Angina pectoris
Angina is a type of ischemic heart disease, for which the pain symptom is the main one. Angina pectoris is widespread among people of mature as well as advanced age. Both male and female sex are equally at risk of angina pectoris. Thus, in persons aged 40 - 55, this disease affects three to five people out of a hundred subjects, and at the age of sixty years - one in five. The significance of this pathology is extremely great, since in the developed European countries, on average thirty thousand of the primary cases of angina are registered.
As early as in the 80th of the last century experts from the World Health Organization identified several varieties of the disease: angina pectoris( this refers to angina pectoris that appeared for the first time, stable as well as progressive), variant angina pectoris( also called stenocardia of rest),In which the separate type includes angina of Prinzmetal. There is also a second variant of classification, in which stable, unstable angina, newly diagnosed( VVS), progressive( PS), early angina after infarction or operative intervention, vasospastic are isolated.
Angina of the history of the disease
When a patient with angina pectoris enters the hospital, immediately he receives a special document that has not only important medical significance, but also legal. This document is called a "medical history".Even in the waiting room, the patient's medical history records all his passport details, the address where he lives, the place of work and the position he occupies, the composition of the family, and the living conditions.
Then the patient with angina is examined by the doctor on duty. All complaints that the patient makes when questioning, immediately fixed in history. After this, the doctor should conduct a full examination, listening to the phonendoscope, palpation, and percussion. Already in the waiting room in this document it is necessary to enter a preliminary diagnosis( if the doctor doubts, without having the data of the research, at the end a question mark is put).If the patient has severe pain or is in serious condition, he should be immediately delivered to the cardiology or resuscitation department without conducting a preliminary examination in the waiting room. In these offices, specialized doctors conduct the necessary examination and activities, the data of which are necessarily recorded in the history.
In the course of interviewing a patient with angina pectoris, it is necessary to find out all the troubling moments for the underlying disease, as well as for accompanying, if any. The data of the survey are entered in the relevant points in the medical history.
On the first day, when the patient entered the treatment, he has an anamnesis of the disease. In other words, data are collected about when the disease manifested, what preceded it( other diseases, occupational hazards, difficult life circumstances), how often the disease makes itself felt, what unpleasant symptoms are manifested. It is also necessary to find out whether someone from close relatives has suffered from angina pectoris, and in general, what hereditary diseases are present in the family of this patient.
In the history of the disease you need to indicate what the person was sick during life( acute respiratory illnesses, chicken pox, measles, etc.), whether there is an allergy to any food or medicines. It is also necessary to find out and inscribe in this paragraph whether the patient was suffering from especially dangerous infectious and venereal diseases( tuberculosis, syphilis, AIDS, etc.), whether he had surgery or blood transfusion. The patient should find out whether he is currently taking any medications, and whether he took them in the near future. At the end of the anamnesis of the disease, it is necessary to indicate information about the epidemic environment of the patient with angina pectoris.
The next item to fill in the history is an anamnesis of the patient's life. This point should be given attention, since in a detailed analysis of life, it is possible to find factors that gave impetus to the development of the disease. The anamnesis of life begins to be collected from the data on when and where the patient was born, how the child counted, how the mother's pregnancy and delivery proceeded, how the patient developed( lagged behind or not from the physical development of his peers), how many years he went to first grade, How he learned the school material, where he received higher education.
Next, find out who the patient is( worked for) and for how long, what are the conditions for work( production hazards, emotional stress, work related to life-threatening risks).In the history of life, it is also necessary to enter data on the family composition, illnesses of the spouse( wife) and children, on housing conditions( satisfactory or not, house or apartment, how much space is required for a person, etc.).This item, in addition to all the above data, should include information about the patient's bad habits with a detailed description( if smoking, then how many years and the number of cigarettes smoked per day, if alcohol consumes, how often, and in what quantities).If there are bad habits of close relatives and family members, this should also be indicated.
