Stenocardia tension: general information

Stenocardia tension - a clinical syndrome, consisting in the appearance of discomfort or pressure in the chest due to transient ischemia of the myocardium. These symptoms usually increase with exercise and disappear at rest, or when taking nitroglycerin under the tongue. The diagnosis is made on the basis of clinical manifestations, ECG data and myocardial imaging. Treatment may include nitrates, b-blockers, calcium channel blockers, and coronary angioplasty or coronary artery bypass grafting.

[1], [2], [3], [4], [5], [6], [7]

Causes of angina pectoris

Stenocardia of tension develops when the work of the myocardium and, as a consequence, its need for oxygen exceed the ability of the coronary arteries to provide adequate blood flow and to deliver a sufficient amount of oxygenated blood (what happens when the arteries narrow). The cause of narrowing often becomes atherosclerosis, but a spasm of the coronary artery or (rarely) its embolism is possible. Acute coronary thrombosis leads to the development of angina, if the obstruction to blood flow is partial or transitory, but this condition usually leads to the development of myocardial infarction.

Since myocardial oxygen demand is determined mainly by heart rate, cardiac wall tension in systole and contractility, the narrowing of the coronary artery usually leads to angina that occurs during exercise and decreases at rest.

Stenocardia tension: causes

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Symptoms of angina pectoris

The main symptom of angina pectoris is the occurrence of pain (unpleasant sensations) in the chest during exercise and their rapid disappearance at rest after the termination of exercise. In most cases, the duration of angina pectoris is from 1 to 5 minutes (often 1-3 minutes, depending on how quickly the patient stops the load). It is characteristic of a feeling of squeezing, severity, raspiraniya, burning behind the sternum (these feelings are conditionally denoted by the term "anginal pain"). Typical irradiation of painful sensations is to the left and to the inner surface of the left arm. However, atypical variants of character, localization and irradiation of pain sensations can also be observed. The main sign is the connection with physical activity. Additional value has a clear effect of taking nitroglycerin (especially the effect of prophylactic intake of nitroglycerin - before the load).

Stenocardia of stress is also called stable angina. This emphasizes its reproducible nature. After establishing the presence of a patient with angina, it is necessary to determine the functional class (PK) of angina pectoris:

• I FC - "latent" angina. Attacks occur only at extreme stresses. Clinically, it is very difficult to diagnose latent angina, it is necessary to use instrumental methods of investigation.
• II FC - attacks of angina occur at usual loading: at fast walking, at lifting on a ladder (more than on 1 floor), at accompanying adverse factors (for example, at a psychoemotional stress, in cold or windy weather, after meal).
• III FC - a sharp restriction of physical activity. Attacks occur with a slight load: when walking at an average tempo less than 500 m, while climbing the stairs to 1 floor. Occasionally, seizures occur at rest (usually lying or with psychoemotional stress).
• IV FC is an inability to perform any, even minimal, load without the occurrence of angina pectoris. Attacks of angina pectoris at rest. Most patients have a history of myocardial infarction, signs of circulatory failure.

Stenocardia tension: symptoms

Diagnosis of angina pectoris

With a typical ("classical") angina, the diagnosis is fully established based on anamnesis. With atypical manifestations ("atypical pain syndrome"), when there is no clear connection with the load, the diagnosis remains conjectural. At atypical manifestations, additional instrumental methods of investigation are needed to clarify the diagnosis. The main way to document myocardial ischemia is to carry out a sample with physical activity. In cases where the patient is not capable of performing physical exertion, pharmacological tests, cardiac pacemakers or daily ECG monitoring are used.

Stenocardia tension: diagnosis

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Treatment of angina pectoris

Risk factors that are amenable to correction should be eliminated as much as possible. People with nicotine addiction should quit smoking: after 2 years of quitting, the risk of myocardial infarction decreases to a level in patients who never smoked. Proper treatment of hypertension is necessary, since even moderate AH leads to an increase in the workload on the heart. Decreased body weight (even as the only correctable factor) often reduces the severity of angina pectoris. Sometimes the treatment of even a small deficiency of the left ventricle leads to a marked decrease in the severity of angina pectoris. Paradoxically, foxglove preparations sometimes increase angina pectoris, possibly due to an increase in myocardial contractility and, accordingly, an increase in the need for oxygen, or due to an increase in the tone of the arteries (or with the participation of both mechanisms).

Stenocardia tension: treatment

Prognosis of angina pectoris

The main adverse outcomes are unstable angina, myocardial infarction and sudden death due to arrhythmia.

The annual mortality rate is approximately 1.4% in patients with angina without a history of myocardial infarction, with a normal resting ECG and normal BP. However, women with IHD have a tendency to a worse prognosis. Mortality is approximately 7.5% in those cases when systolic hypertension is present, 8.4% in cases of ECG changes, and 12% when both factors are present. Diabetes mellitus type 2 almost doubles the mortality in each of these groups.

The prognosis worsens with the increase in age, the progression of symptoms of angina pectoris, with the presence of anatomical lesions and a decrease in the functions of the ventricles. The pathology of the left main coronary artery or the proximal left anterior descending artery indicates a particularly high risk. Although the prognosis correlates with the number and severity of changes in the coronary arteries, it is much more favorable in patients with stable angina, even in the case of three vessels, provided the ventricles function normally.