Angina pectoris - This is a condition in which a person develops paroxysmal pain in the chest area. This is due to an acute lack of blood supply to the myocardium. Thus, the patient has clinical manifestations coronary heart disease.
Types of angina pectoris
In medicine, it is customary to determine several varieties of angina pectoris, depending on its frequency and nature. So, with first-come angina symptoms of angina pectoris occur for about a month, after which there is a regression of the disease, or the transition of the disease into a form of stable angina pectoris.
At intense (stable) angina pectoris regular development of seizures occurs. They arise at this stage as a consequence of various kinds of stress. This form of angina pectoris is spoken of as the most “pure” form of ailment. This stage of the disease often signals a high risk of development in the patient myocardial infarction.
At progressive (unstable) angina pectoris the patient’s seizures occur suddenly and unexpectedly. Often they develop in a person who is at rest. In the process of developing such an attack, a person feels very severe chest pain. This type of angina is most dangerous precisely because of the increased risk of myocardial infarction. Very often with unstable angina, the patient is hospitalized.
At variant angina the development of an attack often occurs at night and is a direct consequence of vasospasm. You can track this form of angina pectoris by ECG results. In general, it is a rather rare ailment.
Causes of Angina Pectoris
Angina pectoris is both a disease and a clinical syndrome. If we are talking about a separate disease, then most often angina occurs as a consequence atherosclerosiscoronary arteries. This phenomenon provokes a noticeable narrowing of the lumen of the arteries, which, in turn, prevents the normal blood supply to the myocardium. Especially often, angina pectoris manifests itself in a person due to intense physical and emotional stress. If arteries due to sharp atherosclerosis are narrowed by 75% or more, then angina attacks occur in the patient and due to moderate mental and physical stress.
An angina attack usually occurs after the blood flow to the mouth of the coronary arteries decreases. This happens in patients. arterial hypotension (especially dangerous in this case diastolic hypotension), at venous hypotension, cardiac output, tachyarrhythmias. Also, a reflex effect from the esophagus, biliary tract, and spine can provoke an attack of angina pectoris, if there are concomitant ailments of these organs. Acute narrowing of the lumen of the coronary artery occurs as a consequence of a non-obstructing thrombus, swelling of an atherosclerotic plaque.
An attack of angina pectoris subsides if the level of work of the heart muscle normalizes under the influence of Nitroglycerin or reduce the load. In this case, blood flow to the coronary arteries is normalized.
Symptoms of angina pectoris
Symptoms of angina pectoris are always clearly defined. So, the pain in angina pectoris is paroxysmal in nature, having a clearly defined time of the beginning and end of the attack. Pain always manifests itself under similar circumstances and conditions. After taking nitroglycerin, the pain gradually subsides or stops completely.
The main condition for the manifestation of an attack of angina in a person is a state of stress. Most often, it develops when walking - for example, during acceleration of movement, lifting up, in the process of carrying a heavy load or when moving immediately after a heavy meal. However, other forms of tension, as well as emotional overload, can provoke the manifestation of symptoms of angina pectoris. If physical effort continues or their intensity increases, then chest pain intensifies. But if a person stops efforts, then the pain symptoms of angina gradually disappear after a few minutes.
Sometimes pain with angina pectoris is localized behind the sternum, which is the most typical symptom. In more rare cases, the pain radiates to the neck, lower jaw, teeth, left arm and shoulder blade. Basically, the pain has a pressing, compressive character, in more rare cases, a burning, similar to heartburn pain. Sometimes a person feels heaviness in the chest, discomfort from the sensation of the presence of a foreign body in the chest.
With angina pectoris, the patient has a sharp increase blood pressure, perspiration is manifested, the person turns pale.
All the above characteristic features of pain are taken into account in the process of diagnosing a disease. They make it possible to distinguish the manifestation of angina pectoris from pain in the heart, which indicates other diseases.
Experts note that a similar mechanism for the occurrence of pain in angina pectoris is of great importance, since due to severe pain a person stops and stops physical activity, which is not possible for his heart.
Diagnosis of angina pectoris
The diagnosis of angina pectoris often occurs at the very first person’s appeal with a specialist. At the same time, to reject such a diagnosis, a patient should be monitored for a long time, a series of examinations should be carried out, as well as a thorough examination of the patient.
In the process of diagnosing angina pectoris, an ECG study is used, as well as stress tests, myocardial scintigraphy, two-dimensional echocardiography, radionuclide ventriculography, coronary angiography and other techniques. In the process of examining a patient using an ECG, a specialist can observe the presence of specific signs that indicate that the patient has myocardial ischemia. True, in the process of diagnosis, the fact that at rest such signs are not observed should be fateful, therefore, when conducting a standard ECG, it is not always possible to establish the correct diagnosis.
To detect such symptoms, a patient with suspected angina pectoris is given Holter monitoring. This technique consists in the fact that for a certain time, as a rule, a day, the ECG is constantly recorded. At the same time, a person continues to live his usual life. Thanks to this technique, it becomes possible to fix the manifestations of ischemia, to determine how much they are dependent on various kinds of tension, to find out how effective the treatment is and whether pathological changes are very pronounced.
Using stress tests, in which a situation is simulated when myocardial oxygen demand increases, a number of points that are important in the diagnostic process can be determined. Such tests are carried out exclusively under the strict supervision of a specialist, in the process of their implementation, signs of ischemia are recorded. It is important to consider that with unstable angina and myocardial infarction, such tests are not carried out. Also a contraindication to the use of this method is severe arrhythmia, Availability heart and respiratory failure, arterial hypertension high BP, strong tachycardia.
To date, three types of stress tests are used: physical loads on a bicycle ergometer and treadmill, pharmacological tests, pacemaker.
Using any of these methods, one of the methods is used to record ischemia: ECG, scintigraphy, echocardiography. The most commonly used tests are physical exercises on a bicycle ergometer (special exercise bike) or on a treadmill (treadmill) using ECG monitoring. Using special tables that take into account gender and age, the allowable load level is calculated. Test termination occurs after reaching this value. If there are no symptoms of ischemia, then the result of the test will be negative, and the person is not sick with angina pectoris. If signs of ischemia occur, then a person has angina pectoris. If a particular case seems to be very difficult for specialists, then the use of coronarography is possible. This method is highly informative. In the process of conducting such a study, selective contrasting and visualization of the coronary arteries using x-ray equipment is performed. Coronarography allows you to determine the presence of stenotic sections of the arteries and their degree of narrowing.
