Printsmetal's stenocardia

Description:

Printsmetal's stenocardia (synonyms: vasospastic stenocardia, alternative stenocardia, spontaneous stenocardia) — the rare kind of stenocardia caused by a vasospasm feeding heart and S-T which is followed by raising of a segment.

Symptoms of Stenocardia of Printsmetal:

Clinical manifestation of a spasm of coronary arteries is sudden emergence of sharp most severe pains at rest or during sleep in the morning  between 4 and 8 hours), more rare in the afternoon, without explicit communication with physical tension, often developing at the same time days. The nature of pains can be intolerable, the patient becomes covered then, emergence of tachycardia and hypotonia is possible. Pains are followed by changes on an elektrokadiogramma (ECG) in the form of rise (or depressions) ST segment on 2 mm and more (0,2 mV), with preservation of these signs within 5-10 minutes and having reversible character. Datas of laboratory without changes. Any attack of this type of stenocardia can pass into an acute myocardial infarction.
Careful poll of the patient allows to find out character and extent of defeat of coronary vessels in 70% of cases. Six main characteristics of pains in a thorax allow to judge existence of an ischemic heart disease and extent of disturbance of coronary circulation. This nature of pains, localization, duration, factors provocative, the factors stopping emergence conditions. At the same time today we cannot lean only on assessment of a pain syndrome, on subjective indicators for studying of a condition of a coronary bed especially as in 10-15% of cases of an ischemic heart disease has bezbolevy character. For assessment of extent of disturbance of coronary circulation consistently use a number of methods of a research. Their sequence begins with registration of an ECG in 12 assignments.

Reasons of Stenocardia of Printsmetal:

The main etiological factor - atherosclerosis, for development of a disease happens its rather initial stage. The atherosclerotic plaques giving a resistant stenosis are found in 75% of patients.

Treatment of Stenocardia of Printsmetal:

At an attack give sublingual (under language) nitroglycerine and nifedipine of short action, at the same time to support the ABP. At increase of attacks use of drugs of long action is possible: nitrates (isosorbide mononitrate) and antagonists of calcium (nifedipine, verapamil, diltiazem). The positive effect of use of alpha adrenoblockers is noted  (Prazozinum). Beta adrenoblockers  are not appointed since they can extend an attack of alternative stenocardia only. If Printsmetal's stenocardia is combined with heavy coronary atherosclerosis, then perhaps surgical treatment.
Use of acetylsalicylic acid is shown to patients for prevention of a myocardial infarction.