How angina pectoris hurts. Angina - what is it, signs, symptoms, treatment and emergency care for an attack of angina
Angina is a common heart disease that, as it progresses, leads to chronic heart failure and myocardial infarction. Angina pectoris is often considered a symptom of coronary artery disease in the heart - it occurs during exercise or stressful situation sudden pressing pain in the chest.
Probably, many have heard the expression "angina pectoris strangles." However, not everyone knows that the reasons for such chest discomfort lie in heart disease. Any discomfort accompanied by pain in the chest region is the first sign of a disease such as angina pectoris. All the fault is the lack of blood supply in the heart muscle, which is why a painful attack appears.
In this article we will look at angina pectoris, the symptoms, what to do and what not to do. In addition, we will tell you about the treatment, and effective ways prevention of the disease.
Causes
Why does angina pectoris occur, and what is it? Angina pectoris is a form of coronary heart disease characterized by severe pain in the sternal region. It is connected with the fact that normal blood supply is disrupted in a certain part of the heart. For the first time such a condition of the heart muscle was described by W. Geberden in 1768.
All causes of myocardial malnutrition associated with a decrease in the diameter of the coronary vessels, These include:
- Atherosclerosis of the coronary vessels is the most common reason myocardial ischemia, in which cholesterol is deposited on the walls of the arteries, leading to a narrowing of their lumen. In the future, it can be complicated by myocardial infarction (death of a part of the heart muscle, due to the complete closure of the artery by a thrombus).
- - an increase in heart rate, which causes an increase in muscle oxygen demand and nutrients, while coronary vessels do not always cope with their adequate supply.
- - increasing systemic blood pressure in blood vessels above normal causes spasm (narrowing) of the coronary vessels.
- Infectious pathology of the coronary arteries - endarteritis, in which the lumen of the vessels narrows due to their inflammation.
Among the predisposing causes of angina pectoris are called old age, which is associated with wear and tear of blood vessels, metabolic disorders, tissue susceptibility to degenerative changes... Angina pectoris develops in young people if various diseasesas directly of cardio-vascular system, and endocrine, nervous, metabolism.
Risk factors are being overweight, smoking, unhealthy diet, congenital defects heart and blood vessels, hypertension, diabetes mellitus.
Classification
Depending on the reaction of the heart to provoking factors, several types of angina pectoris are distinguished:
- Stable angina stresses - its symptoms are manifested in the form of pressing, drilling pains or a feeling of heaviness behind the breastbone. Irradiation is typical in left shoulder or left hand. Pain is caused by physical exertion, stress. Pain disappears spontaneously at the end of physical activity or after taking nitroglycerin.
- Unstable angina (progressive angina)... A person can suddenly feel that he has become worse. And all of this is happening for no apparent reason. Doctors associate the development of this type of angina pectoris with the existence of a crack in the cardiac vessel, located near the atherosclerotic plaque. This leads to the formation of blood clots inside the coronary vessels, which interfere with normal blood flow.
- Spontaneous (variant) angina is rare, it is caused by spasm of the coronary arteries, which causes the myocardium to receive less blood and oxygen. It is manifested by severe pain behind the sternum, heart rhythm is disturbed. Spasm does not lead to a heart attack, quickly passes, causing prolonged oxygen starvation of the myocardium.
Angina symptoms
When angina pectoris occurs, the main symptom, as in most heart diseases, is pain. Most often, it appears during heavy physical exertion, but it can also develop against the background of emotional excitement, which happens somewhat less often.
The pain is localized behind the sternum, is pressing in nature, therefore angina pectoris has a second name - "angina pectoris". People describe the sensations in different ways: someone feels as if a brick in the chest, which interferes with breathing, someone complains of pressure in the heart area, someone tends to feel a burning sensation.
The pain rolls over in attacks that last no more than 5 minutes on average. If the duration of the attack exceeds 20 minutes, this may already indicate the transition of an attack of angina pectoris to acute heart attack As for the frequency of attacks, everything is individual here - the intervals between them are sometimes long months, and sometimes the attacks are repeated 60 or even 100 times per day.