As the main mechanisms of calming an attack of angina pectoris: a rapid decrease in the level of work of the heart muscle and normalization of the adequacy of the inflow are determined. Therefore, the treatment of angina pectoris, first of all, involves the relief of attacks of the disease. Patients should be aware that this disease is a dangerous ailment, so therapy should be carried out exclusively under the supervision of a specialist and preferably in a hospital.
Using adequate treatment for angina pectoris, it is important to achieve the following results: reduce the risk of a patient developing future myocardial infarction, and improve the patient’s overall quality of life.
In order for the treatment of the disease to be as effective as possible, it is important to follow the doctor's recommendations without fail. So, you must completely stop smoking, balance your daily diet, optimize physical activity, and constantly monitor blood pressure.
Diet for patients with angina provides for the use of a minimum amount fats. It is important to prevent the occurrence of excess weight, and also limit alcohol consumption to 30 g per day.
To eliminate the causes that directly affect the manifestation of angina attacks in a person, it is important to prevent situations that increase the need for myocardial oxygen. So, both physical and emotional stresses that provoke the appearance of pain should not be allowed. If it is difficult to put into practice, then for prevention should definitely be taken antianginal drugs. It is equally important to abandon physical exertion, which occurs in parallel with other factors that provoke angina attacks. This is cold, wind, the state of the body after eating and after sleep. You can not take drugs that increase the myocardial oxygen demand for the treatment of other diseases.
As a medical treatment for angina pectoris, three main groups of drugs are prescribed that act on the coronary vessels, expanding them. These drugs are nitrates, b-blockers, calcium channel blockers. To stop an attack of angina pectoris, fast-acting drugs are chosen: this is, first of all, nitroglycerine in tablets, aerosols, applications, ampoules, as well as tablets nifedipine. Most often, patients take these funds sublingually, but today sprays are also becoming very popular. After nitroglycerin, the effect is noticeable after 1-3 minutes. If there is no effect after taking the pill, you can take another nitroglycerin tablet after five minutes. In the most severe cases, nitroglycerin preparations can be administered intravenously.
Long acting nitrates are drugs nitrosorbide, sustak forte, among the drug-in-blockers, it is most often used metoprolol, atenolol. Calcium channel blockers are diltiazem, verapamil, nifedipine. As a rule, at the beginning of treatment, the simplest and cheapest drugs are used - nitrates. If there is no effect from taking them, or the patient does not tolerate such a medicine, other groups of drugs are connected.
Angina pectoris - A form of ischemic heart disease, characterized by paroxysmal pain in the heart, due to acute myocardial blood supply insufficiency. There are angina of exertion that occurs during physical or emotional stress, and angina of rest, arising outside of physical effort, often at night. In addition to pain behind the sternum, it is manifested by a sensation of suffocation, pallor of the skin, fluctuations in the pulse rate, and sensations of interruptions in the work of the heart. May cause the development of heart failure and myocardial infarction.
The development, progression and manifestation of angina pectoris is influenced by modifiable (disposable) and unmodifiable (unremovable) risk factors.
Non-modifiable risk factors for angina include gender, age, and heredity. It has already been noted that men are most at risk for angina pectoris. This trend prevails until the age of 50-55, that is, before the onset of menopausal changes in the female body, when the production of estrogens, the female sex hormones that “protect” the heart and coronary vessels, decreases. After 55 years, angina pectoris occurs in persons of both sexes with approximately equal frequency. Often, angina pectoris is observed in direct relatives of patients suffering from coronary artery disease or who have suffered myocardial infarction.
Modifiable risk factors for angina pectoris a person has the opportunity to influence or exclude them from his life. Often, these factors are closely interrelated, and reducing the negative impact of one eliminates the other. Thus, a decrease in fat in food consumed leads to a decrease in cholesterol, body weight and blood pressure. Removable angina risk factors include:
- Hyperlipidemia. In 96% of patients with angina pectoris, an increase in cholesterol and other lipid fractions with an atherogenic effect (triglycerides, low density lipoproteins) is detected, which leads to the deposition of cholesterol in the arteries that feed the myocardium. The increase in the lipid spectrum, in turn, enhances the processes of thrombosis in the vessels.
- Obesity. Usually occurs in individuals who consume junk food with excessive amounts of animal fats, cholesterol and carbohydrates. Patients with angina pectoris need to limit cholesterol in their diet to 300 mg, table salt - up to 5 g, increase the intake of dietary fiber - more than 30 g.
- Lack of exercise. Inadequate physical activity predisposes to the development of obesity and impaired lipid metabolism. The impact of several factors simultaneously (hypercholesterolemia, obesity, physical inactivity) plays a decisive role in the occurrence of angina pectoris and its progression.
- Smoking. Cigarette smoking increases the concentration of carboxyhemoglobin in the blood - a combination of carbon monoxide and hemoglobin, which causes oxygen starvation of cells, primarily cardiomyocytes, arterial spasm, and increased blood pressure. In the presence of atherosclerosis, smoking contributes to the early manifestation of angina pectoris and increases the risk of acute myocardial infarction.
- Arterial hypertension. Often accompanies the course of coronary heart disease and contributes to the progression of angina pectoris. With arterial hypertension, due to an increase in systolic blood pressure, myocardial tension increases and its need for oxygen increases.
- Anemia and intoxication. These conditions are accompanied by a decrease in oxygen delivery to the heart muscle and provoke angina attacks, both against the background of coronary atherosclerosis and in its absence.
- Diabetes. In the presence of diabetes mellitus, the risk of coronary heart disease and angina pectoris increases by 2 times.Diabetics with a 10-year experience of the disease suffer from severe atherosclerosis and have a worse prognosis in the case of angina pectoris and myocardial infarction.
- Increase in relative blood viscosity. It promotes the processes of thrombosis at the site of development of atherosclerotic plaque, increases the risk of coronary artery thrombosis and the development of dangerous complications of coronary artery disease and angina pectoris.
- Psycho-emotional stress. Under stress, the heart works under conditions of increased stress: angiospasm develops, blood pressure rises, and the supply of myocardium with oxygen and nutrients worsens. Therefore, stress is a powerful factor provoking angina pectoris, myocardial infarction, sudden coronary death.
Among the risk factors for angina pectoris also include immune reactions, endothelial dysfunction, increased heart rate, premature menopause and hormonal contraceptives in women, etc.
The combination of 2 or more factors, even moderate, increases the total risk of developing angina pectoris. The presence of risk factors should be taken into account when determining treatment tactics and secondary prevention of angina pectoris.
