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Medicine Medicine | Practice Angina, CHD. Diagnosis, treatment and prognosis
Medicine Medicine | Practice Angina, CHD. Diagnosis, treatment and prognosis
| Angina, CHD. Diagnosis, treatment and prognosis |
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| Written by Âàõà Äèçèãîâ | |
| Friday, 06 June 2008 | |
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Transferred via translate.google.com Angina, coronary heart disease. Diagnosis, treatment and prognosis. Nitroglycerine and operation. The first part Coronary heart disease - the most important problem of modern health care. For several reasons it is - one of the main causes of death among the population of industrialized countries. It amazes bodied men (more so than women), unexpectedly, in the midst of the most active. Those who do not die are often disabled. Angina is a form of ischemic heart disease. For the first time, the criteria proposed stenocardia English physician B. Geberden in 1772godu. Even 90 years ago, doctors rarely met with this pathology and is usually described as a casuistic. Only in 1910, VP Obraztsov and ND Strazhesko in Russia, and in 1911 Gerrik (Herrik) in the United States gave the classic description of the clinical picture of myocardial infarction. Now myocardial infarction is known not only doctors, but also the general population. By the early twentieth century, through the accumulated evidence, local clinicians have indicated the nature of neurogenic thoracic toads (strokes), although not excluded, and the frequent combination of spasm of coronary arteries with them sclerosis (EM packaging, 1958; FI Karamyshev, 1962 ; AL Myasnikov, 1963; IK Shvatsoboya, 1970, etc.). This concept exists so far. In 1957, a group of experts to evaluate atherosclerosis in the World Health Organization has proposed the term 1) stenocardia tension; 2) myocardial infarction (old or fresh); 3) intermediate forms; 4) ischemic heart disease without pain syndrome: a) asymptomatic form, b) atherosclerotic cardiosclerosis. In March 1979, the WHO adopted a new classification of ischemic heart disease, which identifies five forms of coronary heart disease: 1) The primary stop blood circulation; 2) angina; 3) myocardial infarction; 4) heart failure; 5) arrhythmias. Many patients first consult a doctor about stenocardia themselves unaware of the previously transferred myocardial infarction (according to ECG), and some patients were arrhythmia or heart failure as a manifestation of ischemic heart disease. More often found in patients with angina tension that arises in response to physical or emotional stress and may provoke other states, accompanied by tachycardia and increased blood pressure. This disease can be as independent disease or a symptom of coronary heart disease. 'Ischemic heart disease (CHD) has for many years was the main cause of mortality in developed countries. Currently, cardiovascular disease (CVD) play a crucial role in the evolution of total mortality in Russia. According to the GNITS preventive medicine, in the Russian Federation, nearly 10 million working population have IBS. As shown by the international study of ATP-Survey (Angina Treatment Patterns), conducted in 2002 in 9 European countries, including 18 centers in Russia, Russian patients predominated angina patients II and III functional class (FC), the latter was almost 2 times more than in other countries participating in the study. Please be aware that angina as the first manifestation of ischemic heart disease occurs almost 50% of patients. In Russia, the GCC and the prevalence of CHD is increasing, but mortality from these countries is among the highest in the world, which necessitates the use of modern doctors and effective treatments and prevention. Evaluation of treatment should be based on clinical performance and results of objective instrumental methods (tests with physical load, ambulatory Holter monitoring electrocardiogram - ECG, etc.) in connection with possible myocardial ischemia bezbolevoy.''