Stable stenocardia

Description:

Stable angina of exertion — one of the main manifestations of an ischemic heart disease. The main and most typical manifestation of an angina of exertion — the retrosternal pain arising at an exercise stress, an emotional stress, at an exit to cold, walking against wind at rest after plentiful meal.
Classification of the Canadian cardiovascular society (1976):
Class I — "the usual exercise stress does not cause a stenocardia attack". Pains do not arise during the walking or rise on a ladder. Attacks appear at a strong, bystry or long tension in work.
Class II — "easy restriction of usual activity". Pains arise when walking or bystry rise on a ladder, walking uphill, walking or rise on a ladder after food, during cold, against wind, at an emotional stress or within several hours after awakening. Walking on distance more than 100-200 m on the flat area or rise more than 1 ladder flight on a ladder a normal step and in normal conditions.
Class III — "considerable restriction of usual physical activity". Walking on the flat area or rise by a normal step in normal conditions provoke emergence of an attack of stenocardia to 1 ladder flight of stairs.
Class IV — "impossibility of any exercise stress without discomfort". Emergence of attacks is possible at rest.

Symptoms of Stable stenocardia:

Complaints. Characteristic of a pain syndrome:
Localization of pain — retrosternal. Conditions of developing of pain — an exercise stress, strong emotions, plentiful meal, cold, walking against wind, smoking. Young people quite often have a so-called phenomenon of "passing through pain" (a phenomenon of "warm-up") — reduction or disappearance of pain at increase or preservation of loading (vslestvy opening of vascular collaterals).
Pain duration — from 1 to 15 min., has the increasing character ("crescendo"). If pain proceeds more than 15 min., it is necessary to assume development to THEM.
Conditions of the termination of pain — the termination of an exercise stress, nitroglycerine reception.
The nature of pain at stenocardia (squeezing, pressing, holding apart, etc.), and also fear of death have very subjective character and have no serious diagnostic value as in many respects depend on physical and intellectual perception of the patient.
Irradiation of pain — both in left, and in the right departments of a thorax and neck. Classical irradiation — in the left hand, a mandible.

The accompanying symptoms — nausea, vomiting, the increased perspiration, bystry fatigue, an asthma, increase of a heart rhythm, increase (sometimes decrease) the ABP.

Stenocardia equivalents: an asthma (because of disturbance of diastolic relaxation) and sharp fatigue at loading (because of decrease in cordial emission at disturbance of systolic function of a myocardium with insufficient supply of skeletal muscles with oxygen). Symptoms anyway have to decrease at the termination of influence of a provocative factor (an exercise stress, overcooling, smoking) or nitroglycerine reception.

Physical data.
At a stenocardia attack — pallor of integuments, an obezdvizhennost (patients "fade" in one situation as any movement strengthens pain), perspiration, tachycardia (bradycardia is more rare), increase in the ABP (decrease is more rare than it).
Extrasystoles, "cantering rhythm", the systolic noise arising because of insufficiency of the mitral valve as a result of dysfunction of papillary muscles can be listened. On the stenocardia of an ECG which is written down during an attack it is possible to find changes of a final part of a ventricular complex (a tooth of T and a segment of ST), and also disturbances of a heart rhythm.

Reasons of Stable stenocardia:

In most cases the angina of exertion arises because of atherosclerosis of coronal (coronary) arteries. Though between extent of atherosclerotic narrowing, its extent and expressiveness of clinical manifestations of a stenokradiya correlation is insignificant, consider that coronal arteries have to be narrowed not less than for 50–75% before discrepancy between the need of a myocardium for oxygen and its delivery will be shown and there will be a clinical picture of a disease.
Other reasons (relative insufficiency of coronary circulation): stenosis of the mouth of an aorta, hypertrophic cardiomyopathy, primary pulmonary arterial hypertension, heavy arterial hypertension, insufficiency of the aortal valve.

Treatment of Stable stenocardia:

The purposes — improvement of the forecast (prevention by IT and a sudden cardiac death) and reduction of expressiveness (elimination) of symptoms of a disease. Apply non-drug, medicamentous (medicinal) and surgical methods of treatment.
Non-drug treatment — impact on risk factors of an ischemic heart disease: dietary actions for the purpose of reduction of a dislipidemiya and decrease in body weight, smoking cessation, sufficient physical activity in the absence of contraindications. Normalization of the ABP level and correction of disturbances of carbohydrate metabolism are also necessary.
Medicinal therapy — use three main groups of drugs: nitrates, b-adrenoblockers and blockers of slow calcium channels. In addition antiagregant appoint.