Help with coronary heart disease. Treatment of coronary artery disease: how to stop the disease and save lives from a heart attack Pathophysiology of myocardial ischemia

To most accurately determine the symptoms of angina pectoris, you need to understand what kind of disease it is. As you know, this is a form of cardiac ischemia, which is explained by the presence of an obstacle in blood circulation. This may occur in one or two coronary arteries. In addition, myocardial attacks are observed, which means that there is not enough oxygen in the heart muscle.

• General symptoms
• Determining the type of disease by symptoms
• A little about the reasons
• First aid and treatment

The development of angina manifests itself in an imbalance between how oxygen enters the heart muscle and what its actual need is. This means that the supply of oxygen does not correspond to its required amount. Because of this, metabolism in the heart muscle is disturbed and its necrosis occurs. This situation may occur due to local disturbance of blood supply, which occurs either due to narrowing of the lumen of the artery, or due to a long and sharp spasm of the vessels of the heart. If the lack of oxygen in the heart muscle is higher than possible, then an angina attack can turn into a heart attack.

The cause of the disease may be spasm, atherosclerosis or vascular thrombosis

Kinds

The classification of angina pectoris is determined depending on various factors. Consider a few types that are used most often.

1. First appeared.
2. In a state of tension, or stable angina.
3. Progressive angina, unstable.
4. Variant.

It is worth noting that for the first time, progressive and angina pectoris is sometimes combined with the term "unstable". First consider general symptoms diseases, and then we will see how the signs of one manifestation of the disease differ from another.

General symptoms

Signs of this heart disease may appear after a very heavy lunch or dinner. It should be borne in mind that our motor works with special force in a supine position than when walking or standing. That is why an attack often overtakes a lying person. It so happened that the symptoms manifested themselves due to a sharp change in natural temperature.

1. Pain. This is the first of the signs that appear during the disease. Of course, there are cases in which it does not make itself felt, but this happens very rarely. Pain in angina pectoris is localized in the chest region, and spread to left side. In some cases, they cover the region of the clavicles and solar plexus. Up to this point, a person's well-being may be fine, although a nervous state or a run is possible. After that, pain suddenly comes, which can be very strong and sharp. As abrupt as its beginning was, so often is its end. The pain will be felt even more if you do not stop physical activity.

1. Increased blood pressure.
2. Profuse sweating.
3. Pallor.
4. Lack of oxygen. This usually manifests itself with a nocturnal attack, that is, with rest angina. At this moment, it seems to the sick person that he is suffocating, which may cause panic.
5. Change in heart rate. In this case, the pace can be both slow and frequent.

Here are some signs that are not classified as angina pectoris:

• constant, aching and dull pain;
• lasts more than twenty minutes;
• aggravated by nitroglycerin.

However, these symptoms should not be overlooked, as they are also serious and indicate a violation in the work of the heart, so you should immediately call an ambulance.

Mild angina is accompanied by symptoms that are short-lived. If the necessary measures are taken immediately, including taking the medicine, then the attack will pass in five minutes. Unfortunately, the longer it lasts, the more likely it becomes that a myocardial infarction will occur. The medicine to be taken immediately is nitroglycerin. One tablet of it will most likely stop the pain. If its action is not as fast as before, this is not a good sign. In any case, you should immediately call an ambulance doctor who will do everything necessary and prescribe medications that will be included in the treatment of angina pectoris.

Determining the type of disease by symptoms

With the first occurrence of angina, symptoms are observed for about a month. After that, regression occurs or the disease passes into the stage of a stable type. For the first time, the form that has arisen is manifested by retrosternal pain. In addition, suffocation and pain in the irradiation zone are possible.

Progressive angina is manifested by unexpected attacks, which can sometimes manifest themselves in a state of rest. Chest pain is usually severe. At the same time, the risk of developing a myocardial infarction is very high. The habitual stereotype of pain changes under the influence of overload, emotional or physical. Attacks become more severe and frequent, as well as longer and more intense. Possible irradiation of pain and the emergence of its new directions.

Some patients may experience the following symptoms: nausea, choking, rapid heartbeat. If earlier seizures were manifested only during exercise, now they are observed at night. They can also occur during urination and defecation. It happens that nitroglycerin does not help. Progressive angina requires timely hospitalization, and it must also be carefully treated.

The most common type of disease is stable angina. There are regular attacks that recur after emotional or physical stress. The pain is pressing, as if burning the heart. However, it is not very obvious, it just feels tightness, compression or dull pain. Irradiation occurs in the left shoulder or arm, but its manifestations are possible in the shoulder blade, face, teeth, neck, jaw and in the right side. It is very rare that pain radiates to lower limbs, left side of the abdomen and lower back. Stable angina includes four functional classes, which are divided depending on how the patient is able to perform physical activity.

1. Ordinary physical activity is quite well tolerated by the patient. Seizures are observed in case of intense load.
2. This class means that physical activity is slightly limited. Symptoms occur when walking more than 500 meters on level ground and when climbing higher than the first floor. If walking is carried out against the wind, in cold weather, with emotional arousal, and also in the first few hours after waking up, the likelihood of an attack increases.
3. More pronounced limitation. Symptoms appear even when walking at a distance of 100 to 500 meters and when climbing to the first floor.
4. Even small physical loads contribute to the manifestation of angina pectoris. It can also appear at rest.

Stable angina is sometimes manifested by dry mouth, urge to urinate, pallor, and increased pressure. Pain is usually relieved with nitroglycerin. If the attack lasts more than 15 minutes, the intervention of a doctor who knows how to alleviate the serious condition of the heart is necessary.

A little about the reasons

The main causes of angina are:

• smoking;
• hereditary predisposition;
• hypertension;
• diabetes;
• sedentary lifestyle;
• excess weight;
• a large amount of cholesterol in the blood.

First of all, you need to get rid of bad habits.

However, the causes of angina pectoris do not end there. Sometimes they become congenital defects of the heart and blood vessels. In addition, angina pectoris can develop with exacerbations of diseases gastrointestinal tract, acute bronchopulmonary diseases and during cholelithiasis.

First aid and treatment

What else needs to be done? It is necessary that the patient was in a semi-sitting position, roll up the clothes and put them under the shoulders, head and knees. You also need to put a nitroglycerin tablet under the tongue. It is advisable to warn the victim that after this there may be a feeling as if the head is bursting, headache, dizziness or fainting, so he should not get up immediately after the pain subsides. You may have to give another nitroglycerin tablet. If the pain does not go away for about twenty minutes, an ambulance is needed. It is better to call her at the very beginning.

Semi-sitting position is the most optimal for the patient

To establish a more accurate diagnosis, a thorough diagnosis of angina pectoris should be carried out. To do this, the patient must accurately describe all the symptoms and sensations. An important point is an electrocardiogram, which will help to see the state of the heart, and an X-ray examination of the chest. After the diagnosis is made, the doctor will select effective treatment angina. It is very dangerous to treat yourself with your own methods, this can lead to irreparable consequences.

Therapy for angina pectoris includes two important areas:

1. improved prognosis and prevention of complications;
2. reducing the intensity and frequency of seizures, which leads to an improvement in the quality of life.

What should a qualified doctor do? Of course, he needs to talk to the patient. In a conversation, he will explain how to cure angina effective ways and what a person needs to do. In order to stop and prevent further attacks, he will prescribe drugs of the nitrate group. Other drugs are also prescribed, for example, lipid-lowering and antiplatelet drugs. A diet for angina is very important, which excludes alcohol, nicotine and fatty foods. All this is very bad for the heart. You also need to add dosed physical activity to your life.

Prevention of angina pectoris will help to significantly reduce the risk of its occurrence or further development. What should be done to prevent this disease? It is important to avoid stress, they greatly affect health. You need to monitor your pressure so that it rarely rises. You should quit smoking and excessive alcohol consumption. Angina does not like these bad habits. You also need to eat right and lead an active lifestyle, however, if angina has already manifested, physical activity should be discussed with a doctor. In this case, you need to take all prescribed medications to reduce the risk of new attacks.

Angina pectoris is a serious disease that requires careful attention and timely treatment. Diagnosis of angina pectoris will determine the condition of the heart, however, the further situation will depend not only on the doctor, but also on the patient, who must remember: our heart does not like to be joked with.

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• Arrhythmia
• Atherosclerosis
• Varicose veins
• Varicocele
• Haemorrhoids
• Hypertension
• Hypotension
• Diagnostics
• Dystonia
• Stroke
• heart attack
• Ischemia
• Blood
• Operations
• A heart
• Vessels
• angina pectoris
• Tachycardia
• Thrombosis and thrombophlebitis

• heart tea
• Hypertension
• Pressure bracelet
• Normallife
• Allapinin
• Asparkam
• Detralex

Diet for coronary heart disease

In the coronary arteries, the lumen narrows (by 30-70%) due to the formation of plaques, so atherosclerosis occurs. This leads to attacks of angina pectoris and coronary heart disease due to a lack of oxygen delivered by the blood. IHD and operations on the heart vessels often lead to complications: heart failure and myocardial infarction. To help treat angina attacks and ischemic heart disease drugs a diet for coronary heart disease No. 10c is introduced.

The purpose of the prescribed diet No. 10c

The introduced diet food for coronary heart disease (CHD) and angina pectoris has the following therapeutic effect:

• slows down the development of atherosclerosis;
• restores blood lipid profile and general metabolism;
• prevents spasm of the coronary arteries and increased blood pressure;
• reduces the viscosity and density of the blood;
• maintains the tone of the heart muscle.

Lipid Restoration Products

Important. The diet includes foods to remove cholesterol and limit foods with high cholesterol. The body should not receive more cholesterol from food than is contained in the yolk of an egg - 200-300 mg / day.

To remove cholesterol, the diet is replenished:

• Low-fat fish products: they are low in cholesterol, but contain fish oil. It includes polyunsaturated fatty acids omega-3 and omega-6, which strengthen the walls of arterial vessels and remove cholesterol. Sometimes it is allowed to include stewed, boiled or steamed fatty fish in the menu: mackerel, halibut and flounder.
• Vegetables, berries and fruits. Carbohydrate food, rich in fiber, increases the motor function of the intestine, actively removes cholesterol and harmful products of its metabolism. Potatoes contain starch, which increases calories in food, increases body weight, so its consumption is limited.
• Cereals: wheat, oatmeal and buckwheat.
• Bran: when added to cereals and soups, bran (1-3 tablespoons / day) removes excess cholesterol and carcinogens.

High cholesterol levels in the following foods:

• in fats: butter, sausages with fat, lard, animal fats. Restriction of vegetable oils is necessary in case of advanced level triglycerides.
• in meat products: beef, pork, lamb, turkey and chicken meat (more in the shins and wings, less in the brisket). Offal: Kidney, liver and brain should be excluded due to high cholesterol content.
• in eggs, fish and shrimp caviar, since cholesterol is necessary for the growth and development of bird embryos and underwater organisms.
• in dairy products: sour cream, cheeses (40-60% fat), cottage cheese from fat milk.
• in alcohol: it is high in calories, it increases appetite and triglyceride levels in the blood.
• in white bread and muffins, cakes and pastries. Products are high-calorie due to the content of animal fats, eggs and sugar.

In order to treat ischemia of the heart and angina pectoris and as a prophylaxis on diet No. 10c, you should refuse such dishes:

• broths: chicken, meat, fish and mushroom;
• with smoked meats, radishes, radishes and legumes;
• from pastry, sweets;
• from sorrel, spinach, legumes, fried mushrooms;
• from fried meat and fatty fish;
• from fish offal and caviar, brains and egg yolks.

How to prevent spasm of coronary vessels and increase in blood pressure?

Spasms of the arteries manifest coronary artery disease and angina attacks and cause compressive, pressing, burning pains in the heart. To reduce spasm, nitroglycerin (nitrate) is taken, and foods (food supplements) with the presence of nitrites that constrict blood vessels are also excluded. Namely: sausages, preserves and other semi-finished products.

There is a lot of salt in many ready-made and convenience foods. After their consumption, you want to drink, and a sharp increase in fluid in the body overloads the cardiovascular system and leads to hypertension. Fans of salty foods have constantly elevated blood pressure, angina attacks occur, and rupture of plaques and blood vessels is possible: heart or brain.

To prevent spasms and reduce blood pressure per day, you should eat up to 5 g of sea or table salt, which is 1 tsp. without top. During cooking, salt can be replaced with a variety of spicy and aromatic plants, then the food will not seem bland.

How to reduce the viscosity and density of blood?

Except medicines prescribed by a doctor, observe the drinking regimen. It is supposed to drink 1.5-2 liters / day and up to 3 liters in hot weather: clean drinking water, alternating with unsweetened milk drinks, compotes, juices: vegetable, fruit and berry. Avoid carbonated drinks and beer.

How to maintain the tone of the heart muscle?

You can avoid attacks of angina pectoris and coronary heart disease by eating the recommended dishes and foods according to diet No. 10c:

• wheat bread of the 2nd grade, with bran and rye or black;
• olive oil containing monounsaturated fatty acids (5-10 g / day), unrefined vegetable oil: sunflower, rapeseed, mustard with Omega-6 polyunsaturated acids (1 tbsp. l.);
• marine fish: sardine, herring and mackerel with omega-3 polyunsaturated fatty acids (100 g / day);
• vegetarian soups from vegetables, cabbage soup, beetroot, dairy, cereal and fruit;
• from meat and poultry, steamed, baked or boiled;
• lean fish: boiled, baked or steam;
• low-fat boiled milk and dairy products;
• egg white omelet 1 egg or boiled egg - 1 time per week;
• vegetable salads, excluding mushrooms, legumes, sorrel and spinach;
• cereals and boiled pasta, including casseroles and puddings;
• fresh fruits and berries;
• kissels, mousses, compotes, excluding grape juice;
• any nuts: walnuts, almonds, hazelnuts, etc.;
• drinks: weak tea, infusion of rose hips, fruit juices, diluted with boiled water

Keep the heart in good shape with daily intake of vitamins with antioxidant properties: folic acid, E, A and C, minerals: sodium and magnesium, potassium, calcium and sulfur, phosphorus and chlorine. As well as trace elements: manganese and selenium, molybdenum, chromium and cobalt, zinc, copper, iodine and iron. All of these contain fresh berries and fruits. Most vitamins and macro- and microelements are in carrots and beets, radishes and turnips, celery (root), sea kale, pumpkin and sunflower seeds, nuts.