Permanent companions of angina attacks are also the feeling of impending disaster, panic and fear of death. In addition to the above symptoms, signs such as shortness of breath and fatigue, even with light exertion, may indicate angina pectoris.
Angina symptoms are similar to. It can be difficult to distinguish one disease from another. An attack of angina pectoris disappears after a few minutes if the patient sits down to rest or takes nitroglycerin. And such simple remedies do not help from a heart attack. If pain in the chest and other symptoms do not go away longer than usual, call an ambulance immediately.
What to do in case of an angina attack - an emergency
If symptoms of angina pectoris occur, what should be done, what should not be done? Before the arrival of an ambulance with such an attack of angina pectoris, it is necessary next treatment at home:
- In no case you can't give in to emotions and panic, as this can significantly aggravate the spasm. That is why it is necessary to calm down a sick person by all methods and not show your fear yourself.
- Sit down the patient with his legs down, do not let him get up. If an attack of angina pectoris is found indoors, you need to ensure a good supply of fresh air into the room - open windows or a door.
- Give a nitroglycerin tablet under the tongue in the indicated dose, which was previously prescribed by a cardiologist, if nitroglycerin is in aerosol form, then one dose without inhaling. The concentration of nitroglycerin in the blood reaches a maximum after 4–5 minutes and begins to decrease after 15 minutes.
- Why exactly under the tongue? Sucked into oral cavity, nitroglycerin does not enter the general bloodstream, but directly to the coronary vessels. They expand, blood flow to the heart muscle increases several times, the symptoms of angina pectoris stop.
- If a the attack does not subside within 10-15 minutes even after repeated administration of nitroglycerin, you need to use analgesics, since a prolonged attack can be the first manifestation of acute myocardial infarction. Usually an attack of angina pectoris stops after 5, maximum 10 minutes.
- Nitroglycerin cannot be used more than 3 times, since a sharp drop in blood pressure can occur, which will entail serious consequences.
- An ambulance should be called in the event that an attack of angina pectoris occurs for the first time in life, and against the background of all the above actions, more than ten minutes does not pass.
In general, first aid in case of an attack of angina pectoris is reduced to taking medicinesdilating the coronary vessels. These include chemical derivatives of nitrates, that is, nitroglycerin. The effect occurs within a few minutes.
Angina pectoris treatment
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.
The most important role in achieving the first goal is played by changing the patient's lifestyle... Improving the prognosis of the disease can be achieved by the following measures:
- To give up smoking.
- Moderate physical activity.
- Diet and weight loss: Limiting salt and saturated fat intake and consuming fruits, vegetables and fish regularly.
Planned drug therapy angina pectoris includes the use of antianginal (anti-ischemic) drugs that reduce the need for heart muscle in oxygen: long-acting nitrates (erinitis, sustak, nitrosorbide, nitrong, etc.), b-blockers (trasicor, etc.), molsidomine (corvaton), calcium blockers channels (, nifedipine), etc.
In the treatment of angina pectoris, it is advisable to use anti-sclerotic drugs (group of statins - lovastatin, zokor), antioxidants (tocopherol, aevita), antiplatelet agents (aspirin). In the advanced stages of unstable angina pectoris, when the pain does not disappear for a long time, they are used surgical techniques treatment of angina pectoris:
- Coronary artery bypass grafting: when an additional heart vesseldirectly from the aorta. The absence of oxygen starvation completely relieves the symptoms of angina pectoris.
- Stening of the vessels of the heart with angina pectoris allows you to create a certain diameter of the arteries, not subject to narrowing. The essence of the operation: a tube is inserted into the heart arteries, which is not compressed.
The course of angina pectoris and the outcome of the disease
Angina pectoris is chronic. Seizures can be rare. The maximum duration of an attack of angina pectoris is 20 minutes, it can result in myocardial infarction. In patients with long-term angina pectoris, cardiosclerosis develops, heart rhythm is disturbed, symptoms of heart failure appear.