According to the international classification adopted by WHO (1979) and the All-Union Cardiology Research Center (VKNC) of the Academy of Medical Sciences of the USSR (1984), the following types of angina are distinguished:
Angina pectoris - proceeds in the form of transient attacks of sternal pain caused by emotional or physical stress that increases the metabolic needs of the myocardium (tachycardia, increased blood pressure). Usually the pain disappears at rest or is stopped by taking nitroglycerin. Angina pectoris includes:
The first angina pectoris - lasting up to 1 month. from the first manifestation. It can have a different course and prognosis: to regress, go into stable or progressive angina pectoris.
Stable angina pectoris - lasting more than 1 month. According to the patient’s ability to tolerate physical activity, it is divided into functional classes:
- I class - good tolerance to normal physical exertion, the development of angina attacks is caused by excessive loads, performed for a long time and intensively,
- II class - normal physical activity is somewhat limited, the occurrence of angina attacks is provoked by walking on flat terrain more than 500 m, climbing stairs more than 1 floor. Cold weather, wind, emotional arousal, the first hours after sleep influence the development of an angina attack.
- III class - normal physical activity is sharply limited, angina attacks are caused by walking at the usual pace on flat terrain for 100-200 m, climbing stairs to the 1st floor.
- IV class - angina develops with minimal physical exertion, walking less than 100 m, in the middle of sleep, at rest.
Progressive (unstable) angina pectoris - an increase in the severity, duration and frequency of seizures in response to the patient's usual load.
Spontaneous (special, vasospastic) angina pectoris - due to sudden spasm of the coronary arteries. Angina attacks develop only at rest, at night or early in the morning. Spontaneous angina pectoris, accompanied by a rise in the ST segment, is called variant, or Prinzmetal angina.
Progressive, as well as some variants of spontaneous and first-occurring angina, are combined into the concept of "unstable angina."
Classifications of Unstable Angina Pectoris Edit
Class I. The recent onset of severe or progressive angina pectoris. An history of exacerbation of coronary heart disease less than 2 months.
Class II Angina pectoris of rest and tension subacute. Patients with anginal attacks during the previous month, but not during the last 48 hours
Class III Acute angina pectoris. Patients with one or more anginal attacks at rest over the past 48 hours
Classification of unstable angina pectoris depending on the conditions of occurrence
Class A. Secondary unstable angina. Patients in whom NS develops in the presence of factors aggravating ischemia (anemia, fever, infection, hypotension, uncontrolled hypertension, tachyarrhythmia, thyrotoxicosis, respiratory failure).
Class B. Primary unstable angina. Patients in whom NS develops in the absence of factors aggravating ischemia.
Class C. Early postinfarction unstable angina. Patients in whom NS developed during the first 2 weeks after AMI.
Classification of unstable angina pectoris depending on the availability of therapeutic measures during its occurrence
- - in the absence or minimal treatment.
- - against the background of adequate therapy.
- - against the background of therapy with all three groups of antianginal drugs, including intravenous administration of nitroglycerin.
At present, it can be considered established that angina pectoris is caused by acute insufficiency of coronary blood supply arising from a mismatch between the flow of blood to the heart and its need for blood. The result of acute coronary insufficiency is myocardial ischemia, which causes a violation of the oxidative processes in the myocardium and excessive accumulation of under-oxidized metabolic products (lactic, pyruvic, carbonic and phosphoric acids) and other metabolites in it.
The most common cause of angina pectoris is coronary atherosclerosis. Significantly less often angina occurs with infectious and infectious-allergic lesions.
Provoke attacks of angina pectoris emotional and physical stress.
With a sudden cessation of blood flow to the area of the heart muscle, its ischemia sets in, and then necrosis. Later, around the focus of necrosis, inflammatory changes are formed with the development of granulation tissue.
Most patients with angina pectoris feel discomfort or pain in the chest area. Discomfort is usually oppressive, compressive, burning character. Often, such patients, trying to describe the area of discomfort, apply a clenched fist or an open palm to the chest. Often the pain radiates (“gives”) to the left shoulder and the inner surface of the left hand, neck, less often to the jaw, teeth on the left side, the right shoulder or arm, the interscapular region of the back, and also to the epigastric region, which may be accompanied by dyspeptic disorders ( heartburn, nausea, colic). Extremely rarely, pain can be localized only in the epigastric region or even in the head region, which makes diagnosis very difficult.
Attacks of angina pectoris usually occur with physical exertion, strong emotional arousal, after taking an excessive amount of food, staying at low temperatures or with an increase in blood pressure. In such situations, the heart muscle needs more oxygen than it can get through the narrowed coronary arteries. In the absence of coronary artery stenosis, spasm or thrombosis, chest pain associated with physical exertion or other circumstances leading to an increase in oxygen demand of the heart muscle can occur in patients with severe left ventricular hypertrophy caused by aortic valve stenosis, hypertrophic cardiomyopathy, as well as aortic regurgitation or dilated cardiomyopathy.
An attack of angina pectoris usually lasts from 1 to 15 minutes. It disappears when the load stops or when short-acting nitrates are taken (for example, nitroglycerin under the tongue).
Laboratory tests help establish a possible cause of myocardial ischemia.
- Clinical blood test. Changes in the results of a clinical blood test (lowering hemoglobin levels, shifts in the leukocyte formula, etc.) allow us to identify concomitant diseases (anemia, erythremia, leukemia, etc.) that provoke myocardial ischemia.
- Determination of biochemical markers of myocardial damage. In the presence of clinical manifestations of instability, it is necessary to determine the level of troponin or the CF fraction of creatine phosphokinase in the blood. An increase in the level of these indicators indicates the presence of acute coronary syndrome, and not stable angina pectoris.
- Blood chemistry. All patients with angina pectoris need to study the lipid profile (total cholesterol, HDL, LDL and triglyceride levels) to assess cardiovascular risk and the need for correction. Creatinine levels are also determined to assess renal function.
- Glycemia score. To identify diabetes mellitus as a concomitant pathology in angina pectoris, fasting glucose is assessed, a glycated hemoglobin test is performed. The universally accepted glucose tolerance test is obsolete.
- In the presence of clinical signs of thyroid dysfunction, the level of thyroid hormones in the blood is determined.
Instrumental methods Edit
- ECG alone. All patients with suspected angina pectoris need to register an ECG at rest in 12 standard leads. Although the results of this method are normal in approximately 50% of cases of observation of patients with angina pectoris, signs of coronary heart disease (for example, history of myocardial infarction or repolarization disorders), as well as other changes (left ventricular hypertrophy, various arrhythmias) can be detected. This allows you to determine the further plan of examination and treatment. An ECG may be more informative if it is recorded during an attack of angina pectoris (usually during inpatient observation).