To live without angina pectoris and coronary artery disease, you should switch to 5-6 meals a day. Portions should be small, cold or too hot dishes are excluded.

It is important to know. Hot food or drinks can burn the mucous membranes of the mouth, pharynx, esophagus, and stomach. The mucosa is damaged and swells, which leads to a violation natural process swallowing and voice changes, spasms of the esophagus, shortness of breath and vomiting.

The last portion of food is eaten 2 hours before bedtime. A fractional diet is easy to organize by adding fermented milk products, juices, fruits or salads, 1 egg or a cup of berries with honey (1 tsp) between three main meals.

If bee products cause allergies, then sweet berries are consumed without sugar, and sour ones are sprinkled with a small amount of sugar (no more than 1 tsp).

It should be remembered! Sugar and sugary foods, including candy, are high-calorie carbohydrates. They contribute to the appearance of excess ballast in the body.

To supply blood to a large body, the heart will need oxygen for enhanced work, and during ischemia, the heart already feels its deficiency. Everyone overweight weight will add 20 g more cholesterol than the liver normally produces. Therefore, atherosclerosis in the coronary arteries will progress. For the sake of healthy blood vessels, you should abandon refined carbohydrates or reduce their consumption to a minimum.

Useful foods for normal heart function

The rhythmic work of the heart muscle will be preserved when used:

1. Dried fruits
   Dried apricots (and fresh apricots) and raisins contain potassium. The tonic properties of prunes increase efficiency. A nutritious mixture of dried apricots, raisins, prunes and nuts, lemon with peel and honey in the same weight proportions will help the heart. Everything needs to be crushed in a meat grinder.
2. apples
   Flavonoids in apples reduce cholesterol, and the phytoelement quercetin is an excellent antioxidant that prevents inflammation and blood clots.
3. green salad
   Lettuce and Beijing cabbage contain the main trace elements and B vitamins, as well as vitamin K, which is necessary for blood clotting. Vegetables are involved in the removal of cholesterol.
4. Orekhov
   With walnuts, pine nuts and almonds, the heart receives omega-3 fatty acids, potassium, magnesium, vitamins B, C and PP.
5. Liver
   Beef and chicken liver contain coenzyme Q10. The substance helps to function all the muscles and tissues of the body, including the heart. After the age of 50, the body slows down the production of coenzyme Q10, so it is obtained from food.
6. Avocado
   Its benefits are in polyunsaturated fatty acids involved in fat metabolism. The fruit increases "good" cholesterol and prevents atherosclerosis, strengthens the heart muscle with potassium, copper and iron, vitamins B, E, C, beta-carotene and lycopenes.
7. bitter chocolate
   Chocolate with a cocoa content of at least 70% is beneficial. With its use, the work of the heart and blood vessels is normalized, blood pressure and cholesterol in the blood are reduced. Chocolate with a high content of sugar and other components is considered a "bad" delicacy that contributes to obesity, which negatively affects the work of the heart.

Drugs and drugs for ischemia of the heart

If there is a violation of blood supply in the coronary arteries, the patient is prescribed drugs of various effects, which are very effective in ischemia of the heart. Oxygen starvation occurs due to narrowing of the vascular canal and atherosclerotic lesions. Without timely treatment, coronary artery disease will result in serious consequences.

Importance of drug therapy

Ischemic disease is enough dangerous pathology. If a person does nothing to eliminate the characteristic symptoms, serious complications are not excluded, in particular, heart attack and heart failure.

The presence of IHD requires complex therapy. The treatment course is compiled exclusively by the attending physician, taking into account the severity of the disease.

Anti-ischemic drugs are prescribed in order to:

1. Maintain blood pressure at a level that is optimal for a particular patient.
2. Lower and regulate the amount of cholesterol in the blood.
3. Monitor blood density to prevent blood clots.

In addition, it is impossible to effectively treat coronary heart disease without a radical change in lifestyle.

This is about:

• revision of the nutritional diet;
• sufficient physical activity;
• release from alcohol and nicotine addictions;
• following the correct daily routine.

You can achieve a favorable prognosis with the help of:

• antiplatelet agents;
• lipid-lowering agents;
• angiotensin-converting enzyme inhibitors.

For symptomatic treatment, you can not do without:

• beta-blockers;

• sinus node inhibitors;
• calcium antagonists;
• potassium channel activators;
• nitrates;
• diuretics.

Usually patients have to deal with the treatment of coronary artery disease for life.

In addition, in order to save wellness you will need to follow some rules:

1. It is necessary to take medicines in the dosage prescribed by the doctor. In no case should you independently increase or reduce the number of drugs, as well as skip the time of admission.
2. If side effects occur, you should immediately consult a doctor.

Significant Medications

Drug treatment of coronary artery disease with the help of antiplatelet drugs, that is, antiplatelet agents, is carried out to thin the liquid tissue. Taking this type of medication helps prevent the condition when platelets or red blood cells combine, thereby reducing the likelihood of thrombosis.

What tablets should be taken?

1. Aspirin. This is the main means of preventing the appearance of clots. It is not prescribed for stomach ulcers and disorders of the circulatory system.
2. Clopidogrel. The drug has similar properties and is indicated for patients who cannot take Aspirin.
3. Warfarin. There is a more intense action.

An obligatory component of treatment for coronary artery disease are lipid-lowering drugs such as statins. The need for drugs with hypolipidemic effect is dictated by the need to neutralize, bind and remove cholesterol and other lipoids. Excess cholesterol prevent, for example, Simvastatin, Rosuvastatin.

With coronary heart disease, it is important to keep the pressure normal. To avoid an increase in blood pressure, which negatively affects the coronary arteries, it is necessary to take ACE inhibitors.

Treatments that eliminate the cause of coronary heart disease - the activity of the angiotensin-2 enzyme, contribute to:

1. Decreased blood pressure.
2. Eliminate the likelihood of hypertrophy of the heart muscle or its contraction.

Positive results are observed after the use of Enalapril, Lisinopril, Perindopril.

Features of symptomatic therapy

A patient with coronary artery disease also requires drugs, thanks to which the relief of clinical manifestations is carried out. You can improve the work of the heart with the help of beta-blockers.

These medications work in the following way:

• lower the heart rate;
• control blood pressure levels.

BAB is prescribed for angina pectoris, as well as for those patients who have experienced a heart attack. Pathology can be cured with Oxprenolol, Bisoprolol, Carvedilol.

A possible attack of angina pectoris can be prevented by calcium antagonists Verapamil, Nifedipine. Medicines also help to reduce heart contractions and eliminate arrhythmia.

If beta-blockers are contraindicated for a patient, he can take, for example, Ivabradine, which is a sinus node inhibitor. It reduces the heart rate, but does not affect blood pressure.

The pathological disorder requires treatment with potassium channel activators. Thanks to, for example, Nicorandil, the expansion of the coronary arteries occurs, and cholesterol formations do not appear on the vascular walls. Nicorandil shows good results in the presence of microvascular angina.

With paroxysmal pain, nitrates do an excellent job - drugs that are actively used to treat coronary heart disease.

Action of nitrates:

1. Elimination of pain discomfort.
2. Expansion of the lumen of the coronary vessels.
3. Reduction of excessive blood flow to the heart, resulting in a drop in oxygen demand.

With this disease, patients drink Nitroglycerin (maybe not only for internal use, but also in the form of patches and ointments), Nitrosorbide, Mononitrate and other nitrate-like drugs. Medicines can be used both in case of an attack and regularly.

If there is intolerance to nitrates, molsidomine is needed.

Diuretics also fight high blood pressure. These are drugs whose action is aimed at reducing the amount of fluid by removing it through the organs of the urinary system.

Their use leads to:

• normalization of pressure indicators;
• minimizing the risk of swelling.

Often, patients are prescribed Furosemide, Hypothiazid, Lasix. However, diuretics are strictly prohibited for some patients. For example, they should not be taken in diabetes.

If you need to urgently stop the pain, before the appearance of an ambulance, first aid consists of:

1. Taking Nitroglycerin. It is desirable that the victim was sitting, otherwise fainting is not excluded. Nitroglycerin is allowed to be replaced by Nitrolingval or Isoket.
2. In the absence of signs of improvement, a person is given crushed Aspirin or Baralgin in tablet form.
3. Medicines can be taken a maximum of 3 times in a row, while a short break is made between doses.

Coronary heart disease (CHD) develops as a result of hypoxia, more precisely, myocardial ischemia with relative or absolute coronary insufficiency.
For many years, coronary artery disease was called coronary disease, since it is precisely coronary circulation as a result of spasm of the coronary artery or its blockage by an atherosclerotic plaque.

1. Epidemiology of IHD

CVD in Russia has the character of an epidemic. Every year, 1 million people die from them, 5 million people suffer from coronary artery disease. In the structure of mortality from diseases of the circulatory system, IHD accounts for 50%, and cerebrovascular pathology - 37.7%. A much smaller proportion falls on diseases of the peripheral arteries, rheumatism and other diseases of the circulatory system. Russia is far ahead of the developed countries of the world in terms of mortality from coronary artery disease, both among men and women. Since the 1960s, mortality from CVD in Russia has been on the rise, while in Western Europe, the USA, Canada, and Australia, a steady downward trend in mortality from coronary artery disease has been observed over the past decades.
IHD can manifest itself acutely with the onset of myocardial infarction or even sudden cardiac death (SCD), but often it immediately becomes chronic. In such cases, one of its main manifestations is angina pectoris.
According to the State Research Center for Preventive Medicine, almost 10 million working-age population in the Russian Federation suffer from coronary artery disease, more than 1/3 of them have stable angina pectoris.

2. Risk factors for coronary artery disease

Risk factors
Managed:
- smoking;
- high level total cholesterol, LDL cholesterol, triglycerides;
- low level of HDL cholesterol;
- low physical activity (physical inactivity);
- overweight (obesity);
- menopause and postmenopausal period;
- alcohol consumption;
- psychosocial stress;
- food with excess calories and high content of animal fats;
- arterial hypertension;
- diabetes;
- high content in the blood LPa;
- hyperhomocysteinemia.
Unmanaged:
- male;
- elderly age;
- early development IHD in family history.
It is noteworthy that almost all of the listed risk factors are almost the same in atherosclerosis and hypertension. This fact indicates the relationship of these diseases.
In this lecture, two more risk factors are considered: high levels of LPA in the blood and hyperhomocysteinemia.
LPa - indicator early diagnosis risk of atherosclerosis, especially with an increase in LDL. The risk of developing coronary artery disease with an increase in the level of LPa in the blood has also been established. There is evidence that the content of LPA in the blood is genetically determined.
The determination of LP is used for early diagnosis of the risk of developing atherosclerosis in individuals with a aggravated family history of the development of cardiovascular pathology, as well as for solving
the issue of prescribing lipid-lowering drugs. The normal level of LPA in the blood is up to 30 mg/dL. It increases with the pathology of the coronary arteries, stenosis of the cerebral arteries, untreated diabetes, severe hypothyroidism.
Hyperhomocysteinemia is a relatively new and not completely proven risk factor for atherosclerosis and coronary artery disease. But a high correlation has been shown between the level of homocysteine ​​in the blood and the risk of developing atherosclerosis, coronary artery disease and IBM.
Homocysteine ​​is a derivative of the essential amino acid methionine, which enters the body with food. Normal metabolism of homocysteine ​​is possible only with the help of enzymes, cofactors of which are vitamins B6, B12 and folic acid. Deficiency of these vitamins leads to an increase in homocysteine.
As a rule, the influence of uncontrollable factors on the risk of CHD is mediated by other factors, usually combined with them - hypertension, atherogenic dyslipidemia, overweight, etc., which must be taken into account when conducting primary and secondary prevention of CHD.
The combination of several risk factors increases the likelihood of developing coronary artery disease to a much greater extent than the presence of one factor.
In recent years, close attention has been paid to the study of such risk factors for the development of coronary artery disease and its complications, such as inflammation, disorders of the hemostasis system (CRP, increased fibrinogen levels, etc.), vascular endothelial function, increased heart rate, conditions that provoke and aggravate myocardial ischemia - thyroid diseases. glands, anemia, chronic infections. In women, the development of coronary insufficiency may contribute to the use of contraceptives. hormonal drugs and etc.

