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CHD. Angina pectoris

Angina pectoris is a form of coronary heart disease characterized by chest pain due to myocardial ischemia, often triggered by physical exertion or stress. Risk factors include hypertension, smoking, and diabetes, while treatment involves lifestyle changes, medications, and potentially surgical options. The prognosis varies based on the severity of atherosclerosis and the frequency of angina attacks.

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2 views3 pages

CHD. Angina pectoris

Angina pectoris is a form of coronary heart disease characterized by chest pain due to myocardial ischemia, often triggered by physical exertion or stress. Risk factors include hypertension, smoking, and diabetes, while treatment involves lifestyle changes, medications, and potentially surgical options. The prognosis varies based on the severity of atherosclerosis and the frequency of angina attacks.

Uploaded by

Falcon Gaming
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Topic# 1. CORONARY HEART DISEASE (CHD). ANGINA PECTORIS.

Definition: Angina pectoris is one of the main forms of ischemic (IHD) or


coronary heart disease (CHD)/coronary artery disease (CAD) and is characterized
by recurring episodes of retrosternal chest pain or other areas associated with
myocardial ischemia.
Etiology: atherosclerosis, vasospasm.
Risk factors: hypertension, hypercholesterolemia, smoking, diabetes mellitus,
physical inactivity, obesity, heredity.
Pathogenesis: Angina is caused by transient myocardial ischemia, which occurs
when there is a mismatch between the oxygen demand of the heart muscle and its
delivery by coronary blood flow.
Symptoms
• Retrosternal chest pain (or discomfort), radiating to the left and up (to the left
shoulder, arm, scapula, neck, less frequently in the lower jaw region).
• By character - burning, constricting, oppressive.
• It is provoked by physical exercise, eating, psycho-emotional stress, exposure to
cold, often pain can occur at rest, especially at night during sleep.
• The relief of pain at rest or after nitroglycerin take (usually within 1–1.5 min)
Classification
1. Angina pectoris
- First appeared - lasting less than 1 month.
- Stable - with relative constancy of the clinic and the course of the disease, has
functional classes (FC):
I FC (functional class) - when accelerated walking or walking at medium speed up
to 1000 m causes chest pain (Bicycle exercise test - power threshold load 750 kgm
/ min);
II FC - when walking on flat terrain up to 500 m causes chest pain (Bicycle
exercise test - 450 kgm / min.);
III FC - when walking on flat terrain of 150-200 m causes chest pain (Bicycle
exercise test - 150-300 kgm / min);
IV FC - inability to perform any physical exertion without the occurrence of chest
pain (Bicycle exercise test is not performed).
- Progressive - a sudden increase in the frequency and duration of attacks with the
same degree of physical activity.
2. Resting angina (vasospastic or variant, Prinz metal angina)
Instrumental diagnostics
1. Angina pectoris:
- ECG during pain - ST segment depression more than 1 mm.
- Bicycle exercise test or treadmill test - sample - during the load - ST segment
depression ≥ 1 mm.
- TEES (transesophageal electrostimulation),
- Holter ECG monitoring.
- Coronary angiography
2. Resting angina:
- ECG during pain –ST segment elevation more than 1 mm
- Hyperventilation test, cold test
- Holter ECG monitoring
- Coronary angiography
Laboratory diagnosis
Complete blood count - no change,
The level of troponins, CPK is normal.
Cholesterol, LDL, VLDL - increased.
Treatment
1. General measures (risk factor correction):
- Diet. Regulation of working conditions, life. Exercise therapy.
- Treatment of hyperlipidemia (statins), arterial hypertension, diabetes mellitus.
2. Relief of angina pectoris attack:
- stop exercise, take nitroglycerin under the tongue (valid for the first 5 minutes)
3. Prevention of angina attacks:
- nitrates, isosorbitadinitrate,
- beta-blockers, calcium channel blockers
- antiplatelet agents.
4. Surgical treatment:
- coronary artery bypass surgery
- stenting
Prevention
Primary: lifestyle changes to fight the risk factors.
Secondary: rational employment, supporting drug therapy, sanatorium treatment.
Prognosis: depends on the severity of atherosclerosis of the coronary arteries, on
the frequency of strokes.

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