After an anamnesis of illness and life is collected, go on to a systematic system of objective research. They begin, first of all, with an assessment of the general condition of a person with angina pectoris( satisfactory, moderate or severe severity).Assess the patient's consciousness( clear, clouded or not at all), his position on the bed( active, passive) and behavior( adequate or inadequate, calm or not).Further, the parameters are estimated and historical data on the body weight, growth and body type are entered into the history. Next, the skin and visible mucous membranes are evaluated with the skin color, humidity( normal, increased or dry skin), elasticity and turgor in the corresponding paragraph of the document, and the fat fold on the abdomen is measured. Next, palpation of the lymph nodes of the chin, axillary, cervical, thoracic and inguinal groups is carried out, indicating their size and strength, morbidity( if any), consistency, signs of adhesion to surrounding tissues( soldered or not).After assessing the joints: symmetry, the volume of motor activity( movements are retained or chained), painful sensations in the study.
After a general inspection, they pass to the evaluation of the systems. Begin with the respiratory. Assess nasal breathing( free or not), the type of breathing, the frequency of respiratory movements, the shape of the chest, the synchronism of the participation of both halves in the act of breathing, the severity of the supra- and subclavian pits( normal, retracted, smoothed).Then go to palpation: assess the soreness, the elasticity of the patient's chest angina pectoris. Then percussion is carried out( comparative - on symmetrical sites, topographic - for estimating the height of the tops of the lungs, Krenig fields) and listening.
After the system of respiratory organs, they begin to examine the cardiovascular system. In patients with angina pectoris, this system must be studied especially carefully. Begin with finding the apical impulse and determining its main parameters( localization along the intercostal spaces, resistance and height).After passing to the pulse. It is measured on both extremities simultaneously, determining wave synchronism, resistance, rhythm, tension and degree of filling. Then they move on to auscultation. A patient with angina pectoris should be listened to several times - first at rest, and then after a small load( if the patient's condition allows).It is important to evaluate the rhythm of tones, how clear and sonorous they are, to determine if there are any changes in the correlation of tones that can occur with a disease such as angina of the heart. After listening to a patient with angina, pressure should be measured.
The next system to be studied and described in the patient's medical history is digestive. At this point, you need to check the patient's main symptoms: Schetkina-Blumberg, Ortner, Frenicus-Symptom and Murphy. It is necessary to conduct palpation of the liver and determine its size.
In a study of the genitourinary system in a patient with angina pectoris, it is necessary to find out whether there are complaints of an increase or decrease in diuresis, which diuresis prevails( day or night), if he ever had a kidney or bladder.
Neuropsychiatric status includes checking for the main tendon reflexes, pupil and pupil reflexes, and gait evaluation.
After evaluation of all systems, a patient is diagnosed with angina pectoris and a plan is determined by which he will be examined. In the examination of the patient with angina necessarily include laboratory tests( blood and urine), blood biochemistry, instrumental methods: electrocardiography, chest X-ray, ultrasound of the heart.
Following the results of all examinations and studies, the patient is given a final( final) diagnosis and begins to receive therapy. Every day, a doctor, for whom a patient with angina is fixed, must bypass and enter all the data on the change in the patient's well-being and indicators to a special point in the history of the disease-the diary. It is filled daily and without fail.
When the patient is ready for discharge from the hospital, the epicrisis is filled in the case history. It describes in brief form the patient's entire stay in the hospital, performed manipulations, research, treatment. In the epicrisis also give a general forecast and recommendations for the necessary drugs, daily routine and dietary nutrition.
Angina of causes
One of the main causes of this type of IHD is the atherosclerotic lesion of large vessels, which is characterized by a narrowing of the arteries lumen due to the occlusion of its lipids by its plaques. At the initial stages of atherosclerosis, the patient will not be bothered by angina. The first painful attacks occur when the lumen of the vessel is closed by cholesterol conglomerates more than half.
Clinical manifestations of angina pectoris intensify as vascular stenosis increases. The severity of the course of angina pectoris is related to how large the site has been blocked, and how many arteries have been involved in this process. Sometimes the development of angina pectoris can contribute simultaneously to three factors: atherosclerosis, chronic vasospasm and the presence of thrombi of non-lipid genesis near the walls.