IHD classification

IHD has various clinical manifestations.
Sudden cardiac death (SCD) is the primary cardiac arrest.
Angina:
- angina pectoris -
first-time angina pectoris;
stable angina;
progressive angina pectoris (unstable), including rest angina;
- spontaneous angina (synonyms: variant, vasospastic, Prinzmetal's angina).
Myocardial infarction.
Postinfarction cardiosclerosis.
Circulatory failure.
Heart rhythm disturbances.
Silent (painless, asymptomatic) form of coronary artery disease.
Sudden cardiac (coronary) death
SCD, according to the WHO classification, is one of the forms of coronary artery disease. This refers to sudden death from cardiac causes occurring within 1 hour of the onset of symptoms in a patient with or without known heart disease.
The prevalence of SCD ranges from 0.36 to 1.28 cases per 1000 population per year and is largely associated with the incidence of coronary artery disease. In more than 85% of patients (including a significant number of asymptomatic patients) who died from SCD, at autopsy, narrowing of the lumen of the coronary arteries by an atherosclerotic plaque of more than 75% and multivessel lesions of the coronary bed are found.
In more than 85% of cases, the direct mechanism of cessation of blood circulation in SCD is ventricular fibrillation, in the remaining 15% of cases, electromechanical dissociation and asystole.
On examination, dilated pupils, absence of pupillary and corneal reflexes, respiratory arrest are detected. Pulse on the carotid and femoral arteries and heart sounds are absent. The skin is cold, pale gray.
The ECG usually shows ventricular fibrillation or asystole.

angina pectoris

angina pectoris(from lat. stenocardia - compression of the heart, angina pectoris- angina pectoris) is one of the main forms of coronary artery disease and is characterized by paroxysmal pain behind the sternum or in the region of the heart.
The occurrence of pain (anginal) attacks is determined by the existing relationship of two main factors: anatomical and functional. It has been proven that in the vast majority of cases with typical angina pectoris, we are talking about atherosclerosis of the coronary arteries, leading to a narrowing of their lumen and the development of coronary insufficiency. An attack of angina pectoris occurs as a result of a discrepancy between the need of the heart muscle for oxygen and the ability of the vessels supplying it to deliver the required amount. The result is ischemia, which is expressed in pain.
Pain syndrome is a signal of trouble, a “cry” of the heart for help. As atherosclerosis of the coronary arteries progresses, attacks of angina pectoris become more frequent.
Angina pectoris is the most common form of angina pectoris, it is: first-time, stable and progressive.
Angina pectoris, first onset
New-onset angina refers to angina pectoris that lasts up to 1 month from the onset. The clinical symptoms of newly emerged angina pectoris are similar to the symptoms of stable angina described below, but, unlike it, it is very diverse in its course and prognosis.
For the first time, angina pectoris can become stable, take a progressive course, and even lead to the development of myocardial infarction. In some cases, there may be a regression of clinical symptoms. Taking into account such variability in the course of first-time angina pectoris, it is proposed to attribute it to unstable angina pectoris until the moment when it stabilizes. Stable exertional angina
Stable exertional angina- this is angina pectoris that has existed for more than 1 month and is characterized by stereotypical (similar to each other) attacks of pain or discomfort in the heart in response to the same load.
The stable form of exertional angina is currently divided into 4 FCs.
- To I FC stable angina pectoris include cases when attacks occur only with high-intensity loads that are performed quickly and for a long time. Such angina is called latent.
- II FC angina is characterized by attacks that occur when walking fast, climbing uphill or stairs above the 1st floor, or walking at a normal pace for a long distance; there is some limitation of normal physical activity. This is a mild degree of angina pectoris.
- Angina pectoris III FC is classified as moderate. It appears during normal walking, climbing to the 1st floor, attacks of pain may appear at rest. Normal physical activity is markedly limited.
- IV FC angina is severe angina. Attacks occur with any physical activity, as well as at rest.
- Thus, the determination of the functional class of a patient with stable angina is the most important indicator of the severity of the disease and helps to predict its course, and also makes it possible to choose the optimal treatment.

The clinical picture of an angina attack

Pain (squeezing, pressing, burning, aching) or a feeling of heaviness behind the sternum, in the region of the heart, radiating to the left shoulder, shoulder blade, arm, and even the wrist and fingers.
- There is a feeling of fear of death.
- The occurrence of pain, as a rule, is associated with physical exertion or emotional experiences.
- Attacks of angina pectoris appear with an increase in blood pressure, during sleep, when going out into the cold, after abundant intake food, alcohol and smoking.
- Pain, as a rule, disappears in 1-5 minutes after the termination of the load and the intake of nitroglycerin.
The clinical picture of an angina attack was first described by the English physician W. Heberden in 1768. Currently, the criteria for angina pectoris developed by the American Heart Association are used, which are determined during a survey of patients. According to these criteria, typical exertional angina is characterized by the presence of three signs:
- pain (or discomfort) behind the breastbone;
- the relationship of this pain with physical or emotional stress;
- the disappearance of pain after the termination of the load or taking nitroglycerin.
The presence of only two of the three listed signs indicates atypical (possible) angina pectoris, and the presence of only one sign does not give grounds to establish a diagnosis of angina pectoris.
The main sign of angina pectoris is a sudden onset of pain, which in a few seconds reaches a certain intensity that does not change during the entire attack. Most often, pain is localized behind the sternum or in the region of the heart, much less often in the epigastric region. By its nature, the pain, as a rule, is compressive, less often - pulling, pressing, or felt by the patient in the form of a burning sensation. The typical irradiation of pain in left hand(ulnar part of the left arm), the area of ​​the left shoulder blade and shoulder. In some cases, pain is felt in the neck and lower jaw, rarely in the right shoulder, right shoulder blade and even in the lumbar region. Some patients report a feeling of numbness or coldness in the area of ​​pain irradiation.
The zone of irradiation of pain to a certain extent depends on the severity of an angina attack: the more severe it is, the more extensive the area of ​​irradiation, although this pattern is not always observed.
Sometimes during an attack of angina pectoris, a pronounced pain syndrome does not occur, but an indefinite feeling of embarrassment, awkwardness, and heaviness behind the sternum appears. These sensations sometimes do not lend themselves to a clear verbal definition, and the patient, instead of their verbal description, puts his hand to the sternum.
In some cases, patients are concerned about pain only under the left shoulder blade, in the shoulder, lower jaw or in the epigastric region.
In some cases, pain in angina pectoris may not be localized behind the sternum, but only or mainly in the atypical zone, for example, only in places of irradiation or in the right half of the chest. Atypically localized pain should be properly assessed. If it occurs at the height of the load, passes at rest, after taking nitroglycerin, it is necessary to assume angina pectoris and to confirm the diagnosis, conduct an appropriate instrumental study.
In some patients, angina pectoris may manifest as an asthma attack due to a decrease in the contractile function of the heart resulting from coronary insufficiency and the development of blood stasis in the pulmonary circulation.
In many patients, there is a connection between angina attacks and the adverse effects of cold, headwind, and abundant food intake. Severe anginal attacks can be triggered by smoking, especially against the background of intense mental work. According to statistical studies, smokers develop angina pectoris 10-12 times more often than non-smokers.
An important circumstance of diagnostic value is the connection of seizures with physical or psycho-emotional stress. Since physical activity causes and intensifies pain, the patient tries not to move during an attack.
Factors provoking an attack of angina pectoris can also be sexual intercourse and tachycardia of any origin (fever, thyrotoxicosis, etc.).
As a rule, the pain syndrome lasts from a few seconds to 1-5 minutes, extremely rarely - up to 10 minutes and disappears as suddenly as it appears.
With stable angina, tension pains are stereotyped: they occur in response to certain loads, they are the same in intensity, duration and irradiation zones.
The course of angina pectoris in many patients is undulating: periods of rare occurrence of pain alternate with their increase and increased intensity of the attack.
A change in the nature of the pain syndrome may indicate the progression, aggravation of the disease, its transition to an unstable form. At the same time, seizures occur at lower loads than before, they become more frequent and severe, the intensity of pain and its duration increase, and the area of ​​pain irradiation becomes more extensive. In addition to pain, an attack of angina pectoris may be accompanied by general weakness, fatigue, a feeling of melancholy or a sense of fear of death. The skin is often pale, sometimes revealed their redness and moderate sweating. Often there is a heartbeat, the pulse quickens, the blood pressure rises moderately. At the end of the attack, there is a feeling of weakness, sometimes it stands out increased amount light urine.
Unstable angina- a reason to assume the possibility of developing a myocardial infarction. Such patients are subject to hospitalization.
Exceptional importance in recognizing an angina attack has long been attached to the assessment of the action of nitroglycerin, after which the pain usually disappears after 1-3 minutes, and its effect lasts at least 15-25 minutes.
A more severe form of angina pectoris is rest angina. Attachment to angina pectoris of pain that occurs at rest, more often at night during sleep, is an unfavorable sign, indicating the progression of stenosis of the coronary arteries and a deterioration in the blood supply to the heart muscle. This form of angina pectoris is more common in the elderly, in persons also suffering from hypertension. Pain attacks that occur at rest are more painful and last longer. Pain relief requires more intensive therapy, because taking nitroglycerin does not always completely stop it. Resting angina is an extreme variant of progressive, unstable angina.
Despite the various "masks" of an angina pectoris attack, almost all of its manifestations are paroxysmal. Spontaneous angina (Prinzmetal's angina)
Some patients with coronary artery disease experience episodes of local spasm of the coronary arteries in the absence of obvious atherosclerotic lesions. This pain syndrome is called variant angina or Prinzmetal's angina. In this case, oxygen delivery to the myocardium is reduced due to intense spasm, the mechanism of which is currently unknown. Often the pain syndrome is intense and prolonged, occurs at rest. The relatively low effectiveness of nitroglycerin was noted. Indicated emergency hospitalization. The prognosis is serious, the likelihood of developing myocardial infarction and SCD is high. Silent (painless, asymptomatic) form of coronary artery disease
A fairly significant proportion of episodes of myocardial ischemia can pass without symptoms of angina pectoris or its equivalents until the development of MI. According to the Framingham Study, up to 25% of myocardial infarctions are first diagnosed only with a retrospective analysis of the ECG series, and in half of the cases they are completely asymptomatic. Severe atherosclerosis of the coronary arteries may be asymptomatic and is found only at autopsy in persons who died suddenly.
With a high degree probability, we can assume the presence of MI in individuals without clinical signs of coronary artery disease, but with several risk factors for CVD. With multiple risk factors, SM ECG is recommended, and if MIMD is detected, an in-depth examination up to coronary angiography (CAG) is recommended. In some cases, a test with physical activity is shown, as well as stress echocardiography.
IHD is often manifested only by cardiac arrhythmias without pain. In these cases, it is necessary to assume first of all MI, immediately take an ECG and hospitalize the patient in a specialized cardiology department. Emergency care for angina pectoris
If the patient experiences pain in the heart area, you should immediately call a doctor, before whose arrival nurse must provide first aid.

Tactics of a nurse before the arrival of a doctor:

Reassure the patient, measure blood pressure, count and evaluate the nature of the pulse;
- help to take a half-sitting position or lay the patient down, providing him with complete physical and mental rest;
- give the patient nitroglycerin (1 tablet - 5 mg or 1 drop of its 1% alcohol solution on a piece of sugar, or a validol tablet under the tongue);
- put mustard plasters on the heart area and on the sternum, with a protracted attack, leeches are shown on the heart area;
- inside take Corvalol (or Valocordin) 30-35 drops;
Before the arrival of the doctor, carefully monitor the patient's condition.
The nurse should know the mechanism of action of nitroglycerin, which is still the drug of choice for attacks of angina pectoris. The sooner a patient with an attack of angina pectoris takes nitroglycerin, the easier the pain is stopped. Therefore, you should not hesitate to use it or refuse to prescribe the drug due to the possible occurrence of headache, dizziness, noise and a feeling of fullness in the head. The patient should be persuaded to take the drug and, in parallel, an analgesic for headaches can be given orally. Due to the significant peripheral vasodilating effect of nitroglycerin, in some cases it is possible to develop fainting and, very rarely, collapse, especially if the patient stood up abruptly and assumed a vertical position. The action of nitroglycerin occurs quickly, after 1-3 minutes. If there is no effect 5 minutes after a single dose of the drug, it should be re-administered at the same dose.
For pain that is not relieved by the double administration of nitroglycerin, further administration is useless and unsafe. In these cases, one must think about the development of a pre-infarction state or myocardial infarction, which requires the appointment of stronger drugs prescribed by a doctor.
The emotional stress that caused the attack and accompanied it can be eliminated by the use of sedatives.
The nurse in critical situations for the patient must show restraint, work quickly, confidently, without undue haste and fussiness. It must be remembered that patients, especially those with diseases of the circulatory system, are suspicious, so communication with the patient must be very delicate, careful, tactful, as a real professional sister of mercy should be.
The effect of treatment, and sometimes the life of the patient, depends on how competently the nurse is able to recognize the nature of pain in the region of the heart.

3. Nursing process in angina pectoris

Patient problems
Real:
- Complaints of pain in the region of the heart (behind the sternum), compressive, occur during physical exertion and after unrest, and sometimes at rest. Pain is relieved by taking nitroglycerin (after 2-4 minutes), but after an attack, a headache bothers;
- pain in the region of the heart is sometimes accompanied by short interruptions in the region of the heart;
- shortness of breath on exertion. Physiological:
- Difficulties with the act of defecation. Psychological:
- the patient is very worried because of the unexpectedness of his illness, which violated his life plans, and also reduced the quality of life.
Priority:
- shortness of breath on exertion.
Potential:
- pain in the region of the heart, which occurs at rest, indicates the progression of the disease, myocardial infarction may develop.
Lack of knowledge:
- about the causes of the disease;
- about the prognosis of the disease;
- the need to take the prescribed treatment;
- about risk factors;
- about proper nutrition;
- about self-care.
Nurse actions
General patient care:
- change of underwear and bed linen, feeding the patient according to the prescribed diet, airing the ward (make sure that there are no drafts);
- fulfillment of all doctor's prescriptions;
- preparing the patient for diagnostic studies.
Teaching the patient and his relatives the correct intake of nitroglycerin during an attack of pain.
Teaching the patient and his relatives to keep a diary of observations
Conducting conversations:
- fix in the patient's mind the fact that myocardial infarction can develop during an attack of angina pectoris, in the absence of a careful attitude to one's health, an attack can end fatally;
- convince the patient of the need to systematically take antianginal and lipid-lowering drugs;
- about the need to change the diet;
- about the need for constant monitoring of their condition.
Conversation with relatives in connection with the need to comply with the diet and monitor the timely intake of medications.
Motivate the patient to change lifestyle (reduce risk factors).
Advise patient/family on prevention.
Complications of angina pectoris:
- acute myocardial infarction;
- acute rhythm and conduction disturbances (up to SCD);
- acute heart failure.
Indications for hospitalization:
- first-time angina pectoris;
- progressive angina pectoris;
- angina pectoris that first occurred at rest;
- spontaneous (vasospastic) angina pectoris.
All patients with the above types of angina pectoris should be urgently hospitalized in specialized cardiology departments.