- Exercise ECG. Apply treadmill test or bicycle ergometry with ECG monitoring in 12 standard leads. The main diagnostic criterion for ECG changes during such tests: horizontal or oblique depression ST ≥ 0.1 mV, remaining at least 0.06-0.08 s after point J, in one or more ECG leads. The use of stress tests is limited in patients with an initially changed ECG (for example, with blockade of the left bundle branch block, arrhythmias, or WPW syndrome), since it is difficult to correctly interpret changes in the ST segment.
- Daily ECG monitoring (Holter). This method is inferior in informativeness to stress tests, but allows to detect myocardial ischemia during normal daily activities in 10-15% of patients with stable angina pectoris who do not experience ST segment depression during stress tests. This method is especially valuable for the diagnosis of vasospastic angina pectoris.
- Echocardiography alone - allows you to detect or rule out other disorders (for example, valvular heart defects or hypertrophic cardiomyopathy) as the cause of the symptoms, as well as evaluate the function of the ventricles, the size of the heart cavities, etc.
- Physical or pharmacological scintigraphy they carry out isotopes of thallium-201, technetium-99 sestamibi or tetrophosmin in combination with physical activity. If patients can not perform physical activity, scintigraphy is used in combination with pharmacological tests (administration of dobutamine, dipyridamole or adenosine).
- Stress Echocardiography. It has both advantages and disadvantages compared with myocardial scintigraphy and is an alternative to the latter. Perform echocardiography in combination with pharmacological or physical activity.
Given the possible complications of this invasive procedure, coronary angiography is indicated in the following cases:
- in patients who are highly likely to need myocardial revascularization,
- in patients who have had cardiac arrest, or with life-threatening ventricular arrhythmias,
- if the diagnosis is not confirmed using non-invasive methods.
The goals of treating angina pectoris:
- improving the prognosis of the disease by preventing the development of myocardial infarction and death,
- reduction or elimination of symptoms.
Causes of angina pectoris
Perhaps the main cause of angina pectoris is a narrowing of the lumen of the coronary arteries (their spasm), which occurs against the background of pathological processes in these arteries. As a result of a spasm, a mismatch appears between the oxygen demand of the myocardium and its delivery. The most common (92%) pathological process - the cause of arterial spasm - is atherosclerosis, sometimes it can be combined with thrombosis. Another cause of stenosis may be a violation of the function of the endothelium (inner membrane) of the vessels.
Fig. 1. Causes of narrowing of the coronary arteries.
In recent years, researchers have identified risk factors that can lead to coronary atherosclerosis. All of them are divided into 3 main groups.
1 group - a way of life.
Risk factors of this group are modifiable, i.e. mutable:
- a high cholesterol diet (egg yolks, caviar, cheeses, margarine, pork, etc.),
- excessive drinking
- low physical activity (lack of exercise).
Group 2 - physiological characteristics, which are also modifiable features:
- elevated levels of total cholesterol in blood plasma (normally it should be 3.6-5.2 mmol / l),
- high blood pressure
- low levels of “good” cholesterol (HDL cholesterol),
- elevated plasma triglycerides (normal - less than 1.7 mmol / l),
3 group - personality characteristics (unmodifiable factors):
- age (over 45 years for men and 55 years for women),
- burdened family history of atherosclerosis.
The combination of several risk factors significantly increases the likelihood of developing atherosclerosis and, as a consequence, coronary heart disease and its form - angina pectoris. Today, coronary heart disease is the main cause of mortality. According to the State Research Center (State Research Center) of Preventive Medicine in Russia, about 10 million able-bodied people suffer from coronary heart disease. It should be borne in mind that angina pectoris as the beginning of coronary heart disease occurs in almost 50% of patients. At the same time, about 40-50% of these people are aware of their disease, while 50-60% of cases of the disease remain unrecognized and untreated. It is for these reasons that it is very important to recognize angina pectoris in time and seek help from a doctor.
First aid for angina pectoris:
- Take a comfortable, comfortable position, optimally sitting.
- Take nitroglycerin: 1 tablet under the tongue or 1-2 drops of a 1% solution of nitroglycerin on a piece of sugar, which must also be put under the tongue. You need to take the drug immediately when pain occurs. You can take ½ tablets if the drug causes severe headache.
- If after 5 minutes after taking nitroglycerin the pain has not stopped, you can take the drug again, but do not repeat more than 3 times!
- To reduce the headache, which is sometimes observed when taking nitroglycerin, you can take validol (under the tongue), citramone (inside), drink hot tea. For severe headaches, instead of nitroglycerin, you can use Sydnopharm (1 tablet = 2 mg under the tongue) or Corvaton (1 tablet = 2 mg under the tongue).
- With a rapid heartbeat (tachycardia), take anaprilin up to 40 mg under the tongue.
- If the pain persists after taking the drugs again, and moreover, symptoms such as develop:
- increased pain in the heart,
- severe weakness
- difficulty breathing
- cold sweat
emergency medical attention should be called because there is a risk of myocardial infarction.
Prevention of angina pectoris
Treatment of an attack of angina pectoris, of course, is an important link in preventing the progression of coronary heart disease and the development of complications. Treatment is carried out in three directions:
- impact on modifiable risk factors,
- drug treatment
- surgical methods.
The second and third deposition are carried out only with the help of a specialist doctor, but each person can affect the risk factors.
The recommendations of the American College of Cardiology provide a list of activities whose usefulness and effectiveness in order to prevent angina pectoris and coronary heart disease has been proven and does not raise doubts among experts. These activities include:
- Treatment of arterial hypertension, with the target pressure level being numbers below 130/80 mm Hg. Preference is given to such groups of drugs as β-blockers, calcium antagonists, ACE inhibitors. Medication is selected by a doctor!
- To give up smoking. In smokers, the risk of developing myocardial infarction (acute ischemic heart disease) is 2 times higher than in non-smokers, and the risk of sudden death is 2-4 times. An interesting fact: the risk of coronary heart disease due to smoking is completely eliminated after 2-3 years, after a person stops smoking.
- Treatment (adequate compensation) of diabetes. Uncompensated diabetes mellitus, as a concomitant disease, accelerates the progression of coronary atherosclerosis and, as a consequence, angina pectoris. Type 2 diabetes mellitus increases the risk of death by 2 times in men and 4 times in women. And with type 1 diabetes mellitus, this risk increases by 3-10 times, so the need for optimal hypoglycemic therapy is widely recognized.