Prevention
For effective prevention angina pectoris need to exclude risk factors:
- Monitor your weight, trying to prevent obesity.
- Forget about smoking and other bad habits forever.
- Timely treat concomitant diseases that can become a prerequisite for the development of angina pectoris.
- When genetic predisposition to heart disease, to devote more time to strengthening the heart muscle and increasing the elasticity of blood vessels, visiting the room of physiotherapy exercises and strictly following all the advice of the attending physician.
- 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.
As secondary prevention with an already established diagnosis of angina pectoris, it is necessary to avoid anxiety and physical effort, prophylactically take nitroglycerin before exercise, prevent atherosclerosis, and treat concomitant pathologies.
Angina is a phenomenon that occurs during ischemia of the heart as a result of atherosclerotic disease. In fact, this is one of the. Cholesterol plaques clog the blood vessels supplying the heart muscle, which causes pain in the heart.
The more the vascular lumens are narrowed, the more often angina attacks occur. With narrowing of the arteries by 75% or more, this condition can occur several times a day.
Most often, people over the age of 45 are affected. The attack manifests itself as a sudden sharp pain in the chest area.
Attacks of angina pectoris can also appear with thickening of the heart muscle, severe anemia, or a violation of the heart valve.
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 about the appearance burning and aching pain with left hand recoil.
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 passes by itself or after taking nitroglycerin... If this condition persists, it may mean that an acute myocardial infarction has occurred.
Most often, angina pectoris manifests itself when:
- walking fast;
- climbing stairs;
- excitement;
- going out into the cold;
The most severe exacerbation of angina pectoris occurs with physical activity immediately after a heavy meal.
Angina pectoris can also manifest itself at rest, for example, during night sleep. This happens as a result of spasms of the coronary vessels passing over the surface of the heart. This form of angina is called rest angina and is considered a more severe manifestation of the disease.
Similar pain can also occur with neuroses, chondrosis upper divisions spine, heart defects, diseases of the lungs or gastrointestinal tract, with myocardial infarction.
During attacks, there may be nonspecific symptoms angina pectoris: nausea, vomiting, muscle weakness, excessive sweating, dizziness, panic.
Severe sudden pain in the region of the heart may appear in young men in the early morning or at night... Spasm of the vessels supplying the heart muscle does not always occur as a result of atherosclerosis. Such angina is called vasospastic or Prinzmetal angina.
Women are less likely to experience shortness of breath or pain that radiates to the arm during attacks... Most often, they experience sensations in the form of pulsation or tingling, nausea, and pain in the abdomen. The most common complaints in men are sharp pains in the heart with a return under the scapula or in the arm.
First aid: what to do, what medications to take
We will tell you in detail about the algorithm of actions for providing urgent first aid with angina pectoris.
If the attack occurs during physical activity, it is important to stop, if possible, lie down or sit down... Rest often helps relieve symptoms. At the first sign of angina, it is best to take nitroglycerin, which helps quickly.
If the pain symptom does not go away within two minutes, taking the drug must be repeated. If there is no result, it is necessary to call for medical help, as myocardial infarction is possible.
If you have headaches, you can drink analgesic... If the pulse is very high and reaches 110 beats per minute or more, you need to take anaprillin.
It is important to know that you cannot take nitroglycerin with reduced pressure. You can use aspirin and be sure to call for medical help. After relieving heart pain, anxiety and physical activity should be avoided.
If the attack happened at rest, the patient should sit with his legs down... You need to loosen the collar, open the window and use nitroglycerin. most often, medical attention is required.
Apply for medical help should be mandatory if:
- exacerbation occurred within two months from the onset of myocardial infarction;
- symptoms are accompanied by vomiting;
- pain does not go away after nitroglycerin within 15 minutes;
- there is a blue discoloration of the skin;
- loss of consciousness has occurred;
- blood pressure has increased or decreased significantly;
- each next attack for a month is more and more difficult, and the effectiveness of nitroglycerin decreases.
In the normal course of an attack and long-term ischemic heart disease, if all the measures taken are effective, there is no need to call emergency help and emergency hospitalization.