Principles of diagnosis of coronary artery disease

Diagnosis of angina pectoris during a pain attack
The diagnosis of angina pectoris is often based on the following main features:
- the nature of the pain - compressive;
- localization of pain - usually behind the sternum;
- irradiation of pain - in the left shoulder girdle, in the lower jaw;
- conditions of occurrence - physical stress, psycho-emotional arousal, the effect of cold;
- an attack may be accompanied by tachycardia, moderate hypertension;
- the temperature is normal;
- the clinical analysis of blood is not changed;
- Pain resolves after taking nitroglycerin or at rest.
Initial assessment of the patient's condition
The clinical diagnosis of angina pectoris is made on the basis of a detailed qualified survey of the patient, a thorough study of his complaints and a careful study of the anamnesis. All other research methods are used to confirm or exclude the diagnosis and clarify the severity of the disease - the prognosis.
Although in many cases the diagnosis can be made on the basis of complaints, it should be borne in mind that the patient does not always accurately describe his feelings. Therefore, attempts have recently been made to create a so-called standardized questionnaire for patients suffering from angina pectoris (of course, its use in full is possible in the interictal period).
At the initial examination, before obtaining the results of an objective examination, it is necessary to carefully evaluate the patient's complaints. Pain in the chest can be classified depending on the localization, provoking and stopping factors: typical angina pectoris, probable (atypical) angina pectoris, cardialgia (non-coronary chest pain).
In atypical angina, of the three main characteristics (all signs of pain, association with exercise, pain-relieving factors), two of them are present. In non-coronary chest pain, only one of the three characteristics is present, or none at all.
For a correct diagnosis, the patient's habitus matters.
When examining a patient during an attack of angina pectoris, the expression is frightened, dilated pupils, perspiration on the forehead, somewhat rapid breathing, pallor of the skin. The patient is restless, cannot lie still. There is an increase in heart rate and often an increase in blood pressure, various cardiac arrhythmias are possible. In many patients, hypertension could have occurred before the onset of angina pectoris, and an additional increase in blood pressure can only exacerbate clinical symptoms. During auscultation, as a rule, tachycardia (rarely bradycardia), muffled tones are noted.

Additional research methods for IHD

Laboratory research:
- clinical blood test;
- biochemical blood test: determination of blood levels of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, hemoglobin, glucose, AST, ALT.
Instrumental diagnostics myocardial ischemia:
- ECG registration at rest;
- ECG registration during an attack;
- stress ECG tests (VEM, treadmill test);
- EchoCG and stress echocardiography;
- Holter daily ECG monitoring (With MECG);
- myocardial scintigraphy;
- MRI;
- KAG.
Differential diagnosis with
Heart neurosis
Osteochondrosis
Diaphragmatic hernia
high stomach ulcer
Angina must also be differentiated from syphilitic aortitis.
Pain in the chest also occurs with other diseases, which should be remembered in atypical variants of coronary artery disease.
Cardiovascular:
- dissecting aortic aneurysm;
- pericarditis;
- pulmonary embolism.
Pulmonary:
- pleurisy;
- pneumothorax;
- lung cancer.
Gastrointestinal:
- esophagitis;
- spasm of the esophagus;
- reflux esophagitis;
- intestinal colic.
- Psychoneurological:
- a state of anxiety;
- the heat of passion.
chest related:
- fibrositis;
- injuries of the ribs and sternum;
- intercostal neuralgia;
- herpes zoster (up to the stage of rash).
Separately, reflex angina pectoris is distinguished, which occurs with the pathology of nearby organs: peptic ulcer, cholecystitis, renal colic, etc.
Forecast of the course of coronary artery disease
The quality and duration of life of a patient with angina pectoris depends on:
- early detection of the disease;
- Compliance with the regimen of prescribed medications;
- lifestyle changes and elimination of risk factors. In other words, if you make certain changes in your lifestyle and take the recommended drugs, you can continue to live a full life. The main conditions for this are understanding the essence of the condition and the patient's readiness for mutual cooperation with medical personnel.
Treatment and treatment goals:
- improve prognosis and prevent the occurrence of myocardial infarction or SCD and, accordingly, increase life expectancy;
- reduce the frequency and intensity of angina attacks in order to improve the quality of life.
The choice of treatment depends on the response to the initial medical therapy, although some patients immediately prefer and insist on surgical treatment - TKA, CABG. In the selection process, the opinion of the patient is taken into account, as well as the ratio of price and effectiveness of the proposed treatment.
Non-pharmacological treatment of angina pectoris includes: lifestyle changes and counteracting risk factors for coronary artery disease.
Medical treatment of angina pectoris
1. Antianginal (antiischemic) therapy
This treatment is prescribed for patients with angina attacks or when episodes of myocardial ischemia are diagnosed using instrumental methods.
Antianginal drugs include:
- beta-blockers;
- calcium antagonists;
- nitrates;
- nitrate-like drugs;
- myocardial cytoprotectors.
It is recommended that these classes of drugs be prescribed in this sequence for the treatment of stable angina pectoris, and also used in various combinations.
Drugs that are not recommended for patients to treat angina pectoris: vitamins and antioxidants, female sex hormones, riboxin, adenosine triphosphate (ATP), cocarboxylase.
2. Drugs that improve prognosis in patients with angina pectoris
Recommended for all patients diagnosed with angina pectoris in the absence of contraindications. Antiplatelet drugs, more correctly called antiplatelet agents (acetylsalicylic acid - ASA, clopidogrel) are mandatory means of treating stable angina pectoris.
All patients after myocardial infarction are recommended to prescribe beta-blockers without internal sympathomimetic activity: metoprolol, bisoprolol, propranolol, atenolol.
Lipid-lowering drugs
Beta-blockers (selective action)
- Metoprolol (Betalok ZOK, Corvitol, Egilok, Emzok) 50-200 mg 2 times a day.
- Atenolol (atenolan, tenormin) 50-200 mg 1-2 times a day.
- Bisoprolol (bisogamma, concor, concor cor) 10 mg / day.
- Betaxolol (betak) 10-20 mg / day.
- Pindolol (whisken) 2.5-7.5 mg 3 times a day.
- Nebivolol (nebilet) 2.5-5 mg / day.
- Carvedilol (acridilol, dilatrend, cardivas) - 25-50 mg 2 times a day.
calcium antagonists
1. Dihydropyridine
- Nifedipine
- moderately prolonged (adalat SL, cordaflex retard, corinfar retard) 30-100 mg/day; significantly prolonged (osmo-adalat, cordipin CL, nifecard CL) 30-120 mg / day.
- Amlodipine (Norvasc, Cardilopin, Normodipin, Kalchek, Amlovas, Vero-Amlodipine) 5-10 mg/day.
- Felodipine 5-10 mg/day.
- Isradipine 2.5-10 mg 2 times a day.
- Lacidipine 2-4 mg / day.
2. Non-dihydropyridine
- Diltiazem (Diltiazem-Teva, Diltiazem Lannacher) 120-320 mg/day.
- Verapamil (isoptin, lekoptin, finoptin) - 120-480 mg / day.
Nitrates and nitrate-like medicines
1. Preparations of nitroglycerin
- Short-acting (nitromint, nitrocor, nitrospray) 0.3-1.5 mg under the tongue for angina pectoris.
- Long acting(nitrong forte) 6.5-13 mg 2-4 times a day.
2. Preparations of isosorbide dinitrate
- Long-acting (cardiquet 40, cardiquet 60, cardiquet 120, iso Mac retard) 40-120 mg / day.
- Moderate duration of action (isolong, cardiket 20, iso Mac 20, nitrosorbide) 20-80 mg / day.
3. Preparations of isosorbide mononitrate
- Moderate action (monosan, monocinque) 40-120 mg / day.
- Long-acting (olicard retard, monocinque retard, pectrol, efox long) 40-240 mg / day.
4. Preparations of molsidomine
- Short-acting (Corvaton, Sydnopharm) 4-12 mg / day.
- Moderate duration of action (dilasid) 2-4 mg 2-3 times a day.
- Long-acting (dilasid retard) 8 mg 1-2 times a day.
Surgical treatment of coronary artery disease
The main indication for surgical treatment IHD is the persistence of severe angina (FC III-IV), despite intensive drug treatment. The indications and nature of surgical treatment are specified on the basis of the results of CAG and depend on the degree, prevalence and characteristics of coronary artery lesions.
Patients with frequent attacks of angina pectoris and insufficiency drug therapy or individuals with multiple risk factors, including a family history of sudden death, should have a coronary angiogram. If a narrowing of the main left trunk of the coronary artery is detected, changes in 3 coronary arteries, myocardial revascularization is indicated.
Myocardial revascularization includes
- Various types of TKA (transcutaneous angioplasty) with the installation of a metal frame - an endoprosthesis (stent), burning the plaque with a laser, destroying the plaque with a rapidly rotating drill and cutting the plaque with a special atherotomy catheter.
- Surgery for CABG to create an anastomosis between the aorta and the coronary artery below the site of narrowing to restore effective blood supply to the myocardium.
Currently, there is a certain trend towards bypassing the maximum possible number of coronary arteries using autoarteries. For this purpose, the internal mammary arteries, radial arteries, right gastroepiploic and inferior epigastric arteries are used. Venous transplants are also used.
Despite the quite satisfactory results of CABG, in 20-25% of patients angina pectoris returns within 8-10 years. Such patients are considered as candidates for reoperation. More often, the return of angina pectoris is due to the progression of coronary atherosclerosis and the defeat of autovenous shunts, which leads to stenosis and obliteration of their lumen. This process is especially susceptible to shunts in patients with risk factors: hypertension, diabetes mellitus, dyslipidemia (DLD), smoking, and obesity.
Clinical examination of patients with coronary artery disease
Patients with ischemic heart disease various types angina pectoris are subject to medical examination in cardiological centers or cardiological offices of the polyclinic for life.

For these purposes, all patients suffering from attacks of retrosternal pain should always have nitroglycerin with them.

It should be borne in mind that the first intake of nitroglycerin (especially in an upright position) can cause a decrease in blood pressure and fainting, so it is advisable to seat the patient. And if an attack of angina pectoris occurs in bed, on the contrary, it is necessary to sit down or stand up to reduce the load on the heart.

The same activities are carried out as first aid for coronary heart disease, manifested by the equivalents of angina pectoris - attacks of shortness of breath or severe weakness during exercise.

To alleviate the condition in the event of such complications of coronary heart disease as arrhythmias (sinus tachycardia, atrial fibrillation etc.), in order to slow down the heart rate, massage of the carotid sinus can be used. It is necessary to carry out the procedure very carefully, in the supine position, the neck is unbent.

Within five seconds, pressure is applied to the neck area, which is immediately under the angle of the lower jaw. Pressing is carried out strictly on one side. You can also apply short pressure to eyeballs.

First aid for coronary artery disease, complicated by myocardial infarction, consists in an urgent call for an ambulance. This must also be done if the attack of pain behind the sternum lasts more than five minutes, does not disappear within five minutes after the resorption of the nitroglycerin tablet, is accompanied by weakness, vomiting, and also if such an attack occurred for the first time.

It is also important to properly lay the patient: the head should be raised relative to the body. Under the tongue give a tablet of nitroglycerin. If available: a crushed aspirin tablet, analgin or baralgin, valocordin. It is also advisable to give the patient two tablets of panangin or other potassium preparations before the arrival of the ambulance.

Ischemic heart disease first aid

First aid for feverish conditions

In a feverish state, the patient feels weakness, muscle and headaches, frequent heartbeat; he is thrown into the cold, then into the heat with severe sweating.

A very high temperature may be accompanied by loss of consciousness and convulsions. When the body temperature is high, the so-called febrile state occurs. An increase in body temperature is a response to various infectious diseases, inflammatory processes, acute diseases various bodies, allergic reactions etc.

In febrile conditions, there are subfebrile temperature(not higher than 38°C), high (38–39°C), very high (above 39°C) - fever.

Provide the patient with rest and bed rest;

In case of strong heat, wipe the patient with a napkin dipped in slightly warm water, vodka;

Call the local therapist of the polyclinic to the patient, who will determine further treatment;

In case of a severe febrile condition (with convulsions, loss of consciousness, etc.), call an ambulance.

Coronary artery disease

Ischemic heart disease (CHD, coronary heart disease) is considered as ischemic myocardial damage due to oxygen deficiency with inadequate perfusion.

a) sudden coronary death;

Stable exertional angina;

Progressive angina pectoris;

Spontaneous (special) angina;

c) myocardial infarction:

Large focal (transmural, Q-infarction);

Small-focal (not Q-infarction);

d) postinfarction cardiosclerosis;

e) cardiac arrhythmias;

e) heart failure.

In the 1980s The concept of "risk factors" for cardiovascular disease associated with atherosclerosis has received the greatest recognition. Risk factors are not necessarily etiological. They may influence the development and course of atherosclerosis or may not exert their influence.

Atherosclerosis - This is a polyetiological disease of the arteries of the elastic and muscular-elastic type (large and medium caliber), manifested by infiltration of atherogenic lipoproteins into the vessel wall

with the subsequent development of connective tissue, atheromatous plaques and organ circulatory disorders.

Risk factors for cardiovascular disease can be divided into two groups: manageable and unmanageable.

Unmanaged risk factors:

Age (men > 45 years, women > 55 years);

Controlled risk factors:

Negative emotions, stress;

Gypsycholistriasis (LDL cholesterol> 4.1 mmol / l, as well as a reduced level of HDL cholesterol< 0,9).

angina pectoris paroxysmal pain in the chest (compression, squeezing, unpleasant sensation). The basis of the occurrence of an angina attack is hypoxia (ischemia) of the myocardium, which develops in conditions when the amount of blood flowing through the coronary arteries to the working heart muscle becomes insufficient, and the myocardium suddenly experiences oxygen starvation.

The main clinical symptom of the disease is pain localized in the center of the sternum (retrosternal pain), less often in the region of the heart. The nature of the pain is different; many patients feel pressure, constriction, burning, heaviness, and sometimes cutting or sharp pain. Pain is unusually intense and is often accompanied by a feeling of fear of death.

Characteristic and very important for diagnosis is the irradiation of pain in angina pectoris: to the left shoulder, left arm, left half of the neck and head, lower jaw, interscapular space, and sometimes to the right side or upper abdomen.