In some cases, angina of the heart begins solely due to angiospasm in the absence of atherosclerotic vascular damage. Angina pectoris may well have a reflex character. Reflex variant of this disease develops if a person has any pathology of the digestive tract( cholecystitis, ZHKB, hernia of the diaphragm).In addition to gastrointestinal diseases, allergies, infectious diseases, syphilis and rheumatism can cause angina pectoris, which cause vascular damage( aortitis, vasculitis, etc.).
The occurrence of angina pectoris and its further development has the effect of removable and unavoidable risk factors. Unrecoverable include belonging to the male sex, age( after forty), genetic predisposition. The incidence of angina in men is higher to fifty-fifty-five years, in the elderly, both sexes suffer equally. For disposable factors, a person with angina pectoris can, if desired, influence and significantly improve his life. These factors include fatty foods( lower cholesterol will reduce the rate of atherosclerosis and protect against angina), increased body weight( people who are not overweight, suffer from angina less often), pressure( blood pressure control and timely treatment will reduce the risk of angina).
Angina pectoris symptoms
The defining symptom in the clinical picture of a disease such as angina is pain of a different nature and strength, either behind the breastbone, or to the left of it( in the projection of the heart).Pain can be compressive, stitching, burning, pressing, drawing, less often - drilling and cutting.
The strength of pain in angina fluctuates in a wide range. Pain can be barely perceptible or sharp and very intense, causing people to moan and toss. Pain can give an irradiation to the upper left limb, the lower jaw, the epigastric region, or the subscapular region. Happens and atypical variants of distribution - in the right half of the body. A typical irradiation is due to its spread from the cardiac muscle to the last cervical and first to second thoracic segments of the spinal cord, the impulses from which are transmitted along the nerves.
Often painful feelings overtake a patient with angina at the moment of climbing the stairs, with long walking, after a nervous shock or strong emotions( including positive ones), sometimes the pain can be overtaken during the night. In most cases, the attack of angina lasts no more than a few minutes, sometimes up to twenty. At the time of an attack a person feels that he suffocates, he tries to stop and press down the place where he felt pain. He begins to turn pale, numbness of hands and feet begins. In the first minutes, the pulse with angina begins to increase, and then on the contrary to slow down, it is impossible to exclude the development of extrasystole, tachyarrhythmia or increased blood pressure.
Angina pectoris signs
It is important to know the signs of angina pectoris to be able to differentiate this disease from other cardiac pathologies, including those that can carry a greater threat to human life( for example, a microinfarction or a myocardial infarction).The signs of the fact that the patient has angina pectoris is the duration of the pain( not more than twenty minutes), the nature of the sensations and the factors that stopped this attack( after taking the nitrate derivatives, the pain must pass).Important importance is given to the definition of special cardiac troponins( 1 and 2).These are special markers that allow you to determine the damage to the heart muscle. If they were found in the blood, this indicates the development of a microinfarction or a heart attack. Troponins allow timely treatment and prevent the patient from the occurrence of postinfarction attacks of angina pectoris. On the ECG, if it was made during a pain attack, there will also be signs characteristic of angina only: a decrease in the interval between the teeth S and T, the appearance of a T wave with a negative index in the thoracic lead, the pathology of conduction or rhythm.
Many useful data will give ECG monitoring during the day. It will allow to fix any phenomena of ischemia, changes in heart rate, rhythm. So, if the number of heartbeats grows just before the onset of a painful attack, this is a sign of angina pectoris. If the heart rate was normal, this is a sign of angina spontaneous. With a diagnostic purpose, patients with angina pectoris can undergo scintigraphy. In this case, a special preparation is introduced into the body - thallium. It is intensively absorbed by live cardiomyocytes, and if a person has angina, there will be a marked violation of this perfusion by the cells of the heart. Echocardiography in patients with angina pectoris will show the characteristic localized foci of ischemia, the pathology of myocardial contractility.
Angina pectoris
This disease, like angina pectoris, is divided into four functional classes.