Medical treatment
The main task of ambulance doctors is to recognize an attack, eliminate a threat to life, identify the development of myocardial infarction, and medication.
First and foremost a doctor listens to complaints and diagnoses pain symptoms, conducts blood pressure monitoring, ECG. If the patient does not tolerate nitroglycerin, then the Valsalva test is performed, massage of the carotid sinus zone. The patient is also given Corvalol 30 drops.
If there is no result heparin is injected, oxygen therapy, neuroleptoanalgesia are carried out, the patient is given ½ an aspirin tablet to chew.
If respiratory depression is observed, naloxone solution... As a sedative used seduxen... When extrasystoles are detected, lidocaine is slowly injected.
After the emergency measures have been taken, the patient is taken to the hospital.
What is undesirable to do with this problem
Some people, just feeling pain behind the sternum, immediately call for emergency help. In such cases it's better not to rush, but try to help yourself on your own... Quite often, peace of mind is sufficient to relieve an attack.
If after a couple of minutes the pain has not gone away, you need take nitroglycerin under the tongue... If there is no effect, another pill should be taken after 5 minutes. If pain persists after these measures, medical attention should be sought.
Some, on the contrary, neglected medical help and wait for the self-care of heart pains, refusing even medications... Such an attitude is fraught with deterioration of the condition and the appearance of a threat to life.
Learn more about the disease from Malysheva's video:
What is the danger of ischemic stem stroke and how does it manifest itself? We will discuss all the details.
Prevention
To prevent angina pectoris, it is important to adhere to the basic rules and, first of all, correct lifestyle... To do this, you should give up alcohol and smoking. High cholesterol foods should be avoided in the diet. Weight control is also necessary.
In the presence of hypertension, high blood pressure should be avoided.
An important point is minimizing stress and anxiety... If you have had seizures before, you need to carry nitroglycerin with you and know the rules for its use. After consulting a doctor, you can conduct courses of aspirin-containing drugs.
From this article you will learn: what is an attack of angina pectoris, what causes it, it characteristic symptoms and difference from other pathologies. How to relieve an attack and prevent its occurrence in the future.
Date of publication of the article: 19.12.2016
Date of article update: 05/25/2019
With an attack of angina pectoris, pathological narrowing of the coronary arteries occurs by 50% or more. This condition leads to a lack of oxygen in the heart, which is characterized by certain symptoms (pain, burning sensation, pressure behind the breastbone) and threatens with a complication - myocardial infarction.
An attack of angina pectoris can lead to myocardial infarction
The attack can be completely relieved by taking nitroglycerin, but this will not affect the cause of the problem - this is only a temporary solution. After eliminating the symptoms, you should definitely contact a specialist - a cardiologist - for further treatment.
Causes of an attack of angina pectoris
Angina pectoris can occur for three reasons:
- as a result of atherosclerosis - narrowing of the lumen of blood vessels due to deposits of atherosclerotic plaques);
- thromboembolism - acute blockage blood vessel thrombus;
- spasm - a sudden multiple narrowing of the lumen of blood vessels.
The provoking factors can be any conditions in which the work of the heart increases:
Predisposing factors:
- excess weight;
- age (more common in older people);
- smoking;
- increased blood clotting;
- lack of physical activity;
- high blood pressure;
- diabetes;
- high cholesterol;
- congenital anomalies of the heart and blood vessels;
- heredity.
Diseases of the lungs and stomach can also cause pathology due to a deterioration in the supply of oxygen to the heart.
Symptoms of an angina attack
Main features:
- pain behind the sternum, in the stomach, in the scapula, left arm, shoulder, lower jaw;
- burning sensation;
- the appearance of shortness of breath - rapid and labored breathing, a feeling of lack of air;
- dizziness;
- increased sweating;
- weakness;
- feeling of panic and anxiety.
Some people may not have any symptoms during an attack, such as women, patients with diabetes, and older people. In men, such an attack of angina pectoris is much more often painful.