Pain occurs under certain conditions: when walking, especially fast, and other physical exertion (with physical exertion, the heart muscle needs a greater supply of blood nutrients, which can not be provided by narrowed arteries in atherosclerotic lesions).

The patient must stop, and then the pain stops. Especially typical for angina pectoris is the appearance of pain after the patient leaves a warm room in the cold, which is more often observed in autumn and winter, especially when atmospheric pressure changes.

With excitement, pains also appear out of connection with physical stress. Attacks of pain can occur at night, the patient wakes up from sharp pains, sits up in bed with a feeling not only of sharp pain, but also with the fear of death.

Sometimes retrosternal pain in angina pectoris is accompanied by headache, dizziness, vomiting.

angina pectoris- these are transient attacks of pain (compression, squeezing, discomfort) in the chest, at the height of physical or emotional stress due to increased metabolic needs of the myocardium (tachycardia, increased blood pressure). The duration of an attack is usually 5-10 minutes.

For the first time, exertional angina is isolated in a separate form within 4 weeks, and in elderly patients - within 6 weeks. It is classified as unstable.

Stable angina pectoris. After a certain period of adaptation (1–2 months), a functional restructuring of the coronary circulation occurs, and angina pectoris acquires a stable course with a constant ischemia threshold. The level of stress that causes an attack of angina pectoris is the most important criterion in determining the severity of coronary disease.

Progressive angina pectoris is a sudden change in the nature of the clinical manifestations of angina pectoris, the usual stereotype of pain under the influence of physical or emotional stress. At the same time, there is an increase and aggravation of seizures, a decrease in exercise tolerance, a decrease in the effect of taking nitroglycerin. Progressive angina pectoris is considered as one of the severe types of unstable angina (10-15% of cases end in myocardial infarction).

Among all variants of unstable angina, the most dangerous is rapidly progressing within hours and the first days from the onset of progression. Such cases are classified as acute coronary syndrome and patients are subject to emergency hospitalization.

Spontaneous (special) angina pectoris- attacks of pain in the chest (tightness, compression) that occur at rest, against the background of an unchanged myocardial oxygen demand (without an increase in heart rate and without an increase in blood pressure).

Criteria for the diagnosis of spontaneous angina:

a) angina attacks usually occur at rest at the same time (early morning hours);

b) elevation (total ischemia) or depression of the ST segment on the ECG recorded during an attack;

c) angiographic examination determines unchanged or slightly changed coronary arteries;

d) the introduction of ergonovine (ergometrine) or acetylcholine reproduce changes in the ECG;

e) p-blockers increase spasm and have a pro-ischemic effect (worse the clinical situation).

Treatment of angina pectoris and other forms of coronary heart disease is carried out in four main areas:

1) improvement of oxygen delivery to the myocardium;

2) reduced myocardial oxygen demand;

3) improvement of the rheological properties of blood;

4) improvement of metabolism in the heart muscle.

The first direction is more successfully implemented with the help of surgical methods of treatment. Subsequent referrals are due to drug therapy.

Among the large number of drugs used to treat angina pectoris, the main group stands out - antianginal drugs: nitrates, beta-blockers and calcium antagonists.

Nitrates increase the stroke volume of the ventricles, reduce platelet aggregation and improve microcirculation in the heart muscle. Among them, the following drugs can be distinguished: nitroglycerin (nitromint), sustak, nitrong, nitromac, nitroglanurong, isosorbide dinitrate (kardiket, kardiket-retard, isomak, isomak-retard, nitrosorbide, etc.), isosorbide 5-mononitrate (efox, efox -long, monomak-depot, olicard-retard, etc.). In order to improve microcirculation in the heart muscle, molsidomine (Corvaton) is prescribed.

Beta-blockers provide an antianginal effect, reducing the energy costs of the heart by reducing the rate of heart contractions, lowering blood pressure, negative inotron effect and inhibition of platelet aggregation. Thus, myocardial oxygen demand decreases. Among this large group of drugs, the following have recently been used:

a) non-selective - propranolol (anaprilin, obzidan), sotalol (sotacor), nadolol (korgard), timolol (blockarden), alprepalol (antin), oxpreialol (trazikor), pindolol (visken);

b) cardioselective - atenalol (tenormin), metoprolol (egilok), talinolol (cordanum), acebutalol (sectral), celiprolol;

c) β-blockers - labetalol (trandat), medroxalol, carvedilol, nebivolol (nebilet), celiprolol.

Calcium antagonists inhibit the intake of calcium ions inside, reduce the inotropic function of the myocardium, promote cardiodilatation, reduce blood pressure and heart rate, inhibit platelet aggregation, and have antioxidant and antiarrhythmic properties.

These include: verapamil (isoptin, finoptin), diltiazem (cardil, dilzem), nifedipine (cordaflex), nifedipine retard (cordaflx retard), amlodipine (normodipine, cardilopia).

Primary prevention of cardiovascular disease focuses on reducing atherogenic lipid levels through lifestyle changes. This is the restriction of the use of animal fats, weight loss, physical activity.

High serum cholesterol levels can be corrected by diet. It is recommended to limit the consumption of animal fats and include foods containing polyunsaturated fatty acids (vegetable oils, fish oil, nuts) in the diet. The diet should also include vitamins (fruits, vegetables), mineral salts and trace elements. To normalize the work of the intestines, it is necessary to add dietary fiber to food (products from wheat bran, oats, soybeans, etc.).

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Psychological installations for people sometimes do absolutely amazing things! Therefore, psychologists advise everyone to choose a positive thought, and then follow it throughout the day.

Tomography, according to scientists at the University of Ottawa, will help predict possible relapses after a stroke. These are minor strokes. The nuance is the relevance of tomography, it is necessary.

Arrhythmias. A person usually does not feel the beating of his heart, the appearance of arrhythmias is perceived as an interruption in his work.

Arrhythmia is a violation of the rhythm of cardiac activity caused by the pathology of the formation of excitation impulses and their conduction through the myocardium. Failure of the heart rhythm may be due to psycho-emotional arousal, disorders in the endocrine and nervous systems. Having arisen once, arrhythmias often recur, so their timely treatment is extremely important.

According to the nature of the manifestation and mechanisms of development, several types of arrhythmias are distinguished. Rendering emergency care first of all, paroxysmal tachycardia is required, which is possible both in young and in old age. The attack begins suddenly with a feeling of a strong push in the chest, pancreas, a “blow” in the heart, followed by a strong heartbeat, short-term dizziness, “blackout in the eyes” and a feeling of tightness in the chest.

Paroxysmal tachycardia usually develops as a result of acute coronary insufficiency and myocardial infarction, while the attack is often accompanied by pain behind the sternum or in the region of the heart. There are several forms of paroxysmal tachycardia. The usual medical examination of patients does not always allow them to be differentiated; this can be done only by the method of electrocardiological examination.

Symptoms. At the time of the attack, the pulsation of the patient's cervical veins attracts attention. The skin and mucous membranes are pale, slightly cyanotic. With a prolonged attack, the cyanosis intensifies. The number of heartbeats increases doraz per minute, the filling of the pulse is weaker. Blood pressure can be low, normal or high.

First aid. Any form of paroxysmal tachycardia requires emergency medical attention.

Before the arrival of the doctor, the patient should be laid down, and then use the methods of reflex action on the heart:

a) moderate (not painful) pressure with the ends of the thumbs on the eyeballs for 20 seconds;

b) pressure, also for 20 seconds, on the area of ​​the carotid sinus (muscles of the neck above the collarbones);

c) arbitrary breath holding;

d) taking antiarrhythmic drugs that previously relieved seizures (novocainamide, lidocaine, isoptin, obzidan).

Complete atrioventricular blockade is a violation of the conduction of an impulse from the atrium to the ventricles, resulting in their uncoordinated contractions. The causes of the disease are myocardial infarction, atherosclerosis of the heart vessels.

Symptoms. Dizziness, darkening of the eyes, severe pallor skin sometimes fainting and convulsions. Rare pulse - dobeats per minute. A further decrease in heart rate leads to death.

First aid. Providing the patient with complete rest. Oxygen therapy (oxygen pillow, oxygen inhaler, in their absence - provide access to fresh air). Urgently call an ambulance. If the condition worsens, the first aid provider conducts artificial respiration"Mouth to mouth", closed heart massage. Hospitalization in the cardiology department or intensive care unit of the cardiology department. Transportation on a stretcher in a prone position. The final treatment is not unsuccessfully carried out in the cardiology departments of hospitals, where modern antiarrhythmic drugs, methods of electrical impulse therapy and pacing are used.

In the prevention of arrhythmias, timely treatment of heart diseases, annual preventive examinations and dispensary observation are important. Physical hardening, optimal mode of work and rest, rational nutrition are necessary.

Hypertensive crises - an acute increase in blood pressure, accompanied by a number of neurovascular and autonomic disorders. It develops as a complication of hypertension.

What are the norms for blood pressure in adults?

The World Health Organization proposes to be guided by the following indicators: for persons of age, systolic pressure fluctuates within mm Hg. Art. and diastolic - no more than 89 mm Hg. Art.

Systolic pressure from 140 to 159 mm and diastolic - from 90 to 94 mm Hg. Art. considered to be transitional. If the systolic blood pressure is 160 mm Hg. Art. and above, and diastolic - 95 mm Hg. Art. this indicates the presence of a disease.

The complexity of the fight against arterial hypertension lies in the fact that about 40 percent of patients do not know about their disease. And only 10 percent of those who know and are treated in the clinic manage to reduce the pressure to normal numbers. Meanwhile, a sudden weakening of cardiac activity can cause excitation of the central nervous system which in turn raises blood pressure. That is why people with high blood pressure often experience hypertensive crises.

Symptoms. With arterial hypertension, there is a severe headache, dizziness, tinnitus, flickering of “flies” before the eyes, nausea, vomiting, palpitations, small tremors, chills, the face becomes covered with red spots. Arterial pressure is high - up to 220 mm Hg. Art. Pulse is frequent beats per minute. The crisis can last up to 6-8 hours and, in the absence of emergency medical assistance, be complicated by an acute violation of cerebral or coronary circulation, in some cases - pulmonary edema.

First aid. Urgently call a doctor. Before his arrival, provide the patient with complete rest. The position of the victim is semi-sitting. To lower blood pressure, previously prescribed antihypertensive (lowering pressure) agents are used: reserpine, dopegit, isobarine, tazepam, etc. Heating pads for the legs.

Prevention. Early detection and treatment of hypertension. Patients with high blood pressure are required to regularly take antihypertensive drugs prescribed by a doctor. They should strongly refrain from smoking and drinking alcohol, avoid psycho-emotional overload. It should also be taken into account that the majority of patients are adversely affected by night shift work and its fast pace, forced body position, frequent bending and lifting, very high and very low temperatures, food with fluid and salt restriction.

Ischemic heart disease is one of the most common diseases today, which is based on a violation of the blood circulation of the heart muscle. In a healthy person, there is complete harmony between myocardial oxygen demand and blood supply to the heart; the disease develops when this harmony is disturbed. Most often it occurs in people with so-called risk factors - smokers, sedentary lifestyles, alcohol abusers, overweight, suffering from hypertension. In older people, in addition, the disease is associated with sclerosis of the coronary vessels. Many experts pay attention to the prevalence of coronary disease also among people with certain character traits and lifestyles, for example, those who are characterized by dissatisfaction with what has been achieved, prolonged work overload, chronic lack of time.

Clinically, ischemic heart disease manifests itself most often in the form of myocardial infarction and angina pectoris.

Myocardial infarction - necrosis of a section of the heart muscle due to blockage of a coronary vessel by a thrombus. The main cause of the disease is atherosclerosis ( chronic illness arteries, leading to narrowing of the lumen of the vessel). In addition, metabolic disorders, strong nervous excitement, alcohol abuse, and smoking play an important role in the occurrence of heart attacks.

Every year, a heart attack claims thousands of lives; even more people are permanently deprived of the opportunity to fully work.

Symptoms. The disease begins with acute retrosternal pain, which takes on a protracted character, is not relieved by either validol or nitroglycerin. (Painless forms of myocardial infarction are often observed.)

Pain is given to the shoulder, neck, lower jaw. In severe cases, there is a feeling of fear. Cardiogenic shock develops (it is characterized by cold sweat, pallor of the skin, weakness, low blood pressure), shortness of breath. The heart rhythm is disturbed, the pulse is quickened or slowed down.

First aid. Urgently call a doctor. The patient is provided with complete physical and mental rest and takes measures aimed at stopping the pain syndrome (nitroglycerin under the tongue, mustard plasters on the heart area, oxygen inhalation).

In the acute stage of myocardial infarction, clinical death may occur.

Since its main signs are cardiac arrest and respiration, then revitalization measures should be aimed at maintaining the function of respiration and blood circulation by means of artificial ventilation of the lungs and closed heart massage. Recall the technique for their implementation.

Artificial ventilation of the lungs. The patient is placed on his back. The mouth and nose are covered with a scarf. The caregiver kneels down, supports the patient with one hand, puts the other on his forehead and throws his head back as much as possible; takes a deep breath, tightly pinches the victim's nose, and then presses his lips to his lips and blows air into the lungs with force until the chest begins to rise. 16 such injections are made per minute.

Closed heart massage. After one injection, 4-5 pressures are produced. To do this, they feel for the lower end of the sternum, put the left palm two fingers above it, and the right palm on it and rhythmically squeeze the chest, producing pressure per minute.

Resuscitation measures are carried out until the appearance of a pulse and spontaneous breathing or until the arrival of an ambulance.

Angina occurs as a result of spasm of the coronary arteries, the causes of which may be atherosclerosis of the heart vessels, excessive mental and physical stress.

Symptoms. A severe attack of retrosternal pain radiating to the shoulder blade, left shoulder, half of the neck. The patient's breathing is difficult, the pulse is quickened, the face is pale, sticky cold sweat appears on the forehead. The duration of the attack dominut. Protracted angina often turns into myocardial infarction.

First aid. Urgently call a doctor. The patient is provided with complete physical and mental rest. To relieve pain, they resort to nitroglycerin or validol (one tablet with an interval of 5 minutes). Do oxygen inhalation. On the region of the heart - mustard plasters.