- Physical training. In people with a predominantly sedentary lifestyle, the risk of developing coronary heart disease is increased by 1.5-2 times. Experts recommend exercising for 30 minutes at least 4 times a week, or even better every day. The best sports that have a positive effect on the whole body are swimming, jogging, Nordic walking, gymnastics, aerobics, cycling. Remember: the best medicine for the heart is to train its stamina.
- Hypolipidemic therapy (therapy aimed at lowering blood lipids) is prescribed by a doctor and is an important component of the treatment of coronary artery disease.
- Reducing overweight in the presence of arterial hypertension is an important component of the treatment of patients with coronary artery disease. It is important to adhere to a hypocaloric diet with a sufficient amount of fiber-rich plant foods.
Experts found a very interesting dependence of the risk of coronary heart disease on alcohol by conducting an analysis that combined the results of 34 studies from different countries (USA, England, Japan, Germany, Russia, France, Australia, and many others). Scientists have concluded that moderate alcohol consumption reduces mortality from coronary heart disease. Experts have described the so-called U- or J-shaped relationship between alcohol consumption and mortality from coronary heart disease.
Fig. 2.J-shaped alcohol dependence of the risk of CHD.
1 - a group of people who abuse alcohol,
2 - a group of people who drink alcohol moderately,
bold line - no alcohol at all.
It can be seen from the graph that there is an increased risk among people who do not drink alcohol and those who drink excessively compared to those who drink moderately. Under moderate alcohol consumption, understand no more than 1 fluid ounce (28.41 ml) of pure ethyl alcohol per day. According to the study, the consumption of 10-30 g of absolute alcohol per day reduces the risk of coronary heart disease by 20-50%, and stroke and sudden coronary death by 20-30%. This phenomenon was called the “French paradox," because heart diseases are relatively less common in France (the mortality rate from cardiovascular diseases is 2.5 times lower than, for example, in the UK). This paradox is explained by the fact that the French consume a lot of red wine.
It also follows from the graph that mortality is minimal when drinking alcohol on average 5-10 grams, and regarding safe doses at which mortality is the same in all study groups - 30-40 grams of ethanol.
The question of the influence of psychosocial factors on the risk of developing coronary heart disease remains controversial. The book of Ecclesiastes teaches: "Envy and anger shorten life." Many convincing scientific evidence suggests that hostility, anger, anger may be associated with the risk of coronary heart disease, but final conclusions have not yet been made. The relationship of IHD with stress can be traced to the fact that, being in frustrated feelings, a person smokes a lot, drinks, overeats, quits sports - and all this directly increases the risk of IHD. Therefore, to prevent the development of coronary heart disease, relaxation and psycho-training are recommended as a method of reducing chronic stress.
Coronary heart disease is a formidable disease that is in first place in the structure of mortality. Angina pectoris is a clinical syndrome of coronary heart disease, which over time passes into the clinical form of coronary heart disease and becomes a disease. Human health in many respects depends on himself.
According to the World Health Organization (WHO), human health is 20% determined by heredity, 10% depends on medical care, 20% is allocated to the environmental impact, and 50% of each person’s health is the result of their lifestyle.
Our own health is in the hands of each person, we ourselves determine in many ways whether we are ill or not, and if we are ill, then with what. It is much more effective and cost-effective to prevent the disease, rather than treat it. This also applies to angina pectoris. The need to lead a healthy lifestyle is not empty words. Changing the lifestyle in favor of maintaining health is quite possible, realistically achievable and uncomplicated. All that is required of a person is his desire. It is hard to imagine that there may be no desire.
What can motivate better than a real opportunity to live a healthy, fulfilling life?
Forecast and Prevention
Angina pectoris is a chronic, disabling heart disease. With the progression of angina pectoris, there is a high risk of developing myocardial infarction or death. Systematic treatment and secondary prevention help control the course of angina pectoris, improve prognosis and maintain working capacity while limiting physical and emotional stress.
Effective prophylaxis of angina pectoris requires the exclusion of risk factors: reducing excess weight, controlling blood pressure, optimizing diet and lifestyle, etc. As a secondary prophylaxis with an already established diagnosis of angina pectoris, it is necessary to avoid worries and physical effort, prophylactically take nitroglycerin before exercise, and prevention of atherosclerosis, conduct therapy of concomitant pathologies (diabetes mellitus, gastrointestinal tract diseases). Exactly following the recommendations for the treatment of angina pectoris, taking prolonged nitrates, and a cardiologist’s dispensary monitoring can achieve a state of prolonged remission.
The essence (pathophysiology) of angina pectoris
Angina pectoris is also often called "angina pectoris," because its essence is pain of a different nature, localized behind the sternum, in the central part of the chest in the area of the heart. Typically, angina pectoris is described as a sensation of pain, heaviness, constriction, pressure, discomfort, burning, constriction, or pain behind the sternum. Unpleasant sensations in the chest can spread to the shoulders, arms, neck, throat, lower jaw, shoulder blade and back.
Angina pectoris pain occurs due to insufficient blood supply to the heart muscle in coronary heart disease. The moments in which there is a severe deficiency in the blood supply to the heart muscle are called ischemia. With any ischemia, oxygen deficiency occurs, since insufficient blood is brought to the heart muscle to fully satisfy its needs. It is the oxygen deficiency during ischemia that causes pain in the area of the heart, which is called angina pectoris.
Cardiac muscle ischemia is usually caused by atherosclerosis of the coronary (cardiac) vessels, in which there are plaques of various sizes on the walls of the blood arteries that cover and narrow their lumen. As a result, much less blood than necessary is delivered to the heart muscle through the coronary arteries, and the body begins to “starve”. In moments of especially severe starvation, an attack develops, which from the point of view of physiology is called ischemia, and from the point of view of clinical manifestations, it is angina pectoris. That is, angina pectoris is the main clinical manifestation of chronic coronary heart disease, in which the myocardium feels pronounced oxygen starvation, since not enough blood flows through the vessels with a narrow lumen.
The situation of coronary heart disease, the main manifestation of which is angina pectoris, can be roughly compared with old, rusted tubes, the lumen of which is clogged with various deposits and dirt, as a result of which water from the tap flows in a very thin stream. Likewise, too little blood flows through the coronary arteries that cannot satisfy the needs of the heart.
