-infarction state.

However, despite the variety of drugs offered for the treatment of the disease, many prefer to relieve an angina attack at home. For this purpose, hawthorn tincture is widely used, which is repeatedly mentioned in the programs of Elena Malysheva, folk recipes based on garlic and medicinal plants.

But before taking various alternative medicine, it is necessary to stop the main symptoms of an angina attack.

To do this, you should:

1. Stop any physical exercise.
2. Sit in a comfortable chair.
3. Drink drugs from the nitrate group.
4. Open the window to provide fresh air.
5. Remove tight clothing from neck, abdomen and chest.

Many people recommend massage of reflex points on the neck, knees, wrist and shoulder joints. If after 5-10 minutes after trying to relieve an angina attack at home, the patient's condition does not improve, it is necessary to call an ambulance, but even relief of symptoms is not a reason to postpone a visit to the doctor.

How to treat angina pectoris at home: folk remedies, features of taking Nitroglycerin

Nitroglycerin, the main remedy for how to treat angina pectoris at home, belongs to the pharmacological drugs from the group of nitrates. Its mechanism of action is the release of nitric oxide. It relaxes the musculature of the vascular wall, reduces the load on the myocardium and its oxygen demand. In addition, nitrates relieve spasm of the coronary arteries of the heart.

A feature of Nitroglycerin is its rapid absorption from the mucous membranes, therefore it is recommended to take it in the form of tablets sublingually (that is, under the tongue) or in the form of an aerosol.

Currently, there are several types of this drug:

• short-acting (also called "normal") is used only to relieve angina attacks;
• prolonged, used to prevent attacks of chest pain.

Nitroglycerin can be taken in several ways:

• 1% alcohol solution. 1-2 drops are applied under the tongue or on a piece of sugar, only it is not swallowed, but kept in the mouth until it is completely dissolved. Also, such a drug is used for mild angina pectoris in combination with menthol, tincture of lily of the valley and belladonna (Votchal drops).
• Tablets 0.25-1 mg. Place under the tongue and hold until dissolved.
• Oily 1% solution of nitroglycerin in capsules containing 0.5 or 1 mg of the drug. The method of application is the same as for tablets, only the capsule can be pre-crushed with teeth.
• Spray can. Spray into the oral cavity, in a sitting position, 1-2 doses (but not more than 3) for 15 minutes. One dose contains 0.4 mg of nitroglycerin.

Nitrates, including nitroglycerin, are quickly addictive. For this reason, they cannot be used continuously to treat angina at home. Often, after taking the medicine, a headache appears, which is relieved with conventional pain relievers.

Alternative medicine recipes offer the following ways to combat the disease:

• Add 10 ml of 9% vinegar, 12 stems with ordinary garden parsley leaves to a saucepan with 1 liter of homemade red sweet wine and cook for 5 minutes. Remove from heat, remove foam and add 250 g of may honey, then heat again over low heat for 5 minutes. Then cool, strain, bottle and store in the refrigerator. Take 2 tbsp. twice a day.
• Crush a head of garlic, pour a glass of unrefined sunflower oil, leave for a day. Take 1 tsp, mixing with the same amount of lemon juice on an empty stomach.
• Combine the adonis herb, lavender flowers and rosemary leaves in equal proportions. 1 tsp collection, pour a glass of boiling water and leave for half an hour. Take 100 ml twice a day. In parallel, eat 4 tbsp. peeled pumpkin seeds per day.
• Prepare a mixture of the following medicinal plants: spring comic plant, gray jaundice, mountain arnica, European arnica, fragrant rue. Pour 15 g of collection with 500 ml of hot water and leave for an hour. Strain and take half a glass with the addition of 0.5 tsp. honey three times a day for a month, then take a break for 2 weeks, and then repeat taking the decoction for another 10 days. Such courses of treatment are recommended to be carried out twice a year - in autumn and spring. In parallel, it is advised to take 0.2 g of mummy in the morning on an empty stomach.
• Eat 1 tbsp. the pulp of feijoa berries half an hour before meals in the morning and evening.
• Peel and grate 1 kg of celery roots, add 100 g of chopped horseradish rhizomes and cloves of garlic each and 2 lemons, ground in a meat grinder. Let the mixture stand for exactly one day, then take 1 tbsp. three times a day. With increased acidity of the stomach, this amount is halved.

There are quite a few ways how to treat angina at home. but best result can be achieved by combining them with classical methods of drug therapy. In addition, one should not forget that a patient with diseases of the cardiovascular system should be examined regularly by a cardiologist.