/ I.A.Komissarenko.MGMU / Coronary heart disease (CHD) remains the major problem of modern cardiology. Prevalence of ischemic heart disease is high and reaches 10% among the adult population, and among elderly - 20% or more. Probably due to the aging of the population of Russia, these figures will only uvelichivatsya.Vmeste with arterial hypertension (AH) CHD is the predominant cause of death among the population of European countries. According to WHO, the death rate from CHD is more than 21%, exceeding mortality rate from all cancers. In European countries, ischemic heart disease - the main cause of death for persons over 45 years. According to the European Cardiological Society, the highest death rate from CHD among all European countries, there is in Russia (up to 2500 per 100 000 men aged over 65 years). / B. Makolkin, K. Osadchy, Moscow Medical Academy. IM Sechenov / Coronary heart disease - one of the most prevalent diseases and one of the major causes of mortality, as well as temporary and persistent disability population in the developed world. In this regard, the problem of CHD is one of the leading places among the most important medical problems of 20 th century. It is noted that in the 80's. demonstrated a downward trend in mortality from I. b.. pp. but nevertheless, in the developed countries of Europe it was about 1 / 5 of total mortality, while maintaining the large inequities in the distribution among the contingent of people of different sex and age. In the United States in these years, mortality of men aged 35-44 years accounted for about 60 per 100000 population, with the ratio of deaths for men and women in this age was approximately 5:1. By age 65-74 years, overall mortality from ischemic heart disease of people of both sexes has reached more than 1600 per 100000 population, and the ratio between the dead men and women in this age group is reduced to 2:1. http://heartz.ru/ibs2.php ''Cardiovascular disease today - the main cause of death of Russians - 56% of all cases. Over the past 15 years it has grown 1.5 times and 3 times higher than average. In Russia today, the disease affects 16.2 million people. Angina - this spasm of vessels, which are responsible for the blood the heart muscle. As a result of spasm, the heart stops receiving oxygen in the right quantity. Then there is the famous signal to all of us - the pain. If this process does not stop, will the physical loss of heart muscle - heart attack.'' http://www.buteykomoscow.ru/pages_12.html General information: "Sudden attacks of chest pain due to acute shortage of blood the heart muscle is the clinical form of coronary heart disease is called angina. Angina, in most cases, as well as other forms of ischemic heart disease, heart arteries due to atherosclerosis. Atherosclerotic plaques in the arteries stenocardia narrow lumen and prevent their expansion reflex. Which in turn causes a deficit of cardiac blood supply, especially during acute physical or emotional excess. Angina often can be recognized at the first treatment a patient, whereas diagnosis of angina pectoris to reject the need to monitor the course of angina pectoris and analysis of repeated surveys, and asking the patient angina. The following signs are complementary clinical characterization of angina, but their absence does not exclude the diagnosis of angina pectoris: Localization of pain in the sternum (the most typical!), it can give in the neck, the lower jaw and teeth in the arm, usually the left, in nadpleche and Shoulder (more on the left); nature of the pain - pressing, compressing, less often - hot (like heartburn), or foreign body sensation in the chest (sometimes a patient may feel no pain, and feeling sad for the sternum and then he denies the existence of actual pain); Simultaneously with the attack stenocardia raise blood pressure, pallor sheets, perspiration, pulse rate fluctuations, the emergence of a sense of disruption in the heart. All of the above is the so-called angina voltage, then have the option of strokes occurring in the load. It should be noted that the attack of angina pectoris may be the beginning of the development of such a terrible form of ischemic heart disease as myocardial infarction. Therefore, attack of angina pectoris, prolonged by 20 - 30 minutes, as well as frequent attacks of angina or increased demands electrocardiographic survey in the coming hours (night), as well as, the medical monitoring of the further development of angina pectoris. To ensure that all of this, a patient's hospitalization is indispensable. "/ Kardiotsentr RKNPK MZ RF / Angina - a form of ischemic heart disease. Coronary heart disease is characterized by insufficient supply of oxygen to the heart muscle. Causes of angina pectoris: spasms of heart vessels affected by atherosclerosis; physical and neuro-emotional tension; Quenching the organism. Symptoms: Attack of angina usually lasts no more than 15 minutes. The patient feels a sense of the gravity of the sternum, restraint and pain of pressing nature, giving the left Shoulder, neck, left arm. Action on First Aid: Put the patient and make peace. Give a nitroglycerin tablet under the tongue. At the heart area can be put mustard plaster. Give valokordin or korvalol