With FK1, the standard daily load( walking, stairs) does not provoke a bout of pain. Painful sensations in humans in this case can appear only after an uncharacteristic, unusual load. This latent stage of angina pectoris is extremely difficult to diagnose, as pains are very rare. The angina at this stage is very rarely detected because the patients do not pay attention to minor rare discomforts and simply do not seek help from a doctor.
With FK2, there is already a slight decrease in the usual possibilities. Thus, a person with angina pectoris can feel pain with fast and moderate walking for a distance not exceeding two hundred meters. Ascent to the second floor also provokes a new attack. A characteristic feature of a person with this functional class is an increased sensitivity to changes in weather. Attacks of pain can occur while in the cold, during a nervous shock or after a tight dinner.
In PK3, a severe limitation of physical activity is diagnosed. The attack of angina piercing makes itself felt with a calm motion on a flat road for a distance of one hundred to two hundred meters, ascending to the first floor. Attacks become frequent if the patient smokes. Such patients have angina at rest in the supine position after a nervous shock.
With FK4, every slightest load causes pain and discomfort. Often in a history of a person with this variant of angina pectoris, one can find a heart attack or heart failure in a chronic stage. Often an angry syndrome occurs in complete peace or even at night.
Stenocardia of strain
Any muscle in the human body receives nutrients, as well as oxygen through the coronary arteries. Their source is at the most important vessel in the body - in the aorta. If a person is healthy, then with increasing load, the need for myocardium in substances and oxygen significantly increases and the volume of blood flow along the vessels increases. When damaged by atherosclerosis of the main arteries, plaques appear on their walls, greatly narrowing the diameter of the vessel. It is for this reason that oxygen enters certain areas of the myocardium in a smaller volume than is required at a certain moment. This condition is called "ischemia."
Ischemia, which lasts for more than thirty minutes, in many cases leads to disruption of cardiomyocytes and their irreversible death, which causes a heart attack. Clinically, this oxygen starvation is manifested by angina with predominance of pain symptoms. Angina pectoris, which develops at the time of stress on the body or immediately after, is called angina pectoris.
Stenocardia tension is characterized by the onset of an attack of pain during physical or psychoemotional exercise. Such an attack of ischemia occurs when the demand of the heart muscle for oxygen increases. This type of angina has a lot of characteristic symptoms: pain in the heart after a load( emotional, physical), a feeling of squeezing and embarrassment, reactions of the vegetative system, a sense of lack of oxygen. All these symptoms occur directly at the time the person on the patient has a provoking factor. Characteristic is also the sign that the pain with such angina has a clear definite beginning and the same end. Sometimes the attack is accompanied by a strong fear of death, as well as a cold sweat.
This type of angina provokes atherosclerosis, less often high pressure in a small circle, hypertrophy of the myocardium, spasm of the coronary vessels, stenosis of the vessels, mainly the aorta, congenital vascular anomalies, hypertension and coronaritis. Sometimes angina can provoke an acute development of thrombosis of the arteries, but in most cases this condition still leads to myocardial infarction.
The main factors leading to angina pectoris are age( more often people are mature and elderly), obesity( the effect of excess weight on the development of this pathology was discussed above), tobacco smoking( all know the harmful effects of tobacco on blood vessels), hereditary factorsIncreases if the family has already had cases of angina pectoris).Especially prone to such angina pectoris during menopause, when there is a hormonal adjustment.
It should be remembered that stress angina does not always make itself felt by classical symptoms. In some cases, it may manifest as a feeling of unmotivated severity of weakness, coughing attacks, dyspnea. All these symptoms also have a certain sharp start and the same quick end. This uncharacteristic attack is stopped just like the classic variant of angina pectoris - an immediate cessation of all loads on the body, the use of sublingual Nitroglycerin and a short rest. If the pain persists for a long time, especially if its nature is paroxysmal, taking nitroglycerin does not help, it is necessary to immediately call the ambulance. Emergency medical assistance is necessary, since the above signs can mean the onset of myocardial infarction.
