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What is angina

Angina is a basic and classic form of manifestation of coronary heart disease (CHD). The main clinical symptom of angina is the appearance of an specific pain squeezing, burning character, more often behind the breastbone or on the left side of the chest (often these give pain in left arm, left shoulder, lower jaw or under the shoulder blade) that occur during physical exertion or emotional stress and are using 2-5-10 minutes after taking nitroglycerin.

The intensity of pain attack can be different in severity and discomfort in the chest. Pain attack is often accompanied by sweating, shortness of breath or nausea.

When evaluating the patient with angina and in determining the nature of subsequent treatment (medical, interventional or cardiac surgery), it is necessary to distinguish a stable form of angina and it is very important not to miss the unstable form of angina, which can lead to the development of severe cardiovascular complications (myocardial infarction, life threatening arrhythmias). Destabilization within the unstable form of angina is due to acute circulatory disorders in one of the coronary arteries, arising from the loosening of an atherosclerotic plaque, which causes spasm of the vessel and intravascular thrombosis. Violation of blood supply to the heart muscle, due to the restriction of blood flow stenosis with atherothrombosis in the coronary arteries leads to acute oxygen starvation of the tissues of the myocardium.

An important criterion for the clinical diagnosis of unstable angina is the occurrence of clinical instability in the course of the disease in the form of amplification and the frequency of pain attacks of angina pectoris the usual, the appearance of more prolonged episodes of pain at a lower load, reducing the efficiency of taking nitroglycerin.

There are the following forms unstable angina: new-onset, progressive, post-infarction and vasospastic (usually night) angina. Clinical severity of stable angina is evaluated by functional class (1 to 4) determined in exercise capacity.

With the appearance of clinical signs of unstable angina urgent and necessary instrumental and laboratory diagnosis, intensive drug, including thrombolytic therapy, as well as an urgent decision or interventional cardiac surgery treatment coronary artery disease.

Diagnosis of angina

The main (possibly the priority, including emergency) method for the diagnosis of unstable angina (as well as other clinical forms of ischemic heart disease) is computed tomography of the coronary arteries with intravenous contrast (CT coronary angiography) that in a matter of minutes (10-15 minutes) allows to accurately determine the presence, nature and severity of stenotic process of any localization in all coronary arteries.

To clarify the clinical forms and severity of stable angina, and therefore of the nature of their treatment are used: electrocardiography at rest and with stress (Bicycle ergometry or treadmill test), daily monitoring of ECG and HELL, radiography of the chest and laboratory tests on "cardiospecific" the enzymes in blood and urine.

Echocardiography is an indispensable method of examination of patients with angina pectoris, as it allows to accurately identify the affected ischemic areas of the heart, to determine the size of the ventricles and the Atria, to determine the presence of breaks in the walls of the heart and disorders of the valves. The use of new ultrasound technologies, such as transesophageal echocardiography, stress echo, deformation technology, and 3D/4D - can significantly improve the diagnosis of violations of local contractility of the myocardium in various forms of angina.

Treatment of angina

Treatment depends on clinical form stable or unstable angina, but usually always starts with drugs and unloading mechanism of action", such as: nitroglycerine and long-acting nitrates, calcium antagonists, cardioselective beta-blockers.

Stable form of angina. If you experience pain therapy, short-range tablets nitrates-nitroglycerin, the use of which, in the absence of clinical effect, should be repeated after 5-10 minutes. Convenient for the speedy relief of stenokardicheskiy pain attack, are metered sprays of nitroglycerin. After 2-3-5 techniques of nitroglycerin possible the adoption of long-acting nitrates (isosorbide dinitrate) with a duration of at least 8 hours. Often serve as alternative to nitrates and other drugs "hemodynamically handling actions such as: calcium antagonists (nifedipine, diltiazem or verapamil), cardioselective beta-blockers (metoprolol, bisoprolol) and other. In some cases, using a combination of the medications listed above.

Unstable form of angina. Treatment of the unstable form of angina as stable angina, should begin with an intake of nitroglycerin, calcium antagonists or cardioselective beta-blockers. However, in some cases, treatment of the unstable form of angina, at the proof of atherothrombotic disease of coronary arteries (using conventional x-ray coronary angiography or CT coronary angiography), may require percutaneous transluminal coronary angioplasty with stenting or even coronary artery bypass surgery.

Most often, all patients with angina, in the absence of contraindications, is assigned to aspirin (acetylsalicylic acid) at doses of 75-150 mg.

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