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Stenocardia is a state at which at the person pristupoobrazny pain in a breast is shown. It occurs in view of an acute shortage of supply of a myocardium with blood. Thus, at the patient clinical displays of coronary heart disease take place.
Stenocardia is at the same time both an illness, and a clinical syndrome. If it is about an individual disease, then most often stenocardia arises as an effect of atherosclerosis of coronary arteries. This phenomenon provokes noticeable narrowing of a gleam of arteries that, in turn, interferes with normal blood supply of a myocardium. Especially often stenocardia is shown at the person owing to the strong tension of physical and emotional character. If arteries owing to sharp atherosclerosis are narrowed for 75% and more, then attacks of stenocardia are shown at the patient and owing to moderate mental and physical tension.
The stenocardia attack usually arises after the blood stream to mouths of coronary arteries decreases. It occurs at patients with arterial hypotension (diastolic hypotension is especially dangerous in this case), at venous hypotension, falling of cordial emission, a tachyarrhythmia. Also reflex influence from a gullet can provoke a stenocardia attack, bilious ways, a backbone if the accompanying illnesses of these bodies take place. Acute narrowing of a gleam of a coronary artery happens as an effect of not occlusive blood clot, swelling of an atherosclerotic plaque.
The attack of stenocardia abates if the level of a muscle work of heart is normalized under the influence of Nitroglycerine or reduction of loading. At the same time inflow of blood to coronary arteries is normalized.
Types of stenocardia
In medicine it is accepted to define several kinds of stenocardia, depending on its frequency and character. So, at for the first time the arisen stenocardia there is a manifestation of symptoms of stenocardia approximately for a month then regress of an illness, or transition of an illness to a form of stable stenocardia is observed.
At intense (stable) stenocardia there is a regular development of attacks of disease. They arise at this stage as tension any effect. About this form of stenocardia speak as about the "purest" type of an illness. This stage of an illness quite often signals about high risk of development in a sick myocardial infarction.
At the progressing (unstable) stenocardia at the patient attacks arise suddenly and unexpectedly. Often they develop also at the person who stays at rest. In development of such attack of people feels very severe pain in a breast. This type of stenocardia is most dangerous in view of the increased risk of development of a myocardial infarction. Very often at unstable stenocardia of the patient hospitalize.
At alternative stenocardia development of an attack quite often happens at night and is a direct effect of vasospasms. It is possible to trace this form of stenocardia by results of an ECG. In general it is rather rare illness.
Stenocardia symptoms always accurately are defined. So, pain at stenocardia has pristupoobrazny character, having accurately defined time of the beginning and the termination of an attack. Pain is always shown under similar circumstances and conditions. After nitroglycerine reception pain gradually abates or stops completely.
The main condition for manifestation of an attack of stenocardia at the person is the condition of tension. Most often it develops when walking – for example, during acceleration of the movement, rise up, in process of a heavy load or at movement at once after dense food. However, also other types of tension, and also an emotional overload can provoke manifestation of symptoms of stenocardia. If physical efforts proceed or their intensity increases, then the stethalgia amplifies. But if stops efforts of people, then painful symptoms of stenocardia gradually disappear already in a few minutes.
Sometimes pain at stenocardia is localized behind a breast that is the most typical symptom. In more exceptional cases pain gives to a neck, a mandible, teeth, the left hand and a shovel. Generally pain has the pressing, squeezing character, in more exceptional cases pain, burning, similar to heartburn, is shown. Sometimes the person feels in a breast weight, discomfort from feeling of existence in a breast of a foreign body.
At an angina of exertion the patient has a sharp increase of arterial pressure, the perspiration is shown, the person turns pale.
All characteristics of pain stated above are considered in the course of diagnosis of a disease. They give the chance to distinguish display of stenocardia from pain in heart which testifies to other diseases.
Specialists note that the similar origins of pain at stenocardia are of great importance as owing to severe pain of people stops and stops an exercise stress which not on force to his heart.
Diagnosis of stenocardia
Establishment of the diagnosis "stenocardia" often happens at the very first address of the person to complaints to the specialist. At the same time for a rejection of the similar diagnosis it is necessary to watch a long time a condition of the patient, to conduct a number of examinations, and also careful poll of the patient.
In the course of diagnosis of stenocardia research by means of an ECG, and also loading tests, a myocardium stsintigrafiya, a two-dimensional echocardiography, a radionuclide ventrikulografiya, coronary angiography and other techniques is applied. In the course of research of the patient by means of an ECG the specialist can observe existence of specific characters which demonstrate that at the patient myocardium ischemia takes place. However, in the course of diagnosis the fate the fact that at rest such signs are not observed therefore when carrying out a standard electrocardiogram it is not always possible to establish the correct diagnosis follows.
To find such signs, to the patient with suspicion on stenocardia holterovsky monitoring is carried out. This technique is that throughout certain time, as a rule, days, continuous registration of an ECG is made. The person at the same time continues to lead the usual life. Thanks to such technique there is an opportunity to record displays of ischemia, to define as far as they are dependent on any tension, to find out, treatment is how effective and whether pathological changes are strongly expressed.
It is possible to define a number of the moments important in the course of diagnosis by loading tests at which the situation when the need of a myocardium for oxygen increases is modelled. Similar tests carry out only under strict supervision of the specialist, in the course of their carrying out register symptoms of ischemia. It is important to consider that at unstable stenocardia and a myocardial infarction such tests do not carry out. Also contraindication to use of a similar method is heavy arrhythmia, existence of heart and respiratory failure, arterial hypertension with high rates of the ABP, severe tachycardia.