Unstable angina
Unstable angina is a very dangerous and serious stage of exacerbation of IHD, which is a threat of myocardial infarction or sudden death. As for the clinic, unstable angina pectoris was intermediate between stable angina and acute infarction, but in the case of unstable angina, the duration and intensity of ischemia is insufficient to develop necrosis of the heart muscle. The occurrence of unstable angina is often associated with rupture of the parietal plaque, which contributes to thrombosis in the coronary vessels. In some cases, the cause may be a spasm or an increase in the tone of the arteries.
Stable angina relates to: first diagnosed angina, progressive angina, early angina after infarction and spontaneous angina.
Progressive angina is marked by a sharp and unexpected deterioration in the course of angina: the emergence of characteristic pain in light loads that previously could not provoke an attack, an increase in the duration of pain, angina begins to arise in complete rest. The ECG also shows characteristic changes, which continue to be determined even after the attack has been stopped. With this type of angina, pain attacks can last more than twenty to twenty-five minutes, appear at night. Often there are some additional symptoms: a sharp increase in sweating, a strong heart beat, accompanied by an insurmountable fear and panic, a feeling of nausea.
Unstable angina can be recognized on a cardiogram and by analysis. With it, you can not detect a persistent ST rise on the ECG and markers of necrosis in the blood. In many cases, no metamorphosis associated with ischemia and a defect in the heart muscle can be detected at all. The prognosis is not entirely favorable if there is persistent ST suppression on the cardiogram, a short period of its elevation, a change in the polarity of the T wave. In Echocardiography, in such patients, a significant deterioration in the mobility of the sites that have undergone ischemia can be detected. The intensity of changes directly depends on the severity of the clinic of the disease.
Extremely important is the removal of the ECG, not only during a pain attack, but also in breaks between attacks. The absence of any signs of any changes on the ECG does not give us the right to judge with certainty the absence of ischemia, so more research is needed to ensure that even the minimal risk of an infarction is excluded.
Registration of any of the above changes immediately during a pain attack with the subsequent presence of these signs on the ECG after its end indicates a high risk of developing a heart attack. Very often in patients with unstable angina, ST depression and negative T are recorded. In some people with unstable angina, on the contrary, there may be an elevation of the ST site on the cardiogram.
Stable angina
The cause of stable angina is a deterioration in the supply of blood to the coronary arteries, manifested by stenosis or spasm of blood vessels, interference with blood flow through the formation of a thrombus.
Stable angina is characterized by the same manifestations as other types of this disease - pain in the region of the xiphoid process or in the heart of a pressing or compressive nature. Pain usually lasts no more than five minutes, can be irradiated to the abdominal cavity, scapula, lower jaw or back, may be accompanied by an obsessive sensation of lack of oxygen. The attack is often preceded by intense physical work or too tight dinner. You can stop pain through rest or Nitroglycerin. All symptoms usually disappear within one to three minutes.
To confirm the alleged diagnosis, you need to make the patient an ECG or EchoCG.Also recently, special tests for detection of ischemia and angina pectoris have become quite popular: bicycle ergometry and treadmill test. It is important not to forget that not every pain in the projection of the heart or in the sternum is just angina. Such pain can be completely unrelated to the heart and indicates pathology on the part of other organs. That is why it is so important to conduct a full examination with a patient with suspected angina.
The most common cause of these pains are various diseases associated with the nervous system: intercostal neuralgia, osteochondrosis, neuritis, VSD.Similar symptoms can occur with panic attacks or prolonged depression. Various diseases of the musculoskeletal system can also cause the appearance of pain symptoms similar to those of angina pectoris. Such diseases include diseases of shoulder joints of inflammatory nature, costochondritis and many others. A similar symptomatology can accompany a diaphragmatic hernia, various diseases of the stomach, intestines, pleural cavity, and also lungs.
Angina pectoris
A painful attack occurs due to a lack of supply to the oxygen heart muscle. Due to hypoxia, myocardial cells are damaged or, in the worst case, their necrosis. It is these processes that cause the characteristic pain sensations.
An important symptom of helping to differentiate pain in angina from pain of another genesis is the characteristic symptom of a "clenched fist".It is expressed in the fact that a sick person will apply a fist to his sternum directly during an attack or to describe the doctor his feelings. The attack usually has a short duration - from a few seconds to fifteen to twenty minutes.