Prevention of coronary heart disease. Knowledge of risk factors is the basis of its prevention. An important role is played by the nutritional regime - limiting the calorie content of food, the exclusion of alcoholic beverages. Recommended four meals a day, including vegetables, fruits, cottage cheese, lean meat, fish. In the presence of excess weight, a diet prescribed by a doctor is indicated. Required physical exercise, walking, hiking trips. You need to strongly stop smoking. Rational organization of labor, education of tact and respect for each other are also important means of prevention. We should not forget about timely treatment chronic cardiovascular diseases (heart defects, rheumatism, myocarditis, hypertension), leading to coronary heart disease.

Tags: Heart disease, arrhythmia, complete atrioventricular block, blood pressure, myocardial infarction, coronary heart disease, angina pectoris, first aid, prevention

Emergency care for an attack of angina pectoris

An attack of angina pectoris can be considered a pre-infarction condition, and that is why help with severe heart pain should be provided immediately and correctly. Coordinated actions in such situations can greatly alleviate the patient's condition and prevent the development of severe complications. In everyday life, everyone can face a situation where emergency care is needed. close person, neighbor, colleague or just a stranger on the street. In this case, it is extremely important to know by what signs to recognize an angina attack, and how to alleviate the patient's condition.

Cardialgia (pain) in angina pectoris develops against the background of a lack of oxygen in the myocardium, provoked by ischemia (i.e., insufficient blood supply to the muscle fibers due to narrowing of the coronary vessels). Oxygen deficiency in the heart muscle is especially noticeable during physical and psycho-emotional stress, since it is in these states that the need for it increases significantly. Due to insufficient nutrition of the myocardium, lactic acid accumulates in it, which provokes pain.

Signs of an angina attack

Signs of an attack of angina pectoris are few, but quite characteristic and in most cases they are rarely confused with other diseases. The main symptom of this condition is a sudden onset of pain behind the sternum or to the left of the sternum, which appears after physical or psycho-emotional stress, hypothermia, and sometimes even at rest. The most common causes of an attack are brisk walking (especially in hot, cold, or windy weather), climbing stairs, and overeating. In the later stages of coronary heart disease, an angina attack can also develop during sleep or against the background of absolute rest.

Cardialgia has a pressing or burning character, and in most patients its irradiation (reflection) is observed in the left half of the body (arm, shoulder blade, stomach area, throat, cervical vertebrae, lower jaw). Sometimes the pain may radiate to the right arm. In the prone position, cardialgia increases.

Patients describe the nature of pain during an angina pectoris attack in different ways:

The duration of pain is about 5 minutes (rarely about 15-20). As a rule, after the elimination of the cause provoking it (physical activity, cold, stress), it can pass on its own or disappear 2-3 minutes after taking a Nitroglycerin tablet.

Cardialgia with angina pectoris is often accompanied by a marked anxiety of the patient or fear of death. During an angina attack, a patient may experience:

• nausea and vomiting;
• pallor;
• sweating;
• dizziness;
• belching or heartburn;
• difficulty breathing or shortness of breath;
• palpitations and increased heart rate;
• rise in blood pressure;
• numbness and cold extremities.

Signs of atypical angina attacks

In some cases, an attack of angina occurs atypically or is not accompanied by cardialgia. Such types of this disease greatly complicate their recognition.

In some patients, pain in the heart is completely absent and is felt only in areas of its typical irradiation:

• in the shoulder blades (right or left);
• in IV and V fingers of the left hand;
• in the left or right hand;
• in the cervical vertebrae;
• in the lower jaw;
• in the teeth;
• in the larynx or pharynx;
• in the ear;
• in the area of ​​the upper abdomen.

In some patients, an attack of angina pectoris begins with numbness of the IV and V fingers of the left hand and a sharp muscle weakness of the upper limb. After a while, they develop cardialgia and other signs of angina pectoris.

Often, patients describe an angina attack as shortness of breath, sharply limiting physical activity and occurring on inhalation and exhalation. This condition may be accompanied by a cough that gets worse when you try to move.

In some patients, an attack of angina pectoris can proceed according to the collaptoid variant. With such a course, the patient's blood pressure drops sharply, dizziness, nausea and severe weakness appear.

An attack of angina pectoris can be felt by episodes of arrhythmia that occurs at the peak of physical activity. Such arrhythmias are stopped by taking Nitroglycerin.

In rare cases, an attack of angina is not accompanied by pain. In such cases, myocardial ischemia manifests itself as a sharp weakness or shortness of breath, which are caused by low contractility of the heart or incomplete relaxation of the myocardium.

All atypical forms of angina pectoris are more often observed in patients with diabetes, heart failure, after myocardial infarction or in elderly patients. The symptoms accompanying such forms of myocardial ischemia are eliminated after the cessation of physical or emotional stress and the intake of Nitroglycerin.

First aid

Most often, pain in the environment with angina appears during walking or other physical activity. In such cases, the patient should immediately stop moving and take a comfortable sitting position. When cardialgia appears during sleep, you need to sit in bed and lower your legs down.

During an attack of angina pectoris, it is forbidden to stand up, walk and perform any activities associated with physical activity. The patient needs to provide an influx of fresh air, remove clothing that restricts breathing, and ensure the most comfortable temperature regime.

A person experiencing cardialgia should take a Nitroglycerin or Nitrolingval tablet under the tongue. Also, to eliminate an attack of angina pectoris, drugs in the form of sprays can be used: Isoket or Nitrominat. They are injected under the tongue, and one injection is one dose of the drug. After taking these nitrate drugs, the patient can be offered to take one crushed tablet of Aspirin, and in the presence of signs of emotional arousal, Corvalol or Valocardin.

It is recommended to call an ambulance for an attack of angina pectoris in such situations:

• an attack of angina pectoris happened for the first time;
• the nature of the attack has changed (it has become longer, the pains are more intense, shortness of breath, vomiting, etc. have appeared);
• cardialgia was not eliminated by taking Nitroglycerin tablets;
• heart pain intensifies.

For faster relief of an angina attack after taking the above drugs, it is recommended to carry out a light massage (or self-massage) of the face, neck, nape, shoulders, wrists, left half of the chest and knee joints. Such actions will allow the patient to relax and eliminate tension.

Often an attack of angina pectoris is accompanied by a severe headache. To eliminate it, the patient can take a non-narcotic analgesic tablet (Baralgin, Spazmalgon, Analgin, Sedalgin).

After carrying out such events, it is necessary to count the pulse and measure blood pressure. With severe tachycardia (more than 110 beats per minute), the patient needs to take 1-2 tablets of Anaprilin, and with a pronounced rise in blood pressure, 1 tablet of Clonidine (under the tongue).

Pain in the heart after taking Nitroglycerin or other nitrate drugs should be eliminated after 2-3 minutes, in the absence of such an effect, the patient must repeat taking one of the drugs. During one attack, the patient can be given no more than three tablets of Nitroglycerin and Nitrolingval or no more than three injections of Isoket or Nitrominate.

Usually, after the measures taken, an angina pectoris attack is eliminated after 2-5 (less often 10) minutes. In the presence of cardialgia for 15 minutes after taking Nitroglycerin, it is urgent to call an ambulance, because this condition of the patient can lead to the development of myocardial infarction.

If an attack of angina pectoris was eliminated on its own, then the patient is advised to limit any physical or emotional stress, observe bed rest and call a doctor.

In what cases is Nitroglycerin contraindicated during an angina attack?

The patient or his relatives should be aware that if signs of low blood pressure are detected (with a collaptoid course of angina pectoris), taking drugs from the group of organic nitrates (Nitroglycerin, Isoket, etc.) is contraindicated. The following signs can indicate hypotension:

• the patient experiences severe weakness;
• dizziness;
• pallor;
• cold sweat.

In such cases, the sequence of actions should be as follows:

1. Lay down the patient.
2. Call an ambulance.
3. Let him take a crushed aspirin.
4. To reduce pain, you can use tablet analgesics (Baralgin, Sedalgin, etc.).

Emergency care for a prolonged attack of angina pectoris

Emergency care for a prolonged attack of angina pectoris can only be provided by a doctor.

If necessary, Nitroglycerin is repeated (1-2 tablets under the tongue) followed by intravenous jet administration of non-narcotic analgesics (Baralgin, Maksigan, Analgin) with 50 ml of 5% glucose solution. To enhance the analgesic effect and provide sedative effect antihistamines (Pipolfen, Diphenhydramine) or tranquilizers (Seduxen, Relanium) can be used.

In the absence of anesthesia, the patient is administered narcotic analgesics (Promedol, Morphine hydrochloride, Omnopon) in combination with Droperidol or a tranquilizer. Neuroleptanalgesia can also be used to relieve heart pain ( intravenous administration Talomonal or a mixture of Fentanyl and Droperidol).

With a pronounced decrease in blood pressure, which often occurs after taking drugs from the group of organic nitrates (Nitroglycerin, Isoket, etc.), the patient is administered a Polyglucin solution (intravenously, drops per minute). In the absence of effect, the introduction of 0.2 ml of a 1% Mezaton solution may be recommended.

When stopping an attack of angina pectoris that occurs against the background of a persistent rise in blood pressure, antihypertensive and vasodilator agents (Dibazol, Papaverine, Platifillin, etc.) can be used.

After stabilization of the patient's condition, who brought an attack of angina pectoris, he is recommended to undergo a dynamic electrocardiographic examination and a number of other diagnostic procedures. Based on the data obtained, the doctor will be able to prescribe him further treatment for coronary heart disease.

How to help with an attack of angina pectoris. The cardiologist V. A. Abduvalieva tells

1. First aid for angina pectoris

An attack of angina pectoris is a rather serious manifestation of the disease, which requires urgent care. During an attack, a person is recommended to resort to the following assistance algorithm:

1. Create complete rest to reduce the load on the heart.
2. If a quiet environment does not help, you should take a nitroglycerin tablet, putting it under the tongue. Usually 1-2 tablets are enough, and in severe cases, tablets will be enough.
3. If the attack does not go away, the patient should lie down, raise his head, unbutton the collar of his clothes, loosen the belt on his trousers and make a few breathing movements. By opening windows and doors, it is necessary to provide fresh air to the room, as well as attach warm heating pads to the legs.
4. During an attack, a person is very worried about fear for his life, so you should take some kind of sedative, such as seduxen or valerian. Usually all these measures are enough to eliminate even the most severe attack.

If the angina attack does not stop, the pain does not go away, and repeated administration of nitroglycerin does not work within 15 minutes, an ambulance should be called.

Nitroglycerin is one of the most effective medicines that quickly relieves a heart attack.

It reduces the cardiac demand for oxygen, improving its delivery to the affected areas of the myocardium, increasing the contractility of the heart muscle and eliminating spasm in the coronary arteries. Anesthesia with nitroglycerin occurs quickly, and after 45 minutes the drug is excreted from the body.

The following forms of nitroglycerin are usually consumed: tablets, capsules or drops.

The drug is taken as follows: one tablet or capsule of nitroglycerin is placed under the tongue without swallowing. The medicine gradually dissolves and after a minute or two comes the analgesic effect.

In the case of drops, 2-3 drops of nitroglycerin solution are dripped onto a sugar cube and placed under the tongue. Do not swallow, but wait until it resolves. You can do without sugar by dropping 3 drops of the drug on or under the tongue.

If nitroglycerin is not well tolerated, drops containing nitroglycerin, tincture of lily of the valley, menthol and belladonna are used. This combination is well tolerated by patients, as menthol reduces pain from nitroglycerin. At one time, a drop of tincture is used.

If there is a tendency to heart disease, including angina pectoris, in order to prevent a heart attack, it is recommended to take nitroglycerin: before emotional or physical exertion, before climbing stairs or uphill, a few minutes before going out in windy and frosty weather, with the appearance of severe paroxysmal shortness of breath . In other cases, nitroglycerin is not recommended.

In the event that after the use of nitroglycerin there is pain in the head, the medicine should be taken in small doses (half a tablet or 1/3), gradually increasing the dose.

Nitroglycerin has no analogue. It has an antianginal and analgesic effect, helps to lower blood pressure. Therefore, one should be very careful for those who have a tendency to its sharp decline. The drug can cause headache, weakness and dizziness.

You can not endure pain in the heart, nitroglycerin should be taken as quickly as possible for as long as necessary. It is more difficult to stop the protracted pain, which threatens with a serious complication. Also, it should not be taken unless absolutely necessary. Especially in the case of self-stopping of a heart attack - when it itself passes at rest in 1-2 minutes. It should always be at hand.

Special care should be taken when taking natroglycerin if a person has glaucoma or has had acute disorder cerebral circulation. In such cases, a detailed consultation with a doctor is necessary.

If there is no nitroglycerin in the home medicine cabinet, Corinfar, Cordafen, or Fenigidin can be taken under the tongue instead. The effect can be noticed after 3-5 minutes, and the duration of action of such drugs is up to 5 hours.

After the end of a heart attack, you should not immediately get out of bed, but it is better to lie down for 1-2 hours, observing complete physical and psychological calmness. If an ambulance was not called, it is better to ask your local doctor for help and, until he arrives, observe a home regimen, avoiding complete physical and emotional stress.

Drugs such as validol, valocarmid or valocordin are less effective in such cases. Although they can cause a favorable background to facilitate the effects of other drugs.

Video

See in the video how to provide first aid for an attack of angina pectoris:

Emergency care for angina pectoris

Angina pectoris is the most common form of coronary heart disease (CHD). The high-risk group for sudden death and myocardial infarction is primarily patients with angina pectoris. Therefore, it is necessary to quickly establish a diagnosis and provide emergency care for a protracted attack of angina pectoris. Emergency diagnosis of an angina attack is based on the patient's complaints, anamnesis data, and to a much lesser extent on ECG data, since in a large percentage of cases the electrocardiogram remains normal. In most cases, taking into account the nature, duration, localization, irradiation, conditions for the onset and cessation of pain, it is possible to establish its coronary origin.