Since coronary heart disease is a chronic disease that occurs for a long time, its main manifestation - angina pectoris also happens in humans for years. Angina pectoris usually has the character of an attack that occurs in response to a sharp increase in the oxygen demand of the heart, for example, during physical exertion, strong emotional experience or stress. At rest, angina pain is almost always absent. Attacks of angina pectoris, depending on living conditions, the presence of provoking factors and treatment, can be repeated at different frequencies - from several times a day to several episodes per month. You should know that as soon as a person has an attack of angina pectoris, this indicates oxygen starvation of the heart muscle.
Symptoms of atypical angina pectoris
An atypical angina attack can occur with pain in the arm, in the shoulder blade, in the teeth, or shortness of breath. And women, the elderly, or those with diabetes may not experience any pain with an angina attack. In this category of people, angina pectoris is manifested by frequent palpitations, weakness, nausea, and severe sweating. In rare cases, angina pectoris is completely asymptomatic, and in this case it is called "silent" ischemia.
In general, there are two main options for atypical manifestations of angina pectoris:
1. Shortness of breath arising on inhalation and exhalation. The cause of shortness of breath is incomplete relaxation of the heart muscle,
2. Strong and severe fatigue at any load that occurs due to insufficient oxygen supply to the heart muscle and low contractile activity of the heart.
The atypical signs of the syndrome are currently called angina equivalents.
Stable angina pectoris (exertional angina)
Stable angina pectoris, depending on the severity of the course and the nature of the attacks, is divided into the following functional classes:
- I functional class characterized by a rare occurrence of short-term attacks. Angina pectoris develops with an unusual and very quickly performed form of physical activity. For example, if a person is not used to wearing heavy and uncomfortable objects, then the quick transfer of several basins or buckets of water from one point to another may well become a provocateur of an angina attack,
- II functional class characterized by the development of angina attacks with a quick climb up the stairs, as well as with fast walking or running. Frosty weather, strong winds or dense food can become additional provoking factors. This means that fast movement in the cold wind will cause an angina attack faster than just walking at high speed,
- III functional class characterized by the development of angina attacks even when walking slowly to a distance of more than 100 meters or when climbing stairs one floor. An attack can develop immediately after going outside in frosty or windy weather. Any excitement or nervous experience can provoke angina attacks. With the III functional class of angina pectoris in a person, normal, daily physical activity is very limited,
- VI functional class characterized by the development of angina attacks with any physical activity. A person becomes unable to perform any simple and light physical exertion (for example, sweeping the floor with a broom, walking 50 meters, etc.) without angina attacks. In addition, the functional class IV is characterized by the appearance of rest angina pectoris, when seizures appear without previous physical or psychological stress.
Typically, in the diagnosis or in specialized medical literature, the term “functional class” is abbreviated as FC abbreviation. Next to the letters FC, the Roman numeral indicates the class of angina pectoris diagnosed in this person. For example, the diagnosis can be formulated as follows - "angina pectoris, FC II." This means that a person suffers from angina pectoris of the second functional class.
The determination of the functional class of angina pectoris is necessary, since this is the basis for the selection of drugs and recommendations for a possible and safe amount of physical activity that can be performed.
A change in the nature and course of existing angina is regarded as the development of unstable angina. That is, unstable angina is a completely atypical manifestation of the syndrome, when the attack lasts longer or, conversely, is shorter than usual, is provoked by any completely unexpected factors or develops even against the background of complete rest, etc. Currently, unstable angina pectoris means the following conditions:
- Primary angina pectoristhat arose for the first time in life and lasting no longer than a month
- Progressive angina pectoris characterized by a sudden increase in the frequency, quantity, severity and duration of angina attacks. The appearance of angina attacks at night is characteristic,
- Angina pectoris characterized by the development of seizures on the background of rest, in a relaxed state, which for several hours was not preceded by any physical activity or emotional stress,
- Post-infarction angina - This is the appearance of attacks of pain in the heart at rest within 10-14 days after myocardial infarction.
The presence of any of the above conditions in a person means that he suffers from unstable angina, manifested in this way.
The development of unstable angina is an indication for urgent medical attention or to call an ambulance. The fact is that unstable angina pectoris requires mandatory, immediate treatment in the intensive care unit. If the necessary therapy is not carried out, then unstable angina can provoke a heart attack.
Methods for distinguishing stable and unstable angina
To distinguish between stable and unstable angina, it is necessary to evaluate the following factors:
1. What level of physical activity provokes an attack of angina pectoris,
2. The duration of the attack,
3. The effectiveness of nitroglycerin.
With stable angina, the attack is provoked by the same level of physical or emotional stress. With unstable angina, the attack is provoked by less physical exertion or even occurs at rest.
With stable angina, the duration of the attack is no longer than 5-10 minutes, and with unstable it can last up to 15 minutes. In principle, any lengthening of the duration of the attack compared with the usual is a sign of unstable angina.
With stable angina, the attack is stopped by taking only one tablet of Nitroglycerin. The pain disappears within 2 to 3 minutes after taking the nitroglycerin tablet. With unstable angina, one tablet of Nitroglycerin is not enough to stop the attack. A person is forced to stop taking more than one tablet of Nitroglycerin to stop the pain. That is, if the effect of one tablet of Nitroglycerin for the relief of pain in the heart is enough, then we are talking about stable angina pectoris. If one tablet is not enough to stop the attack, then we are talking about unstable angina.
The relationship between heart attack and angina pectoris
Coronary heart disease is characterized by the constant presence of myocardial ischemia of varying severity. If CHD is in remission, the manifestations of ischemia are angina attacks. If IHD goes into the acute stage, then its manifestation is myocardial infarction. Thus, angina pectoris and heart attack are manifestations of a chronic and acute course of the same disease - IHD.
Since both heart attack and angina pectoris are manifestations of coronary heart disease, they can precede each other. So, according to statistics, with the appearance of angina pectoris, 10% of people develop myocardial infarction within a year. And after a heart attack in a person, angina attacks can become more frequent, that is, its functional class will become higher.
Angina pectoris is not a pre-infarction condition, but its presence indicates a high risk of developing myocardial infarction. And any transferred heart attack can lead to the appearance or aggravation of an existing angina pectoris. However, there is no direct connection between these two manifestations of CHD.
What examinations can a doctor prescribe for angina pectoris?
In addition, if you suspect a thyroid disease, additionally for angina is prescribed blood test to determine the concentration of thyroid hormones (sign up) - T3 and T4.