Angina pectoris treatment
First aid for angina is to perform simple actions. The first thing you need to immediately stop any physical activity( doing work, walking, playing sports) and take a comfortable position( sit down or, if possible, lie down).
If the attack of stenocardia is found indoors, you need to ensure a good supply of fresh air into the room - open the windows or door. In no case can you be affected by emotions and panic, as this can significantly aggravate the spasm. That's why you need to soothe a sick person with all methods and not show your own fear.
If for the patient this attack is not the first, you need to drink the drug at the specified dose, which was previously prescribed by a cardiologist. It is necessary to take the therapeutic dose, as the above actions will greatly facilitate the human condition, and an overdose will cause the body to become addicted to the drug and its complete inefficiency in the future. Repeated dose should be given only if the patient does not begin to ease for five to seven minutes.
An ambulance should be called in the event that the attack of angina appeared for the first time in life, and against the background of carrying out all the above actions does not take more than ten minutes. The doctor should also be consulted if there are any new symptoms with the next attack: irradiation of pain in the jaw or neck, in the abdomen or any other organs and parts of the body, increasing the intensity of pain in comparison with previous cases of angina. In addition, with absolute accuracy to differentiate stenocardia from a heart attack, only a doctor can.
General principles of angina therapy are reduced to several points. First of all, it is necessary to pay attention to the factors that can provoke the progression of the disease. That is why it is important to fight with bad habits, manifestations of atherosclerosis, to move more, to eat right and not to allow the appearance of excess weight. It is also necessary to systematically take medication prescribed by the doctor( antihypertensive, antianginal or antiaggregants).Liberty in the choice of dose and the mode of admission with this diagnosis can not afford to itself - drugs must be taken on time. If the effectiveness of these measures is inadequate, operative intervention should be resorted to.
The main goals that the doctor sets himself in the therapy of angina pectoris are to prevent the occurrence of a heart attack, to improve the quality of life, to minimize unwanted symptoms.
All patients with angina pectoris are prescribed aspirin in small doses( usually seventy-five milligrams per day).But with the appointment of acetylsalicylic acid, it is important to take into account the numerous contraindications. If the patient has serious stomach problems or significantly reduced coagulability, Aspirin is not prescribed. With the above diseases, Clopidogrel is prescribed instead of Aspirin. This drug is much more effective and less likely to cause complications from the stomach, but costs several times more.
For the purpose of symptomatic treatment in patients with angina, beta-blockers are used. These drugs are ideal for eliminating an attack and are the drugs of choice. They have an antianginal effect and reduce myocardial oxygen consumption due to the reduction of heart beats per minute. It is best to choose cardioselective adrenoblockers, since they are much less likely to select unselective effects. Most commonly used are Atenolol, Metoprolol, Talinolol, Bisoprolol, Oxprenolol. They are effective not only for relief of symptoms, but also greatly improve the quality of life and the prognosis of the patient: their use minimizes the risk of ventricular fibrillation( a frequent cause of coronary death) and myocardial infarction. Along with a large number of positive effects, these drugs have some side effects. With the use of cardioselective adrenoblockers, it is possible to cold hands or feet, the development of bradycardia, erectile dysfunction, exacerbation of asthma and COPD, unmotivated weakness and nightmares.
When angina is used and blockers of calcium channels. They are divided into two subgroups, different in principle, but having the same effect - antianginal. The most widely used drugs are Diltiazem, Verapamil, Amlodipine, Nifedipine. These drugs have a prolonged effect, so they are taken once a day. Amlodipine can be combined with a cardioselective beta-blocker in the event that one drug gives insufficient effect. Verapamil or Diltiazem is not strongly recommended to be combined with beta-blockers, since such a combination can cause a strong bradycardia. Verapamil will be an excellent substitute, for example, atenolol or bisoprolol for patients with concomitant asthma or obstructive pulmonary disease. Among undesirable effects, edema in the lower leg area is most common, especially when Amlodipine is used. Diltiazem often causes a rapidly passing bradycardia, Verapamil can cause constipation.