of 25-30 drops. If you continue, let the second attack nitroglycerin tablet. If, after re-admission of nitroglycerin within 10-15 minutes of attack will not stop - give the patient 1 pill pain (baralgin, spazgan or maksigan). Under stenocardia understand feelings of pain or discomfort in the chest, caused, as a rule, myocardial ischemia, occurring on a background of atherosclerosis of coronary arteries, although these symptoms can occur not only in CHD but also in aortic stenosis, hypertrophic cardiomyopathy, and several other states. A special form of angina pectoris Some patients may be found a special form of angina (variant angina, angina-type Printsmetala). Named after a clinician, one of the first to describe it as a separate form of angina pectoris in 1959. For a special form of angina pectoris (type Printsmetala) anginoznyh characterized by attacks of pain occurring at rest accompanied by transient electrocardiographic signs of myocardial damage subepikardialnyh divisions. The nature and localization of chest pain differs little from the pain with regular strokes. Attack, usually occurs at rest or on the background of the patient to perform normal physical activity. About half of patients with angina Printsmetala developed without precursors. One sign of a special form of angina pectoris is the cyclical nature of boley.Vazhneyshim diagnostic sign is the rise of stenocardia Printsmetala ST segment of ECG at the time of pain attack. Atypical manifestations of angina pectoris Do young people stenocardia diagnosis can often cause difficulties. This should be taken into consideration when examining young patients who have attack of angina sometimes occurs only in response to the significant physical and emotional load (I and II functional classes of angina pectoris). Ischemic heart disease are increasingly common in young people, including women. We will consider only the nature of ischemic strokes. Symptoms and diagnosis of angina pectoris Coronary heart disease today is a major cause of death and disability among mature-aged and elderly people. In the past few decades in the cardiology clinic to apply coronary angiographic study. In doing so, coronary angiography is usually a logical final step in the complex examination of patients with ischemic heart disease (CHD), because it is the most informative methods for addressing such important issues as: verification of CHD diagnosis; clarifying the localization of lesion vascular channel; definition of treatment. Given the high incidence of coronary heart disease, as well as the current lack of publicly available measures for its timely diagnosis, the need for coronary angiography will steadily increase. The main task of the modern doctor-cardiologist performing koronarografiyu - to maximize the diagnostic value and safety of invasive research. The accumulation of experiences, implementation of improved techniques, the use of different modes antikoagulyantnyh allowed now to minimize the occurrence of complications such as myocardial infarction, acute violation of brain blood circulation, various dissection and perforation of vessels. Nevertheless, in the performance of coronary angiography is still a risk of so-called local complications such as acute bleeding, hematoma, false aneurysm, arteriovenous souste. Some of these local complications such as hematoma, need no specific treatment. Other (severe bleeding or false aneurysm) may require emergency operative vmeshatelstva. / Kardiotsentr RKNPK MZ RF / In a survey of patients, it is important not only confirm the presence of ischemic heart disease, to assess the severity of angina, patient tolerance to physical load, but be sure to identify all the risk factors for cardiovascular disease. Define what is happening in the vascular wall, according to cardiologists, it is possible in two ways. First: koronarografiya - direct method is very accurate, but do it without the testimony of expensive and dangerous. Second: the indirect method, based on risk assessment. For this purpose it is necessary to determine the level of A / D, to remove the ECG and to see the profile of lipid ( «fat» forming atherosclerosis). After receiving data, you can quickly determine the degree of risk and, if necessary, fix the parameters of the life or medicine. The second method is simple, cheap and reliable, took 1 hour and saves lives by preventing heart attacks, stroke and at the same time. It takes a mini-professor. examination should be 1 every year all the men after 35 years of age and all women after 40 years. This will not only save from a heart attack, but also protect against many cardiovascular