Download Diagnostics of angina pectoris

Ischemic heart disease (IHD).
Classification. Angina pectoris.
Classification. Emergency care.
Cardiopulmonary resuscitation.
Definition
IHD - synonims – coronary disease,
coronary insufficiency – is severe chest
pain due to ischemia (a lack of blood and
hence oxygen supply) of the heart
muscle, generally due to obstruction or
spasm of the coronary arteries (the
heart's blood vessels).
Ethiology.
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Smoking
Dyslipidemia
Arterial hypertension
Diabetes mellitus
Obesity
Dietary factors
Thrombogenic factors
Lack of physical activity
Alcohol abuse
Causes of IHD
• 85 % - stenotic atherosclerosis of
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coronary arteries
10 % - spasm of coronary arteries
5 % - transitory thrombocytes
aggregates
100 % - combination of these factors
Morbidity in males is 4 times higher than
in females
Pathogenesis
Clinical forms of IHD
• 1. Sudden coronary death or heart arrest (HA)
– 1.1. HA with following resuscitation.
– 1.2. HA with following mortal outcome.
• 2. Angina pectoris (AP)
• 2.1 Stable angina at exertion.
• 2.1.1 Stable angina at exertion ( functional class
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should be determined).
2.1.2 Stable angina at exertion in
angiographically intact vessels (coronary
syndrome X).
• 2.2. Angiospastic angina (angina in rest,
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spontaneous, variant, Prinzmetals’ angina)
2.3. Unstable angina.
2.3.1. Primary angina.
2.3.2. Progressive angina.
3. MYOCARDIAL INFARCTION (МI)
4. CARDIOSCLEROSIS (postinfarctional, focal
and diffuse)
5. MYOCARDIAL ASCHEMIA WITHOUT PAIN
6. CARDIAC RRHYTHM DISORDERS (form)
7. HEART FAILURE (stage, functional class)
Angina pectoris
Angina is attack of retrosternal
pressing
pain
or
chest
dyscomfort which occures in
physical load or emotional strain
and is caused by myocardial
ischemia.
Provoking factors:
• physical load;
• Emotional strain;
• cold;
• overeating;
• smoking;
Factors which decrease pain:
• Refuse of physical load;
• Nitroglycerin/
• Patient try to stay or lie down in attack.
Stable angina at exertion
• Occurs in the same provoking
factors, is often follows with the
same complains and changes on
ECG.
AP functional classes
• І FC – attacks occur in a whery high load 1 – 2
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times a year. Coronary arteries lumen is
narrowed not more than on 50 %.
ІІ FC – attacks occur in walking on the plane
surface on the diastance more than 500м, in
going more than on 1 floor upstairs 2 – 3
times a week. Coronary arteries lumen is
narrowed not more than on 75 %.
• ІІІ FC – attacks occur in walking on the
plane surface on the diastance 200 – 300
м, in going 1 floor upstairs.
Postinfarctional angina. Coronary arteries
lumen is narrowed more than on 75%.
• ІV FC – attacks occur in walking on the
plane surface on the diastance less than
on 100 м, in rest. Combination of coronary
and myocardial insufficiency. Complete
obturation of coronary arteries.
Clinical pattern
• The major sign of stenocardia is attack-like
pain in the area of heart. It has squeezing,
cutting or burning character with
localization behind a breastbone, irradiates
in a left arm (left shoulder-blade, left half
of neck, lower jaw, sometimes – in a right
shoulder or shoulder-blade). Duration of
pain of 5-10 min (more frequently – 2-5
min).
Coronary syndrome X
• This is a stable angina at exertion when
small coronary arteries are affected.
• Clinical pattern is the same as for stable
angina but coronarography does not show
obturation of coronary arteries.
Angiospastic angina
• Caused by spasm of coronal arteries. Arises up
in young persons, mainly at night, in rest, when
tone of vagus nerve prevails. Duration of attack
till 30 min, during this time ECG shows changes
typical for MI (depression of ST segment) which
disappear after stopping of attack or application
of spasmolysants. Nitrates are uneffective with
the purpose of removal of attacks.
Acute coronary syndrome
• This is a result of myocardial ischemia
caused by thrombosis of coronaty artery
and its complete occlusion.
• The syndrome includes:
• 1. Unstable angina pectoris.
• Non-Q myocardial infarction.
• 3. Q- myocardial infarction.
Unstable angina pectoris
• At a stenocardia which arose up first, the attacks
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of pain are observed during 28 days for persons,
which did not have clinical signs of stenocardia
before. Usually this is angina at exertion.
Progressing angina is the state, at which
duration, intensity and frequency of anginal
attacks, grow in a dynamics, and the usual dose
of medications which take off an attack becomes
insufficient, that requires its permanent increase.
• Characteristic for progressing stenocardia
is pressing pain behind the sternum,
which periodically calms down and grows,
is not removed by nitrates, is accompanied
with swweating, dyspnea, arrhythmia, fear
of death. The episodes of attacks of
anginal pain become more frequent, and
periods between attacks shorten.
• Every next attack is heavier, than
previous. Nitrates (nitroglycerine,
Nitrosorbidum), which removed the
attacks of anginal pain before, are
uneffective, although a patient uses
considerably increased their amount.
• Pain can arise up not obviously due to
emotional or physical loading, but also in
rest. Sometimes only narcotic facilities
remove him. On a background a
stenocardia there can be an attack of
sharp left-ventricular insufficiency with
dyspnea, dry cough, bubbling in the chest.
Diagnostics of angina pectoris
functional tests:
• - exposure to cold;
• - test with hyperwentilation;
tests with dynamic physical load:
• а) veloergometry;
• б) tredmile test;
emotional stress-test;
pharmacological tests;
• а) test with dityridamole;
• б) test with isadrine;
• в) test with ergometrine;
transesophageat atrial electrostimulation;
daily ECG-mpnitoring
coronary angiography.
Tests with physical load
Laboratory examinations
• Complete blood count – 1 time a year
• Byochemical blood serum study (lipid
spectre, cholesterol - 1 time a year)
• ЕCG and functional tests – 2-3 times a
year in stable angina depending on
functional class.
Treatment
• Healthy life stile. Correction of risk factors,
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limitation of carbonhydratess and saturated fats
in diet. Employment. Psychprrophylaxis.
Medication (nitrates, other antianginal
preparations on a sedate agents) depending on
a functional class and concomitant diseases.
Sanatorium-resort treatment.
•Thank you!