Nitrates for the treatment of angina pectoris most often use Nitroglycerin, Isosorbide mononitrate and dinitrate. It is necessary to know that these drugs differ in the duration of the therapeutic effect. There are short-acting agents that do not have effect for more than sixty minutes, moderate prolonged action, working for about six hours, and a significant prolonged effect, the effect of which lasts for a day.
For angina pectoris FC1, short nitrates( tablets or aerosols of Isosorbide dinitrate or Nitroglycerin) are used. They are drunk a few minutes before physical exertion in order to prevent the development of an attack of angina pectoris. With stenocardia of the second functional class, short-acting nitrates are also added to mild. With angina pectoris FC3 is mandatory assignment of Isosorbide mononitrate( significantly prolonged action).He is drunk regularly during the day, excluding the night period, in order to avoid addiction. With FK4 angina pectoris, extended nitrates are prescribed so that their effect lasts around the clock, connecting them with beta-blockers for better effect. Of the side effects induced by nitrates, face redness and headaches predominate due to vasodilation.
Other anginal remedies are prescribed to patients with tolerance to traditional drugs for angina pectoris. Nicorandil is a hybrid drug that extends not only spasmodic or stenosed vessels, but also unchanged. Its effectiveness as an additional drug has been proven by many studies. It is used every twelve hours for twenty milligrams. Perhaps the development of headache in the background of admission. Ivabradin is a pulsurester. It has important differences from other drugs used in the treatment of angina pectoris: Iwabradine does not slow heart rate, retains the primary contractility of the heart muscle, does not affect the vessels located on the periphery, does not affect the metabolism of fats and carbohydrates and does not reduce blood pressure. Regardless of whether Iwabradine is prescribed as a monotherapy or as part of a treatment regimen, this drug will have a positive effect in treating the symptoms of angina and reduce the risk of heart attack. During the intake of elevated doses, a slight change in color perception is possible. They start receiving from five milligrams every twelve hours, so they take for fourteen days, and then switch to a dose of seven and a half milligrams with the same multiplicity.
Trimetazidine is a metabolic agent that maintains a normal energy metabolism and prevents the occurrence of ionic disorders accompanying ischemia. This drug accelerates the oxidation of glucose, takes part in the oxidation of fatty acids. The effectiveness of this medication is inadequate, the mechanism is poorly understood. Among the side effects are a constant weakness, as well as drowsiness.
In addition to the above, a selective inhibitor of the late current of sodium ions, Ranolazine, is used. Ranolazin is prescribed twice a day for five hundred to one thousand five hundred milligrams. It improves exercise tolerance, reduces the frequency and intensity of angina attacks. The drug is a good addition to the symptomatic therapy of angina pectoris. Side effects include constipation, nausea, and dizziness.
With prolonged ineffectiveness of drug treatment and progression of symptoms of angina pectoris is prescribed surgery. Surgical treatment involves balloon angioplasty, otorocoronary shunting( CABG), or stenting of the coronary arteries. In the course of CABG, a collateral shunt that connects the aorta and the coronary vessel is superimposed on the patient. For the shunt use your own human vessels. The most durable and reliable is considered a shunt made of the internal thoracic artery. Balloon angioplasty, as well as stenting - less traumatic methods of surgical intervention in angina pectoris. The meaning of the operation is to make a hole in the damaged section of the vessel with a special balloon and insert a special miniature structure of metal - a stent. Indications for any of the listed methods of surgical intervention are purely individual and require a complete examination of a person with coronary angiography.
In addition to traditional methods of treating angina pectoris, treatment of this ailment with stem cells is gaining popularity. The idea is that if they get into the body of stem cells, they will independently go to the place of "malfunction" in the body and turn into those cells that need to be replaced. Unfortunately, in this case, none of the specialists will be able to give the patient a 100% result, since these young cells can go by any means of differentiation and turn into not the cells that they should have replaced. Thus, despite the fact that the method declared itself as promising, it was not confirmed by clinical trials, but it is still used in narrow circles and is very expensive.