If the doctor suspects a recent heart attack that a person has survived, which is called "on his feet," then a blood test is prescribed to determine the activity of troponin, KFK-MV (creatine phosphokinase, subunit of MV), myoglobin, LDH (lactate dehydrogenase), AsAT (aspartate aminotransferase). The activity of these enzymes makes it possible to detect even small heart attacks, which proceeded relatively easily, disguising themselves as an attack of angina pectoris.
According to the results of laboratory tests, the necessary diet is prescribed, and medications are selected.
After passing the laboratory tests, the doctor must prescribe the following instrumental studies necessary to assess the severity of angina pectoris:
- ECG (electrocardiography) (sign up). A method that allows you to detect changes in the heart that are characteristic of angina pectoris (rhythm and conduction disturbances, myocardial hypertrophy, lengthening of the heart cycle, possibly signs of a past heart attack). However, outside the attack in many, especially young patients with angina pectoris, no changes are detected on the ECG, that is, it is the same as in healthy people. If the ECG is removed during an attack of angina pectoris, signs of myocardial ischemia are always recorded, such as a high (more than 8 mm) and / or negative T wave, the ST segment drops below the isoline or is sharply raised.
- Holter ECG monitoring (daily ECG) (sign up). The method, which consists in wearing a small device that fixes the ECG continuously for a day. Such monitoring allows you to record even minor attacks of angina pectoris, as well as to determine the conditions for the occurrence of attacks.
- Functional stress tests (bicycle ergometry (sign up), treadmill, dobutamine test, dipyridamole test, transesophageal electrical stimulation of the heart). These samples are an artificial provocation of an attack of angina pectoris in order to accurately identify and confirm it in those patients in whom the ECG is completely normal. During functional tests, an ECG is continuously recorded, pressure is measured every 2 to 3 minutes, and heart sounds are heard. The most commonly performed bike ergometry and treadmill. Dobutamine, dipyridamole tests and transesophageal electrostimulation are carried out only in cases where the patient can not walk the treadmill (run along the path) or bicycle ergometry (pedaling on the simulator).
- Scintigraphy. A method that allows you to identify areas of the heart muscle suffering from ischemia by introducing thallium isotopes into the vessels of the heart. After the introduction of isotopes, their radiation is fixed by special devices, and in the ischemic region, such radiation is much lower than in neighboring, not suffering from a lack of oxygen.
- Echo-KG (echocardiography) (sign up). A method that allows you to assess the condition of the heart muscle and blood vessels, that is, to determine the size of the heart, the degree of filling with blood of the heart, the presence of stagnation in the small circle, thickening of the myocardium, existing blood flow disorders in the cardiac arteries. With angina pectoris, a deterioration in the mobility of the heart wall in the area of ischemia is usually recorded.
- Coronarography (sign up). A method that allows you to identify vessels of the heart affected by atherosclerosis, the size of atherosclerotic plaques, the degree of narrowing of the lumen of the arteries. During coronarography, a radiopaque substance is introduced into the vessels of the heart, after which several x-rays are taken.
Instrumental examinations are necessary to establish the volume of damage to the blood vessels of the heart, as well as to determine the functional class of angina pectoris. These factors are important in the selection of the necessary therapy.
In practice, with angina pectoris, the doctor usually prescribes not all of the listed instrumental examinations, but only some of the most necessary in a particular case. As a rule, for all patients with angina pectoris, the doctor prescribes an ECG, functional stress tests and Echo-KG without fail. We can say that this is the minimum diagnostic set of instrumental examinations for angina pectoris. If technically feasible, Holter ECG monitoring and scintigraphy are also prescribed.
In general, coronary angiography is the best study to identify the severity of angina pectoris and the extent of damage to the blood vessels of the heart, which allows you to accurately determine which part of the myocardium, in what area, and how many arteries are narrowed. Also, using the method, you can establish the degree of narrowing of the vessels that feed the heart muscle. In addition, during coronarography, the doctor can establish additional information about the state of the blood vessels of the heart, such as thrombosis, tearing of the arterial wall, spasm, etc. This method has no contraindications, so it can be used to examine any person, regardless of the severity of his condition .
Coronary angiography must be prescribed in the following cases:
- Angina pectoris of functional class III-IV, persisting during therapy,
- Signs of severe myocardial ischemia based on ECG, Holter monitoring, bicycle ergometry, etc.,
- The presence in the past of episodes of ventricular arrhythmias or cases of sudden cardiac death,
- Progression of angina pectoris during therapy,
- Doubtful results of other instrumental examination methods (ECG, Echo-KG, etc.).
In all other cases, coronarography is optional, and is prescribed if it is technically possible and the patient agrees to an unpleasant examination.
Emergency relief for angina pectoris - relief of an attack
With the development of an attack of angina pectoris, it is necessary to sit comfortably, legs down. Against the backdrop of the ongoing attack, it is strictly forbidden to get up, walk and perform any physical work. It is necessary to free the throat and chest of a person who has developed an attack of angina pectoris, unbuttoning his shirt and removing his tie or scarf. If possible, you should also open a window or window, providing access to fresh air.
In a seated, relaxed position, a person with an attack of angina should chew half or one standard Aspirin tablet, and then, to relieve pain, put Nitroglycerin or Nitrolingval under the tongue. Also, to relieve pain, Izoket can be used by sprinkling one dose under the tongue. Then you should sit quietly and wait for the end of the angina attack, which should not last longer than 15 minutes.
If within 3 minutes after taking Nitroglycerin or Nitrolingval, the pain does not subside, then you can take another pill. Isoket can be sprayed at intervals of one minute in the absence of a clinical effect. You can not use more than three tablets of Nitroglycerin and Nitrolingval or three doses of Isoket to stop one attack of angina pectoris.
Ambulance should be called in the following cases:
- If an angina attack occurs for the first time in my life,
- The pain in the heart continues for more than five minutes, does not subside or intensifies,
- The pain in the heart region intensifies, lasts more than five minutes and is combined with difficulty breathing, weakness and vomiting,
- Pain in the heart did not stop or worsen after taking the Nitroglycerin tablet for five minutes.
In the above cases, it is absolutely necessary to call an ambulance, because a person may not have an angina attack, but the initial stage of a heart attack.
A crucial role in achieving the first goal is played by a change in the patient’s lifestyle. Improving the prognosis of the disease can be achieved by the following measures.
- To give up smoking.
- Moderate physical activity.
- Diet and weight loss: restriction of salt and saturated fat intake, regular consumption of fruits, vegetables and fish.