Today it is applied three types of loading tests: loadings of physical character on the stationary bicycle and the tredmill, pharmacological tests, electrocardiostimulation.
Applying any of the specified methods, for registration of ischemia one of ways is used: ECG, stsintigrafiya, echocardiography. Tests with exercise stresses on the stationary bicycle (the special exercise bike) or on the tredmill (racetrack) using a control ECG are most often applied. By means of special tables in which the gender and age is considered tolerance level of loading is calculated. The termination of the test happens after achievement of this size. If there are no symptoms of ischemia, so the result of test will be negative, and the person is not sick with stenocardia. If symptoms of ischemia take place, so the person is sick with stenocardia. If a certain case is represented to specialists very difficult, then use of coronary angiography is possible. This method is high-informative. In the course of carrying out such research selective contrasting and visualization of coronary arteries by means of a rentgenapparatura is made. Coronary angiography allows to define existence of stenosed sites of arteries and degree of their suzhennost.
Complications of stenocardia
Stenocardia is fraught with development of very serious complications. So, among them most often at patients progressing of a cardiosclerosis, and also the subsequent development of a myocardial infarction is shown. In this case long attack of stenocardia which to last at the patient about half an hour happens the first symptom of a heart attack sometimes. Besides, displays of stenocardia provoke emergence in the most efficient arrhythmia.
Treatment of stenocardia
As the main mechanisms of a zatikhaniye of an attack of stenocardia: fast lowering of the level of a muscle work of heart and normalization of adequacy of inflow is defined. Therefore, treatment of stenocardia, first of all, assumes stopping of attacks of illness. Patients have to realize that this disease is a dangerous illness therefore therapy has to take place only under control of the specialist and it is desirable in a hospital.
By means of adequate treatment of stenocardia it is important to achieve the following results: to reduce risk of manifestation at the patient in the future of a myocardial infarction, to improve the general quality of life of the patient.
In order that therapy of a disease was the most effective, it is important to follow recommendations of the doctor without fail. So, it is necessary to refuse completely smoking, to balance an everyday food allowance, to optimize exercise stresses, to constantly control arterial pressure.
To remove those causes which directly influence manifestation at the person of attacks of stenocardia it is important to prevent those situations which increase oxygen requirement of a myocardium. So, it is not necessary to allow both physical, and emotional loadings which provoke emergence of pain. If it is difficult to realize it, then for prevention it is necessary to accept anti-anginal medicines surely. It is not less important to refuse exercise stresses which happen to other factors provoking stenocardia attacks. It is cold, wind, a condition of an organism after reception of food and after a dream. It is impossible to accept medicines which increase need of a myocardium for oxygen, for therapy of other diseases.
As drug treatment of stenocardia three main groups of drugs which influence coronary vessels are appointed, expanding them. These are drugs - nitrates, in - blockers, blockers of calcium channels. To stop a stenocardia attack, choose high-speed drugs: it is, first of all, nitroglycerine in tablets, aerosols, applications, ampoules, and also nifedipine tablets. Most often patients accept these means sublingual, however today wide popularity is found also by sprays. After nitroglycerine the effect is swept up already through 1-3 minutes later. If the effect after reception of a tablet is not observed, it is possible to take five minutes later one more Tabulettae Nitroglycerini. In the most hard cases the drugs of nitroglycerine can intravenously be administered.
It is long the operating nitrates drugs Nitrosorbidum, Sustac forte are; among drugs - in - blokatoryov it is most often applied metoprolol, atenolol. Drugs — blockers of calcium channels is diltiazem, verapamil, nifedipine. As a rule, in an initiation of treatment the simplest and cheap drugs – nitrates are used. If there is no effect of their reception, or the patient badly transfers such medicine, also other groups of drugs are connected.
Prevention of stenocardia
Prevention of stenocardia first of all is undertaken for the purpose of the prevention of atherosclerosis. Therefore preventive measures should be undertaken already in the middle age – in 35-40 years. It is important to pay attention that prevention of stenocardia is especially necessary for those people whose close relatives had cases of stenocardia.
It is important to balance an everyday food allowance so that to limit amount of digestible carbohydrates and fats which have animal origin. Parents have to watch that children did not overeat, thereby preventing emergence in them of excess weight. Besides, the recommended diet should not contain some fat meat and fish broths, fried and smoked dishes, a herring, canned food, fat meat, seasonings and sauces, alcohol, flour, strong coffee and tea. It is impossible to overeat for the night, it is important to divide food into several equal receptions. Specialists recommend regular carrying out fasting days: it is possible to carry out them once in two weeks.
From early age it is necessary to provide an adequate and constant exercise stress. The most suitable loading in this case is swimming, slow run in the fresh air. Every day it is necessary to walk, at least, within half an hour. Besides, important point in the embodiment in life of measures of prevention of stenocardia is refusal of smoking.
If the person has tendency to heart troubles, it is important to take all measures directed to pressure decrease. People at whom stenocardia is periodically shown need to have always at themselves the tablets ordered by the doctor and to accept them both during an attack, and for prevention of stenocardia. So, nitroglycerine of the patient can accept before serious exercise stresses.