The duration of an anginal attack with angina is most often min, less often - up to 10 minutes. It usually stops after the cessation of physical activity or the intake of nitroglycerin by the patient. If the pain attack lasts more than 15 minutes, then the intervention of a doctor is required, since a prolonged attack of angina pectoris can lead to the development of acute myocardial infarction.

The sequence of measures for a prolonged attack of angina pectoris:

nitroglycerin tablets under the tongue, simultaneously injected intravenously in 20 ml of a 5% glucose solution non-narcotic analgesics(analginml 50% solution, baralgin - 5 ml, maxigan - 5 ml) in combination with small tranquilizers (seduxenml) or antihistamines (diphenhydramine 1 % solution), enhancing the analgesic effect and having a sedative effect. At the same time, the patient takes 0.2-0.5 g of acetylsalicylic acid, preferably in the form effervescent tablet(for example, anapirin).

If the pain syndrome is not relieved within 5 minutes, then immediately proceed to the intravenous administration of narcotic analgesics (morphine hydrochloride ml 1% solution, promedol ml 1% solution, etc.) in combination with tranquilizers or the neuroleptic droperidol (2-4 ml 0.25 % solution). The most powerful effect is provided by neuroleptanalgesia (narcotic analgesic fentanyl ml 0.005% solution in combination with droperidol ml 0.25% solution).

After stopping an anginal attack, an ECG should be done to exclude acute myocardial infarction.

Emergency care for myocardial infarction

Myocardial infarction is an ischemic necrosis of a section of the heart muscle, resulting from an acute discrepancy between myocardial oxygen demand and its delivery through the coronary vessels. This is the most severe manifestation of coronary artery disease, requiring emergency care for the patient. The emergency diagnosis of myocardial infarction is based on clinical picture, the leading one in which is severe pain syndrome, and ECG data. Physical examination does not reveal any reliable diagnostic features, and changes in laboratory data usually appear after a few hours from the onset of the disease. As with angina pectoris, pain occurs behind the sternum, radiates to the left arm, neck, jaw, epigastric region, but, unlike angina pectoris, the attack lasts up to several hours. Nitroglycerin does not give a lasting effect or does not work at all. In atypical cases, pain may be mild, localized only in places of irradiation (especially in the epigastric region), accompanied by nausea, vomiting, or absent altogether (painless myocardial infarction). Sometimes, already at the onset of the disease, complications (cardiac arrhythmias, cardiogenic shock, acute heart failure) come to the fore in the clinical picture. In these situations, the ECG plays a decisive role in the diagnosis. The pathognomonic signs of myocardial infarction are arcuate elevation of the segment S-T above the isoline, formation of a monophasic curve, pathological tooth Q. In clinical practice, there are forms of myocardial infarction without changes segment S-T and Q wave.

Emergency care for myocardial infarction begins with the immediate relief of anginal status. Pain not only delivers the most severe subjective sensations, leads to an increase in the load on the myocardium, but can also serve as a trigger for the development of such a formidable complication as cardiogenic shock. Anginal status requires immediate intravenous administration of narcotic analgesics in combination with antipsychotics and tranquilizers, since conventional analgesics are ineffective.

If less than 6 hours have passed since the onset of myocardial infarction, intravenous administration of Actilyse is very effective. This drug promotes thrombus lysis.

Combinations of drugs used in the treatment of pain syndrome in acute myocardial infarction:

Drugs are recommended to be administered intravenously slowly. They are preliminarily diluted in 5-10 ml of isotonic sodium chloride solution or 5% glucose solution. Until the pain syndrome is completely relieved, which often requires repeated administration of analgesics, the doctor cannot consider his task completed. Other therapeutic measures that are carried out simultaneously or immediately after pain relief should be aimed at eliminating emerging complications (rhythm disturbances, cardiac asthma, cardiogenic shock). In uncomplicated myocardial infarction, drugs are prescribed that limit the zone of necrosis (nitrates, beta-blockers, thrombolytics).

Main symptoms

To understand which algorithm should be followed in an emergency, you need to clearly know all the symptoms and possible manifestations of angina pectoris.

The most typical symptom is pain. It has a number of distinctive characteristics:

In addition to pain, symptoms of an angina attack include:

In addition, angina may be accompanied by atypical symptoms (stomach pain, arrhythmia, neurological disorders). Then the first aid algorithm also changes. In this case, an ischemic history can help to understand. That is, if a patient has suffered from angina pectoris in the past or suffered a heart attack, then a recurrence of an attack is likely. If the patient has a healthy heart, then it is necessary to look for other causes of poor health (stroke, stomach ulcer, etc.).

emergency medicines

First aid for angina pectoris can be provided using various medications that are probably in the first aid kit of a patient with coronary heart disease.

Nitroglycerin is the drug of choice and comes first in the emergency action algorithm. For an emergency, tablets, capsules or spray are suitable. In order for the drug to begin to act as quickly as possible, it is placed in the sublingual region to help the patient. Due to the high permeability of the vein wall, the drug almost instantly enters the systemic circulation and begins to act.

This medicine dilates the coronary arteries and also affects other vessels in the body. As a result, oxygen delivery to myocardial cells improves and the patient's condition improves significantly. In addition, this drug helps to stop hypertensive crisis, which is often a provoking factor in angina pectoris.

When providing emergency care to patients using nitroglycerin, Special attention pay attention to blood pressure. In the event that the pressure in a patient with an angina attack is less than 90/60 mm Hg, nitroglycerin should not be used. This is due to the fact that by dilating the vessels, it leads to even more pronounced hypotension. As a result, blood flow through the coronary arteries becomes even worse and the risk of developing myocardial infarction increases significantly.

Other drugs that are included in the emergency care algorithm for patients with angina pectoris are:

The general principle of emergency care is the use of only drugs with a short interval of action. This is due to the fact that with heart disease the situation changes very quickly and it happens that hypertension and tachycardia are replaced by a decrease in pressure and pulse.

Other techniques

First aid for angina includes other techniques. In this case, the algorithm of actions is approximately the following:

In parallel, it is necessary to use various medicines that are at hand.

Correctly performed emergency first aid with an attack of angina pectoris, it often saves the patient's life and prevents the development of a heart attack.

First aid for coronary heart disease

The main pathogenetic factors of IHD are:

• organic stenosis of the coronary arteries caused by their atherosclerotic lesions;
• spasm of the coronary vessels, usually combined with atherosclerotic changes in them (dynamic stenosis);
• the appearance in the blood of transient platelet aggregates (due to an imbalance between prostacyclin, which has a pronounced antiaggregatory activity, and thromboxane, a powerful vasoconstrictor and stimulator of platelet aggregation).

Ischemic myocardial lesions of a different origin (rheumatism, periarteritis nodosa, septic endocarditis, heart trauma, heart defects, etc.) do not belong to IHD and are considered as secondary syndromes within the specified nosological forms.

Sudden death (primary cardiac arrest)

• the patient is placed on his back without a pillow on a hard base;
• check for a pulse on the carotid or femoral artery;
• upon detection of cardiac arrest, they immediately begin external cardiac massage and artificial respiration.

Resuscitation begins with a single punch to the middle part of the sternum (Fig. 1, a). Then, they immediately begin an indirect heart massage with a frequency of compressions of at least 80 per minute and artificial ventilation of the lungs (“mouth to mouth”) in a ratio of 5:1 (Fig. 1, b). If large-wave fibrillation is recorded on the ECG (amplitude of complexes above 10 mm) or ventricular flutter, an EIT with a power of 6-7 kW is performed, with small-wave fibrillation it is injected into the subclavian vein (the intracardiac route of administration is dangerous and undesirable) 1 ml of a 0.1% solution of adrenaline hydrochloride (through 2-5 minutes, repeated injections are possible up to a total dose of 5-6 ml), 1 ml of a 0.1% solution of atropine sulfate, mg of prednisolone, followed by EIT.

Rice. 1, a - the beginning of resuscitation: a single punch on the middle part of the sternum; b - indirect heart massage and artificial ventilation of the lungs ("mouth to mouth")

The criteria for the effectiveness of resuscitation measures are:

• constriction of the pupils with the appearance of their reaction to light;
• the appearance of a pulse on the carotid and femoral arteries;
• determination of the maximum arterial pressure at the level of Hg. Art.;
• reduction of pallor and cyanosis;
• sometimes - the appearance of independent respiratory movements.

After restoration of a hemodynamically significant spontaneous rhythm, 200 ml of a 2-3% sodium bicarbonate solution (Trisol, Trisbufer) 1-1.5 g of diluted potassium chloride or 20 ml of panangin in a stream, 100 mg of lidocaine in a stream (then drip at a rate of 4 mg / min), 10 ml of a 20% solution of sodium hydroxybutyrate or 2 ml of a 0.5% solution of seduxen in a jet. In case of an overdose of calcium antagonists - hypocalcemia and hyperkalemia - 2 ml of a 10% solution of calcium chloride is administered intravenously.

Rice. 2. The main provisions used for transporting the sick and injured on the shield and stretcher:

a - if a fracture of the spine is suspected (consciousness is preserved); b, c - craniocerebral injury (b - consciousness is preserved, there are no signs of shock, c - an inclined position with the end lowered by no more than); d, e - for victims with the threat of developing acute blood loss or shock, as well as in the presence of them (d - the head is lowered, the legs are raised to; e - the legs are bent in the form of a penknife); e - injuries or acute diseases of the chest, accompanied by acute respiratory failure; g - damage to organs abdominal cavity and pelvis, fractures of the pelvic bones, diseases of the abdominal and pelvic organs; h - wounds maxillofacial area complicated by bleeding; and - lateral stable position for transporting casualties who have lost consciousness

In the presence of risk factors for sudden death (see above), the introduction of lidocaine (mg intravenously. mg intramuscularly) in combination with ornid (mg intramuscularly) is recommended; with a decrease in blood pressure - 30 mg of prednisolone intravenously.

Ischemic heart disease is a disease in which there is insufficient supply of oxygen to the heart muscle. As a rule, this disease develops against the background of circulatory disorders of the heart. Suffice it to mention that 97% of cases of ischemic processes in the heart are caused by narrowing of the lumen of the coronary vessels caused by atherosclerosis. Myocardial infarction occupies a leading position among sudden deaths. Also, coronary heart disease is one of the main diseases leading to persistent disability of the population and a significant decrease in the quality of life.

Risk Factors for Coronary Heart Disease

Poor diet leading to obesity. This factor leads to an increase in total body weight, and accordingly, the volume of circulating blood also increases, because the heart is forced to work in an enhanced mode. Also, malnutrition can be the cause of atherosclerosis. The deposition of fats in the wall of the vessel with the formation of cholesterol plaques in the lumen of the coronary vessel creates an obstacle to the flow of blood, leading to a decrease in the rate of delivery of oxygen and nutrients to the heart muscle.

Psycho-emotional stress. Have you noticed that with psycho-emotional stress, stress, the heart begins to beat more often, and overall well-being worsens. What's happening? The release of adrenaline and adrenal hormones lead to the activation of the heart and vasoconstriction. And this is a double burden on the heart - not only is the heart forced to work in an enhanced mode, but also the narrowed vessels increase systemic arterial pressure, which leads to the fact that in order to release blood into the aorta, the heart has to overcome this increased pressure in the vascular system.

Bad habits. Alcoholism, smoking, drug use. These bad habits lead to the fact that the heart has to work in the conditions of the toxic effects of the drugs taken. harmful substances. In addition, smoking, alcohol and many drugs contribute to an artificial increase in heart rate, which leads to accelerated wear of the heart muscle.


Internal factors

Hypertonic disease(high blood pressure) at times increases the likelihood of developing coronary heart disease. The reason for this is that with hypertension, the heart works at an increased load (it is necessary to overcome the increased pressure in the aorta), blood circulation in the heart itself is disturbed. Sudden changes in blood pressure can lead to a heart attack or angina.

Violation of fat metabolism. The fact is that most of the cholesterol is produced in our body, therefore, a violation of the processes of formation of fats and their metabolism in the body can lead to atherosclerosis and circulatory disorders in the heart muscle.

Violation of carbohydrate metabolism. It is more often manifested by metabolic syndrome or diabetes mellitus. With a prolonged increase in blood sugar levels, the smallest vessels are affected, their wall thickens, which leads to the fact that the passage of oxygen and nutrients to muscle cells through it becomes more difficult. At the same time, ischemia develops (discrepancy between the needs and delivery of oxygen to the tissues).

Congenital or acquired heart defects. Often, heart defects cause the heart muscle to work in an enhanced mode, which requires a constant influx of a large amount of blood.
Manifestations of Coronary Heart Disease (CHD): angina pectoris, myocardial infarction, heart failure, arrhythmia.

angina pectoris

Symptoms of angina pectoris

1. Pain, sharp, pronounced, paralyzing, felt on the left behind the sternum and often radiates to left shoulder blade, left arm and lower jaw on the left. Pain makes you take a forced position, press the area of ​​pain localization with your hand and sharply reduce physical activity. The pain may come on suddenly, or it may increase over a short period of time. As a rule, the appearance of pain is preceded by provoking factors: physical activity, psycho-emotional stress or stress, plentiful food, sex, a sharp change in air temperature or body cooling, smoking.
2. Dyspnea
3. From clinical symptoms characteristic: heart palpitations, high or low blood pressure.
4. Taking nitroglycerin reduces and gradually eliminates soreness over several minutes (1-3 minutes). If nitroglycerin did not eliminate the pain, then this may indicate that. That the pain is not caused by angina pectoris or a myocardial infarction has occurred and an urgent need is required medical care(for this you need to call an ambulance team).

Causes of cardiac ischemia, angina attacks, heart attack and arrhythmias

Spasm of the coronary arteries- the vessels of the heart have their own muscular membrane, which regulates the lumen of the vessel itself. In some cases, there is a narrowing of the coronary vessels: morning hours, the transition from a warm room to a cold one with the inhalation of cold air, a sharp cooling of the skin or hypothermia of the whole body, emotional stress, the use of certain medications.