Dyslipidemia Treatment Edit
Dieting is important as initial therapy in patients with elevated lipid levels, but according to various studies, this is not enough to reduce the risk of cardiovascular complications. Therefore, lipid-lowering drugs - HMG-CoA reductase inhibitors (statins) are prescribed. The goal of treatment is to lower total cholesterol to 4.5 mmol / L (175 mg / dl) or lower and lower LDL cholesterol to 2.5 mmol / L (100 mg / dl) or lower.
Acetylsalicylic acid at a dose of 75-150 mg / day is prescribed to all patients with angina pectoris for life in the absence of contraindications. The dose should be minimally effective, since with an increase in the dose, the risk of developing gastrointestinal side effects (bleeding, ulcerogenicity) increases.
In the presence of contraindications to acetylsalicylic acid, clopidogrel can be prescribed, which in studies has shown greater effectiveness and less often caused the development of gastrointestinal bleeding. However, the high cost of clopidogrel creates certain difficulties. It has also been shown that the addition of esomeprazole (80 mg / day) to acetylsalicylic acid is better than switching to clopidogrel for the prevention of recurrent ulcerative bleeding in patients with peptic ulcer and vascular diseases.
Symptomatic Therapy Edit
β-adrenergic blocking agents are effective for stopping angina attacks, and they are recommended to be used as first-line drugs to relieve anginal episodes. Their antianginal effect is due to a decrease in myocardial oxygen demand due to a decrease in heart rate (HR) and blood pressure. Diastole also lengthens and thereby increases the time of blood supply to the ischemic zones of the myocardium. The most preferred are cardioselective β-blockers (they are less likely to cause side effects than non-selective), among which the most widely used are metoprolol, bisoprolol and atenolol. The effectiveness of β-adrenergic blocking is judged by the following clinical parameters: heart rate at rest Calcium channel blockers
There are 2 subgroups of calcium channel blockers: non-dihydropyridine derivatives (e.g. verapamil and diltiazem) and dihydropyridine derivatives (e.g. nifedipine and amlodipine). The mechanism of action of these subgroups is different, but they all have antianginal action and are effective in the treatment of angina pectoris. All calcium channel blockers are prescribed in the form of prolonged forms, which are taken 1 time per day. Dihydropyridine derivatives can be added to β-blockers in patients who cannot achieve the desired effect. The combination of non-dihydropyridine calcium channel blockers and β-blockers is not recommended, as this may cause excessive bradycardia. Non-dihydropyridine calcium channel blockers can replace β-adrenergic blockers in the presence of contraindications for the purpose of the latter (for example, bronchial asthma, COPD, severe atherosclerosis of the lower extremities).
Among the side effects, peripheral edema of the legs most often occurs (especially when taking dihydropyridine derivatives). Diltiazem can lead to symptomatic bradycardia, verapamil to constipation and hyperemia, which in turn can lead to a deterioration in the contractility of the myocardium, which should be taken into account when combined with β-blockers.
Currently, 3 drugs of this group are used: nitroglycerin, isosorbide dinitrate and isosorbide mononitrate. When prescribing these drugs, you need to know that nitrates are classified into short-acting dosage forms (Other antianginal drugs Edit
They are additionally used for tolerance to other traditionally prescribed drugs (slow calcium channel blockers, β-blockers, long-acting nitrates).
Nicorandil is a hybrid compound containing an activator of ATP-dependent potassium channels and nitrate fragments. The drug dilates both stenotic and non-stenotic coronary vessels. Its effectiveness as an additional drug has been proven. Assign in a dose of 20 mg twice a day. Side effect: headache.
Ivabradine is the first inhibitor of If-channels of selective and specific action, a pulsating drug. Unlike other drugs that reduce heart rate, ivabradine retains myocardial contractility and diastolic function without affecting the electrophysiological parameters of the heart, peripheral vascular resistance, carbohydrate and fat metabolism and without lowering blood pressure. Research results showed a significant decrease in cardiovascular mortality and hospitalization rates due to deterioration in heart failure, additional to what has already been achieved with ACE inhibitors, β-blockers and AMKR.
It has also been proven that ivabradine, regardless of the purpose of monotherapy or combination therapy, is effective against both symptoms of angina pectoris and indicators of physical exercise tests. The addition of ivabradine to optimal therapy was associated with a significant reduction in the risk of hospitalization due to myocardial infarction. Side effect: a slight change in light perception when taking high doses. Starting dosage - 5 mg 2 times a day for 2 weeks, then 7.5 mg 2 times a day.
Trimetazidine is a metabolic drug that maintains energy balance and prevents the development of ionic disorders in ischemia. Trimetazidine also stimulates glucose oxidation and acts as an inhibitor of fatty acid oxidation. Efficiency is extremely low. The mechanism of its action is not fully understood. Side effects: weakness and drowsiness.
Ranolazine is a selective inhibitor of late flow of sodium ions, it slows down the potential dependent release of calcium from the cell and reduces the negative effect on cardiomyocytes. Ranolazine at a dosage of 500-1500 mg twice a day or ranolazine prolonged release at a dosage of 750-1000 mg twice a day, increasing exercise tolerance and reducing bouts of angina pectoris and myocardial ischemia, complements the symptomatic treatment. Side effects: constipation, dizziness, nausea, and overwork.
When performing CABG, a bypass shunt is placed between the aorta and the coronary artery. Autografts (patient's own veins and arteries) are used as a shunt. The most “reliable” shunt is the shunt from the internal thoracic artery (mammary-coronary artery bypass grafting).
A less traumatic method of surgical treatment is balloon angioplasty and stenting, the meaning of which is to dilate the affected area of the coronary artery with a special balloon and implant a special metal structure - a stent. Due to its low efficiency, balloon vasodilation in its pure form (without subsequent stent implantation) is practically not used today. An implantable stent can be “bare” (bare metal stent), or carry on its surface a special drug substance - cytostatic (drug eluting stent). Indications for a particular method of surgical treatment are determined individually in each case after the obligatory coronary angiography.
Stem Cell Treatment
Therapy with stem polypotent cells is a promising method of treating many diseases, however, at present it is in the stage of clinical and pre-clinical trials. The main idea of this therapy is that when stem cells are introduced into the patient’s body, they themselves will go to the site of the injury and turn into cells that need replacing. However, such a result is not at all guaranteed, and the cell can go along any of the differentiation paths. Specific markers that control the direction of cell differentiation are poorly understood. All currently existing methods of stem cell therapy do not have evidence of effectiveness, made in accordance with the standards of evidence-based medicine.