Internal illnesses. Cardiac ischemia. Angina (most important)

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Internal illnesses. Cardiac ischemia. Angina (most important)

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16. ISCHEMIC HEART DISEASE. ANGINA

Ischemic heart disease is myocardial damage caused by a disorder of the coronary circulation, resulting from an imbalance between the coronary blood flow and the metabolic needs of the heart muscle.

Etiology. Atherosclerosis of the coronary arteries, vasospasm, disturbances in the hemostasis system, an underdeveloped network of collateral circulation, hyperproduction of catecholamines are of primary importance.

Pathogenesis. With angina pectoris, there is a discrepancy between the blood supply to the myocardium and its needs, the development of ischemia.

Clinic

With the first occurrence of angina pectoris, a pain syndrome lasting less than 1 month is characteristic.

With stable angina pectoris of functional class I, the pain syndrome occurs during accelerated walking or walking with an average step of up to 1000 m (VEM (veloergometry) - 750 kgm / min.

With stable angina of the II functional class, the pain syndrome occurs when walking on flat terrain up to 500 m (VEM - 450 kgm / min).

With stable angina of functional class III, the pain syndrome occurs when walking on flat terrain up to 150-200 m (VEM - 150-300 kgm / min).

With stable angina of the IV functional class, there is an inability to perform any load without the onset of an angina attack (VEM is not performed).

Progressive angina is characterized by a sudden increase in the frequency and duration of attacks with the same degree of physical activity.

Spontaneous (vasospastic or Prinzmetal's variant) angina occurs at night.

With angina pectoris, pain is more often localized behind the sternum with irradiation to the left arm, shoulder blade, neck, sometimes to the left half of the jaw, has a compressive burning character, pain duration from 5-10 minutes to 25-30 minutes. Possible bradycardia or tachycardia, rise in blood pressure.

Diagnostic research. A biochemical blood test, an ECG study, coronary angiography, stress tests or pharmacological tests, an echocardiogram study are carried out.

Treatment. Pain is relieved with nitroglycerin.

Drug treatment includes the use of long-acting nitrates, nitrate-like agents - nitrong, sustak, sustanite, nitrosorbitol, sydnopharm, erinite. Calcium antagonists are used cordafen, corinfar, verapamil. Of the β-blockers, atenolol, metaprolol (egilok), nebivolol (nebilet), etc. are used. Antiarrhythmic drugs, antispasmodics (if indicated), anabolic agents, prodectin are used.

Surgical treatment includes coronary artery bypass grafting, percutaneous transluminal angioplasty.

Flow. With angina pectoris, the course is undulating, depending on the degree and progression of atherosclerosis of the coronary arteries.

Forecast. With angina pectoris, the prognosis depends on the severity of atherosclerosis of the coronary arteries, on the frequency of angina attacks.

Prevention. Primary prevention includes the following activities: identification of risk factors, rational organization of the regime of work and rest. Secondary prevention includes dispensary observation of persons with unstable forms of angina pectoris, arterial hypertension.

Author: Myshkina A.K.

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