problems. With prolonged attack stenocardia the latter may proceed to the next phase of the disease - myocardial infarction. This form of ischemic heart disease, due to an acute deficiency of blood circulation of heart muscle, with the emergence of focus of necrosis (tissue necrosis) in the latter. The mechanism of myocardial infarction, as a rule, the following: comes acute Prosvjeta artery thrombotic occlusion or narrowing of space nabuhshey atherosclerotic plaque. In the first option, the development of myocardial infarction lumen artery blocked more completely, which usually leads to krupnoochagovomu necrosis of cardiac muscle, in the second case, the so-called melkoochagovym myocardial infarction. The final category of myocardial infarction is not a «shallow» on its clinical importance, the frequency of complications and consequences for patient mortality when they are not lower than in krupnoochagovyh myocardial infarction. The beginning of myocardial infarction consider the appearance of intense and prolonged attack (more than 30 minutes, often many hours) zagrudinnoy pain, no kupiruyuscheysya re nitroglitseriena. More rarely, in the painting dominates asthma attack or the pain is concentrated in the epigastric area, such variants of the disease belongs to atipichnym.formam angina. "Medical examination of the patient does not reveal any direct sign of ischemic heart disease. Many patients with angina is the only sign of disease, while no data inspection or palpation, or auscultation did not reveal deviations from the norm. No signs Certain diagnostic findings of the doctor can do, watching the patient during the attack. Some patients with systolic noise and pathologic III tone appear only at the time of attack and angina disappeared after the end of it. All patients with suspected CHD should be electrocardiographic study of 12 commonly assigned. Identify signs of myocardial ischemia or cicatrices change provides an opportunity to consider the diagnosis of ischemic heart disease more reliable. The lack of changes on the ECG does not exclude the diagnosis of ischemic heart disease, as well as a large percentage of cases electrocardiogram remained normal. Correct interpretation of ECG is often difficult without a careful analysis of the clinical manifestations of disease. " http://medbookaide.ru A young and physically active people (athletes, people involved in heavy physical labor) in the electrocardiographic exercise testing may reveal signs of myocardial ischemia in the absence of any complaints (asymptomatic during CHD). Independent clinical problem in women aged 50-55 years with a diagnosis of CHD on the basis of cardialgia and ECG changes, manifested mainly negative teeth T. It is important to the number of affected vessels. When you defeat a major coronary artery in the majority of patients there were attacks of angina pectoris voltage. As the number of affected coronary arteries increasing the clinical manifestations of CHD. Summarize all the above cardiologists: 1 / ECG does not always or in most cases it is impossible to determine angina or CHD, and only attacks of angina pectoris is the only symptom of the disease, 2 / When you see signs of strokes needed to complete a full examination to confirm or refute the presence of ischemic heart disease, to assess the severity of angina, patient tolerance to physical load, but be sure to identify all the risk factors for cardiovascular disease, 3 / The full survey can be dangerous to the health of patients and should apply them only when absolutely necessary Treatment of angina pectoris Medication stenocardia: hopes and disappointments AProfessor YA Karpov, PhD EV Sorokin RKNPK MZ RF, Moscow Angina, as a form of coronary heart disease (CHD) has long been considered one of the major heart problems. Of course, this is due in the first place and with a large spread of the disease, and with a high risk of myocardial infarction (MI) and other adverse effects. In our country, as in many other countries, ischemic heart disease and its consequences the main cause of death. Over the past 1015 years in the tactics of management of patients with angina has changed a lot. Beyond this review, problems remain the treatment of unstable angina and vazospasticheskoy forms. The focus will be on new data concerning the pharmacological treatment of stable angina pectoris among the most "demanding" areas of modern cardiology. The aim of the treatment of angina pectoris Treatment of stable angina has two objectives. The first is preventing the development of MI and death and, consequently, an increase in life expectancy. The second decrease in the