Thromboembolism of the coronary vessels c – the formation of a thrombus in the lumen of a coronary vessel occurs, as a rule, during the disintegration of an atherosclerotic plaque. As a result of its destruction, the collagen frame of the vessel is exposed, which is the starting factor in thrombosis. There is also a possibility of blockage of the vessel by a thrombus (formed in the cavity of the heart or on the valves aortic valve) or another dense body (vegetation or part of the heart valve in endocarditis) circulating in the blood and formed in another part of the cardiovascular system.

Types of angina, exertional angina, spontaneous angina.

angina pectoris
This form of angina is characterized by the appearance of symptoms of cardiac ischemia in response to an increase in the load on the heart (increased blood pressure, exercise, stress). There are various forms of exertional angina: first-time exertional angina, stable exertional angina, and progressive exertional angina. These forms can pass one into another, which will indicate a favorable or unfavorable evolution of the disease. With any form of angina, myocardial infarction can develop.

New onset angina pectoris
A period of one month from the onset of angina pectoris. In the debut of the disease, symptoms such as soreness, shortness of breath, palpitations are revealed. As a rule, the first attack of angina resolves on its own and does not require the use of nitroglycerin. In this condition, it is necessary to seek help from a cardiologist as soon as possible. Adequately prescribed treatment and compliance with all medical recommendations will help you forget and never feel angina again. If the cure did not occur and in the future there were recurrences of angina attacks, there is already Stable exertional angina.

Stable exertional angina
Regularly recurring angina attacks in response to an increased load on the heart muscle. As a rule, the attacks are short-lived and stop when the load on the heart is removed or when nitroglycerin is taken. The duration of the pain attack can vary within 2-10 minutes.
This type of angina, depending on the tolerance of physical activity, is divided into classes:

I class- heart pains appear only with increased physical exertion (fast running, weight lifting).

II class- pain occurs with moderate exertion: walking more than 500 meters without stopping, climbing the stairs to the 6th-7th floor without stopping. Also, this class is characterized by the appearance of pain during emotional stress, inhalation of cold air, in the morning.

III class- soreness in the sternum occurs when walking a distance of 100-500 meters. When going up one floor. Therefore, such patients are forced to limit their physical activity to movements around the house.

IV class- soreness in the region of the heart can also occur at rest, when walking at a distance of not less than 100 meters.
Even to climb one floor, such a patient needs to make several stops.

progressive exertional angina
With this form, there is a gradual increase in the frequency and duration of angina attacks against the background of a stable level of physical activity, the level blood pressure and psychological stress. With this form of the disease, the effectiveness of relieving soreness by taking nitroglycerin is reduced.

Spontaneous angina
With this form of coronary heart disease, angina attacks are not caused by an increase in the load on the heart muscle, but occurs spontaneously. As a rule, the attacks are longer, worse eliminated by nitroglycerin. This form of angina often leads to myocardial infarction and is less treatable.

Treatment of angina pectoris

At the very attack of angina pectoris, treatment is carried out with nitroglycerin preparations, as well as medicines from the group of beta-blockers and calcium channel blockers.

Preparations with nitroglycerin dilates the coronary vessels, increasing blood flow to the heart muscle.

Beta blockers optimize the work of the heart in conditions of ischemia .

Calcium channel blockers also contribute to the expansion of blood vessels of the heart .
If the drug treatment has not led to the desired effect and there is a progression of angina pectoris, then it is possible to use surgical tactics of treatment.
Drug treatment is prescribed by a cardiologist. It is desirable that one specialist is engaged in your treatment - this will allow him to track the dynamics of the process. As a rule, of all the group of drugs, those are prescribed that have the most pronounced therapeutic effect and are well tolerated by patients.

Coronary bypass - an operation in which additional pathways for the transit of blood are created to bypass the stenotic vessel. Thanks to this operation, it is possible to save the patient from angina pectoris for a long time, improve the quality of life. However, this operation is quite traumatic and requires large financial costs.

Angioplasty - allows using a special catheter to reach the site of occlusion of the vessel, when air is injected into the catheter balloon, the latter is inflated, leading to a mechanical expansion of the narrowed section of the coronary vessel.

Myocardial infarction, symptoms, first aid for a heart attack, diagnosis of a heart attack, after a heart attack.

Heart attack symptoms

• Pain, sharp, pronounced, paralyzing, felt on the left behind the sternum and often radiates to the left shoulder blade, left arm and lower jaw on the left. Pain makes you take a forced position, press the area of ​​pain localization with your hand and sharply reduce physical activity. The pain may come on suddenly, or it may increase over a short period of time. Over time (within 30 minutes), the soreness not only does not subside, but can also intensify against the background of the lack of adequate treatment.
• Dyspnea- a feeling of lack of air. At the same time, an attempt to take a deep breath exacerbates soreness in the sternum, which makes it impossible. The patient breathes with an open mouth, feels a lack of oxygen up to suffocation.
• Lowering blood pressure. Of the clinical symptoms are characteristic: Blood pressure often drops to low numbers, which can lead to loss of consciousness and even coma. A sharp decrease in blood pressure may be associated with cardiac arrhythmia or with a decrease in the contractile function of the myocardium as a result of the fact that a significant part of the myocardium ceases to contract.
• Nitroglycerin does not relieve pain due to the fact that even the restoration of blood supply in the damaged area cannot restore the viability of cardiomyocytes.

First aid for a heart attack

1. Immediately call an ambulance, for this you do not need to wait for the critical condition of the patient. In parallel with calling an ambulance, do the manipulations listed below in the list.
2. The patient must be seated or laid down to reduce the load on the heart, provide access to fresh air (open the window in the room, unfasten the collar).
3. If the pain does not go away during the first minutes after the rest, then it is necessary to take medications (the patient should always have them with him).
4. Help the patient take nitroglycerin:

• Nitroglycerin in the form of tablets at the rate of 0.5-1.0 mg. per reception, this is one or two tablets).
• In drops - this is 2-3 drops dripped under the tongue or on the tongue.

1. Help the patient take Corvalol (30 drops orally) or Valocordin (20 drops orally).

Diagnosis of a heart attack

Laboratory determination of the levels of creatine phosphokinase, lactate dehydrogenase, determination of the dynamics of changes in their concentrations can help to establish with a high degree of probability the presence of a heart attack and the extent of heart damage.

After a heart attack

On the first days after a heart attack, the damaged tissue does not differ microscopically from healthy tissue, although it partially loses its contractile function. If blood circulation was restored quickly enough, then necrotic cardiomyocytes can be located mosaically, alternating with viable ones.

On the second day there is a delimitation of necrotic areas from viable ones. An intermediate zone is formed between damaged and undamaged areas of the myocardium.

Over the next week there is a softening of tissues subjected to necrosis. Simultaneously with the decay of dead cells, there is an active migration to the focus of necrosis of immune cells and the formation of connective tissue. At this stage, the foci of softening may bulge, forming aneurysms. It is for this reason that all patients after a heart attack must adhere to strict bed rest - any load on the heart can lead to the formation of an aneurysm or rupture.

The processes of formation of scar tissue in the heart muscle end by 3-4 months after a heart attack. In the rate of formation of scar tissue, the volume of the affected tissue is of great importance - the higher the volume, the longer the scar is formed.

How not to miss the signs of an approaching heart attack? First aid for a heart attack

Angina therapy rests on two pillars: emergency care for an attack of angina pectoris and treatment aimed at combating the reasons for which there is a discrepancy between the heart's need for oxygen and the delivery of oxygen to the myocardium.

Emergency care for an attack of angina pectoris

If an attack of angina pectoris occurs, it is necessary to dissolve a 0.5 mg nitroglycerin tablet under the tongue. The peculiarity of this method of administration is that nitroglycerin is very quickly absorbed from the mucous membranes: for example, after 1 minute its concentration in the blood reaches its maximum, and after 10 minutes it is completely destroyed.

If chest pains have not gone away, after 2-5 minutes you can take the second pill, and after another 2-5 minutes - the third.

To stop the attack, you can use nitroglycerin in the form of a spray. The aerosol is used by making 1-2 injections under the tongue. Up to 3 doses may be inhaled over 15 minutes.

Also, to relieve pain during an angina attack, isosorbide dinitrate spray (Isosorbide, Nitrosorbide, Isoket spray) is used. To achieve the effect, it is necessary to inject the aerosol onto the mucous membrane oral cavity(1-3 doses of the drug with an interval of 30 seconds). Breathing must be held.

IT IS IMPORTANT TO KNOW that nitrates can significantly reduce blood pressure for a short time, so you need to take them while sitting or reclining.

Very often, when taking nitroglycerin, a severe headache appears. In such cases, you can offer the patient to use nitrosorbide by swallowing or chewing the tablet. Another option that can help cope with a headache is to suck on a piece of sugar previously moistened with Watchel drops. Drops are sold in a pharmacy, in addition to nitroglycerin, they contain menthol, valerian and lily of the valley infusion. A patient suffering from angina pectoris can stock up on a container with such homemade "pills" and always carry it with him.

When (which occurs, as a rule, without connection with physical activity or stress at night), Corinfar is more effective. Corinfar tablet should be chewed to speed up its absorption.

If within 10-15 minutes the pain in the chest does not go away, you need to call an ambulance.

Treatment of progressive angina

If you notice that angina attacks have become more frequent, the need for nitroglycerin has increased, attacks occur with those loads that you previously tolerated well, this is a reason for an emergency visit to the doctor and, most likely, hospitalization. Self-medication is not worth it. Remember that with the transition of angina into a progressive form, the risk of development increases by 3-7 times.

Treatment of stable exertional angina

1. Nitrates

MECHANISM OF ACTION OF NITRATES. The drugs in this group dilate the veins. Deoxygenated blood is deposited in tissues on the periphery, the load on the heart with blood volume decreases (there is less blood in the main bloodstream, which means that less work on “pumping” needs to be done). In addition, nitrates dilate the coronary vessels, which increases the blood supply to the myocardium.

GENERAL RULES FOR PRESCRIBING NITRATES: in functional class I-II angina pectoris, as a rule, nitrates are prescribed situationally. Those. in the event of an anginal attack, or for its prevention, when increased physical activity is expected, it is possible to take nitroglycerin or nitrosorbide. With angina pectoris III-IV of the functional class, nitrates of medium duration are recommended for continuous use, as well as extended (retard) forms.

Medium-acting nitrates "work" for 1-6 hours, so they will have to be taken 3 or more times a day. These include:

• Sustained-release nitroglycerin tablets for oral administration (Nitrong 1-2 tablets 2-3 times a day, Sustak forte 1 tablet 3-4 times a day).
• Buccal (cheek) forms of nitrates (Trinitrolong in the form of a film pasted on the gum).
• Tablets of isosorbide dinitrate (Nitrosorbide) 5-40 mg 1-4 times a day.

Long-acting nitrates "work" for 15-24 hours, so they are usually taken 1-2 times a day. These include:

• Tablets or capsules of isosorbide dinitrate (Kardiket® 20-60 mg, 1 tab. 1-2 times a day).
• Isosorbide-5-mononitrate, including slow-release capsules or tablets (Efox® 10-40 mg 2 times a day, Efox® long 50 mg 1 capsule 1 time per day, Pectrol 40-60 mg 1 time per day, Monocinque® 40 mg 2 times a day, Monocinque® retard 50 mg 1 time per day, and others).
• Patches with nitroglycerin (Deponit 10). Attached to the skin 1 time per day.

IMPORTANT! Patients taking nitrates on a regular basis need to be aware that in the case when the drug is constantly in the blood, immunity to nitrates develops. Therefore, it is important that every day there is a 6-8 hour period when the drug is not in the blood. That is why you can not increase the frequency of acceptance of extended forms.

2. β-blockers

MECHANISM OF ACTION: Patients with a stable form of angina pectoris are prescribed β-blockers, since they reduce the power and frequency of heart contraction. The heart performs work less intensively, which means that the need for oxygen also decreases, which has a positive effect on the frequency of chest pain attacks.

IMPORTANT! The drugs of this group should not be used in patients with atrioventricular blockade of the 2nd and 3rd degree and bronchial asthma.

Beta blockers include:

• Metoprolol (Egilok®, Betalok®, Corvitol) 50-100 mg 2-4 times a day.
• Atenolol (Betacard®, Tenormin) 50 mg 1-2 times a day.
• Nebivolol (Nebilet) 5 mg once a day.

3. Calcium antagonists

MECHANISM OF ACTION: drugs of this group prevent the transfer of calcium into cells. The muscle cells of the vessels need calcium for their work, therefore, with its deficiency, the ability of the vessels to spasm worsens. This leads, on the one hand, to the expansion of the coronary vessels and improvement of the blood supply to the heart, on the other hand, to the deposition of blood in the venules on the periphery. The volume of blood actively circulating in the vascular bed decreases, which means that the heart can work less intensively (less blood needs to be “distilled” per minute). As a result, myocardial oxygen demand decreases. The heart does not experience oxygen starvation - there is no pain in the chest.

Calcium antagonists include:

• Amlodipine (Norvasc, Amlotop) 2.5 - 5 mg 1 time per day.
• Nifedipine (Cordaflex®, Corinfar®, Nifecard®) 10 mg 2-3 times a day, taken after meals.
• Verapamil (Isoptin) 40-80 mg 3-4 times a day. It is prescribed for patients who have heart rhythm disturbances.

IMPORTANT! Reception of Verapamil is contraindicated in chronic heart failure and atrioventricular blockade of 2-3 degrees.

4. Acetylsalicylic acid

MECHANISM OF ACTION: aspirin prevents the formation of a thrombus at the site of a destroyed plaque, since it is an antiplatelet agent - it prevents platelets from sticking to damaged vascular endothelium, as well as from the formation of a clot. It also affects the “flexibility” of red blood cells, improving their passage through the smallest vessels and improving blood flow.

Acetylsalicylic acid in a "cardiac" dosage is produced by many pharmacological companies under a variety of names. For example:

• Aspirin (Trombo ACC®, Aspirin® Cardio) at a dosage of 75-150 mg/day is prescribed to all patients with angina who have no contraindications to taking it, since it has been proven to reduce the chance of developing myocardial infarction.