There are several options for angina pectoris:
- Stable angina pectoris , which includes 4 functional classes, depending on the load.
- Unstable angina, stability or unstable angina is determined by the presence or absence of a relationship between the load and the manifestation of angina
- Progressive angina pectoris. Attacks take on a growing character.
- Variant angina, or Prinzmetall angina . This type of angina is also called vasospastic. This is a vasospasm that occurs in a patient who does not have a lesion of the coronary arteries, there may be 1 affected artery. So how in the basis is a spasm, the attacks do not depend on the physical load, occur more frequently at night ( n.vagus ). Patients wake up, there may be a series of attacks every 5-10-15 minutes. In the interictal period, the patient feels himself normally. An ECG outside the attack is normal. During an attack, a picture of Acute Myocardial Infarction. Any of these attacks can lead to myocardial infarction.
- X is a form of angina pectoris. It develops in people as a result of spasm of capillaries, small arterioles. Rarely leads to a heart attack, develops in neurotics (more in women).
Stable angina pectoris.
It is believed that for the occurrence of angina pectoris, the arteries of the heart should be narrowed due to atherosclerosis by 50 – 75%. If treatment is not carried out, then atherosclerosis progresses, plaques on the walls of the arteries are damaged. Blood clots form on them, the lumen of the vessel narrows even more, the blood flow slows down, and angina attacks become more frequent and occur with mild exercise and even at rest.
Stable angina (tension), depending on severity, is usually divided into Functional Classes:
- I functional class – fits of chest pain occur infrequently. Pain occurs when an unusually large, to quickly perform load Yu
- Functional class II – seizures develop when climbing stairs quickly, walking fast, especially in frosty weather, in a cold wind, sometimes after eating.
- Functional class III – a pronounced limitation of physical activity, seizures appear during normal walking up to 100 meters, sometimes immediately when going outside in cold weather, when climbing to the first floor, they can be provoked by unrest.
- VI functional class – there is a sharp restriction of physical activity, the patient becomes unable to perform any physical work without the manifestation of angina attacks; it is characteristic that seizures of angina pectoris can develop – without prior physical and emotional stress.
The allocation of functional classes allows the attending physician to choose the right medication and the amount of physical activity in each case.
Unstable angina pectoris.
If habitual angina pectoris changes its behavior, it is called an unstable or pre-infarction condition. Under the unstable angina pectoris, the following conditions are understood: The angina pectoris that first appeared in life was not more than one month old;
- Progressive angina pectoris, when there is a sudden increase in the frequency, severity or duration of attacks, the appearance of night attacks;
- Angina pectoris – the appearance of angina attacks at rest;
- Post -infarction angina pectoris – the appearance of rest angina pectoris in the early post-infarction period (10-14 days after the occurrence of myocardial infarction).
In any case, unstable angina is an absolute indication for hospitalization in the intensive care unit and intensive care.
Variant angina pectoris.
Symptoms of variant angina occur as a result of a sudden contraction (spasm) of the coronary arteries. Therefore, doctors call this type of angina pectoris vasospastic angina pectoris . With this angina pectoris, coronary arteries can be affected by atherosclerotic plaques, but sometimes they are absent. Variant angina occurs at rest, at night or in the early morning. Symptom duration 2–5 minutes; Nitroglycerin and calcium channel blockers, nifedipine , help a lot.
The minimum list of biochemical parameters for suspected coronary heart disease and angina pectoris includes the determination of blood levels:
- total cholesterol;
- high density lipoprotein cholesterol;
- low density lipoprotein cholesterol;
- AST and ALT.
The main research methods for the diagnosis of stable angina include the following studies:
- physical exercise test (bicycle ergometry, treadmill ),
- coronarography .
If it is impossible to conduct a test with physical activity, as well as to identify the so-called pain – free ischemia and variant angina, daily ( Holter ) ECG monitoring is indicated .
It should be remembered that chest pain can occur not only with angina pectoris, but also with many other diseases. In addition, at the same time there may be several causes of pain in the chest.
Under the angina may mask:
- Myocardial infarction;
- Gastrointestinal tract diseases (peptic ulcer, esophagus diseases);
- Diseases of the chest and spine (osteochondrosis of the thoracic spine, herpes zoster);
- Diseases of the lungs (pneumonia , pleurisy).
Typical angina pectoris:
Sternum —- pain or discomfort of a characteristic quality and duration Occurs with physical exertion or emotional stress Passes alone or after taking nitroglycerin.
Atypical angina pectoris:
Two of the above symptoms. Heartache pain. One or none of the above signs.
Prevention of angina pectoris.
Methods for the prevention of angina are similar to the prevention of coronary heart disease, atherosclerosis .