Pain syndrome (complex of symptoms) may have different localization, duration and intensity:
| The nature of the pain | Possibly a feeling of pinching or squeezing, drilling or pulling |
|---|---|
| Pain intensity | From insignificant sensations to very strong, unbearable |
| Duration | From 2-5 minutes to 20; if longer, then this indicates the development of a heart attack |
| Localization of pain syndrome |
|
Localization sites and the main signs of an angina attack Features of an attack depending on the type of angina pectoris
When different types angina symptoms of the problem will be different:
With, the severity of which is divided into 4 classes, seizures also have their own characteristics.
Differential diagnosis (difference from other pathologies)
Since an attack of angina pectoris is similar in pain to some diseases, in order to provide competent assistance, it is necessary to carry out a differential diagnosis.
Comparison of an attack of angina pectoris with other pathologies:
First aid (relief of an attack) and treatment
If an attack happened to you, then you need to be able to provide yourself with first aid.
- You need to sit down, stop any activity, call an ambulance.
- Unbutton your clothes, if possible, or remove the top. It is advisable to unfasten the belt, bra, tie.
- Place nitroglycerin under your tongue (1 tablet).
- If after 5-8 minutes the symptoms still continue, then you can put another one.
- Pay attention to the pulse and pressure: if it rises, then you need to drink the appropriate drug.
In the event that the problem overtook any person who is next to you, you should provide him with the same urgent assistance.
Most often, nitroglycerin completely relieves symptoms and a person can move independently, but this does not mean that the problem will not recur.
As such, there is no treatment for an attack - it is simply removed. And since an attack of angina pectoris is not an independent disease, but a syndrome (a complex of symptoms) of other pathologies, then after the attack is removed with nitroglycerin, further treatment of the main problematic pathology is necessary.
Prevention
To prevent the onset of angina attacks, you should exclude those factors that lead to them, especially if you have a predisposition to diseases of the cardiovascular system. Of course, the influence of such a factor as age or gender cannot be prevented, but it is in our power to help ourselves - to protect ourselves from problems in the future. For this you need:
- get rid of bad habits;
- eat right;
- fight excess weight;
- be physically active;
- timely undergo a preventive examination, measure cholesterol and blood sugar levels.
Lifestyle recommendations for preventing angina attacks Health prognosis
An unambiguous prognosis for health after an attack of angina pectoris cannot be made for all patients. The course of the disease is individual and depends on the conditions and lifestyle of the person. Therefore, in one case, subject to preventive measures some will not have seizures at all, while others may experience a complication or tragic outcome.
At the moment, angina pectoris has become much younger. Angina symptoms occur in people younger than 45-50 years old (and even in adolescents). It is important to explain to the child in time dangerous consequences bad habits and the importance of sports, healthy eating and an optimistic outlook on life situations. After all, a healthy attitude towards life is best prevention heart disease.
Chest pain - is it a heartache or something else? What is coronary artery disease? How to distinguish an attack of angina pectoris from other chest pain and why do an ECG under stress? The cardiologist Anton Rodionov, the author of the book "What the ECG Will Tell You", will help us to understand one of the most common heart diseases.
Coronary heart disease
What is ischemia? This is the mismatch between oxygen demand and the ability to deliver oxygen to tissues. As a rule, insufficient blood supply to tissues occurs against the background of vasoconstriction by atherosclerotic plaques. Ischemia can develop in any organs: there is cerebral ischemia, leg ischemia, intestinal ischemia, kidney ischemia and even ischemia bladder... It all depends on which vessels are affected. Today we will start discussing myocardial ischemia.
There are chronic forms of coronary heart disease (CHD): stable angina pectoris and postinfarction cardiosclerosis. there is sharp forms: myocardial infarction and the so-called unstable angina pectoris - they will be discussed in the following publications.
Stable angina: what is it
Classic angina pectoris looks like this: with an increase in the heart's need for oxygen (physical activity, emotions, going out into the cold), discomfort occurs behind the sternum (sometimes pain, sometimes burning, sometimes compression, sometimes even difficult to describe in words), which makes the solution stop or splash under the tongue nitroglycerin from a spray can. An attack of angina pectoris passes quickly, within a few minutes. However, let me make a plate and see for yourself if your pain is similar to angina pectoris.
| Angina pectoris? | |
| Rather "yes" | Probably not" |
| Presses, squeezes, hurts behind the breastbone | Pain in chest piercing character, you can find a pain point |
| Duration no more than 20 minutes | Duration - several hours or even days |
| Occurs during exercise and passes at rest | Occurs at rest, sometimes at night, depending on body position |
| Nitroglycerin helps very quickly - within 1-3 minutes | Nitroglycerin does not work or "helps" after half an hour or more |
| Pain sensations in the left hand, in the neck, jaws arise under load and quickly pass at rest | In the morning after waking up, hand numbness occurs, which disappears after half an hour or more |
So, here are the basic facts about angina pectoris you need to know:
- The duration of an angina attack does not exceed 20 minutes. When a patient comes to the doctor and says that his heart hurts, and upon questioning it turns out that the pain lasts for hours, then this, as a rule, is not angina pectoris.
- The condition of occurrence is physical or emotional stress. The attack of angina pectoris stops as soon as the load stops or decreases. If pain occurs at rest, and the patient tolerates severe stress very well, this is usually not angina pectoris.
- Nitroglycerin helps very quickly with angina pectoris. Experienced patients always have a spray with nitroglycerin with them, which they spray at the time of an attack. If a patient tells us that nitroglycerin "works" in 20-30 minutes, then we state that there is no effect of nitroglycerin. This is most likely not angina.
There are a lot of reasons for chest pain. These are diseases of the spine, joints, neuralgia (the consequences of herpes), diseases of the esophagus. For example, if a patient complains of "burning pains behind the breastbone", we will think about angina pectoris, and if he says "I have," then we will give drugs that reduce the acidity of the stomach. Although, if you look at it, the sensations can be quite similar. And linguistically, both words are associated with the verb "burn." Neurotic disorders quite capable of mimicking heart pains.
In a word, not every pain in the region of the heart is angina pectoris. Among patients visiting a cardiologist with complaints of pain in the heart, the proportion of patients with angina pectoris does not exceed 30%.
However, if you have noticed, in every sentence I used the phrases “as a rule”, “most likely”. An atypical course of diseases also happens, the main rule in any case is: if your heart hurts - go to the doctor.
Exercise ECG: why and how is it done?
Okay. The patient came to the doctor, complained of chest pain. The doctor sent him for an EKG. The nurse made an EKG, and there ... the norm! Congratulations and let you go home? In no case. After all, we agreed that angina pectoris is ischemia that occurs during exercise, so we also need to do a cardiogram under load.
The meaning of the stress test is very simple: you need to somehow increase the heart's oxygen demand, and for this you need to increase the heart rate. The simplest tests are the treadmill test (test on a treadmill) and bicycle ergometry (test on a stationary bike).
The patient performs the load, the load power increases (the track runs faster and uphill or the resistance of the bicycle pedals increases), while the doctor on the computer at this time monitors the cardiogram and looks for signs of myocardial ischemia. As soon as the ECG begins to change, the doctor stops the sample. If the patient has completed the test completely, and the ECG has not changed, then they speak of a negative test. This means a good result.
For those patients in whom, say, they cannot perform such physical activityThere are other types of stress tests. This can be a drug load when drugs that increase the heart rate (dobutamine) are given. Or a thin electrode is inserted through the nose into the esophagus and stimulation is carried out: a more frequent rhythm is imposed on the heart, and we watch how it reacts to such a provocation. It is possible to assess the reaction of the heart to stress not only with eCG... Sometimes echocardiography (then the method is called stress echo) or radioisotope study (stress scintigraphy) is used for this.
Exercise testing is highly desirable, if not mandatory, if we want to confirm the diagnosis of angina. But in Russia, unfortunately, they are terribly afraid to do them. What if what happens ?! Walking down the street, climbing stairs, running after trams is not scary. And in medical office if you have the necessary drugs and a defibrillator at hand, giving a load is scary ...
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