frequency and intensity of attacks of angina reduction (ideally, their complete elimination), which provides improved quality of life. However, the greatest priority is therapy aimed at reducing the risk of MI and death. IA Komissarenko The Department of Gerontology and Geriatrics (Head of Department Professor. LB Lazebnik) GOU VPO Moscow State University medikostomatologicheskogo There are two objectives of treatment stable angina: the prevention of myocardial infarction (MI) and death, ie prolonging life, improving prognosis and reducing the symptoms of the disease - improving the quality of life. Antianginalnoe treatment of ischemic heart disease consists of drug (beta-adrenergic blockers - Bab, calcium antagonists, nitrates, angiotensin converting enzyme inhibitors - IAPF, dezagreganty, tsitoprotektory) and myocardial revascularization. MOSCOW, June 18 / AMI-TASS / Violations suffered heart rate every third inhabitant of the globe. In Russia the death rate of the arrhythmia is 250 thousand people per year. These figures were at the II All-Russian Congress of aritmologov culminating on Saturday in the Science Center of Cardiovascular Surgery / NTSSSH / them. AN Bakulev. Treatment of arrhythmias is one of the global challenges of contemporary cardiology and aritmologii as arrhythmia - one of the most frequent causes of death of cardiac patients. Ciliary arrhythmia carries a higher risk of complications and the decline in the quality of life of patients. For this reason, in 5-7 times increases the likelihood of stroke and heart failure, reduced tolerance of physical nagruzki.Suschestvuet several types of treatment of arrhythmia. According to the head of the surgical treatment tahiaritmy NTSSSH them. AN Bakulev Amiran Revishvili, one of the most effective ways to cure ciliary arrhythmia - is to hold catheter ablation. Risk factors for CHD Smoking Stress hypertension Obesity diabetes Lack of physical activity unfavorable heredity Various diseases of the circulatory system The combination of several risk factors in the majority of patients is crucial in the occurrence and progression of CHD. Medication All patients in the absence of angina contraindications should receive acetylsalicylic acid (AC) in a dose of 75-160 mg per day, thus reducing the frequency of MI and sudden death at least 30%. The main contraindications to the use of AC include peptic ulcer disease, erosive gastritis, duodenitis. In such cases it is possible to use tiklopidina, although its influence on the prognosis did not convincingly proven. Application dipiridamola not shown because of low efficiency and the risk of potentiation attacks of angina pectoris To prevent attacks of angina have traditionally used drugs hemodynamic actions, which influence on the parameters of central hemodynamics, reduce myocardial oxygen demand or increase its delivery. At present, drugs used three main groups: prolonged HT, beta-adrenoblokatory and calcium antagonists. The main side effects of therapy were headache HT, arterial hypotension, flushing of skin, occasionally sinkopalnye state. To a significant drawback of this class of drugs include the development of tolerance, which can be overcome, or a temporary cancellation of the funds or capacity dose. Avoid development of tolerance to nitrates can be achieved by rational dosing, providing "beznitratny period" lasting at least 8 hours (usually at night). In the treatment of angina pectoris preference kardioselektivnym Bab. It should be to reduce the frequency of heart rate at rest to 50-60 ud. / min. / in. Makolkin, K. Osadchy, Moscow Medical Academy. IM Sechenov / WHEN NOT TO MEDICATIONS - Surgical Treatment When atherosclerotic plaques block coronary arteries and the use of medication did not help them discover, then to ensure adequate circulation, have resorted to surgical intervention. There are two types of procedures. Angioplasty The term refers to plastic surgery to the damaged or affected by disease, but now commonly used to refer to the method, when inside the corked artery balloon inflate. Specialist introduces femoral artery (in the inguinal region) and a long tube with a special x-ray equipment holds it through the aorta to the coronary blood vessels. Then the tip of the tube to inflate a balloon to expand corked the walls of the arteries, destroying aterosklero measure plaque, and thus eliminates overlapping vessel. This procedure involves some risk, because the container can cause a gap, and very vascular, so it is only in specialized hospital departments. This requires that the number has been operating in the event of cardiac surgery and possible complications. The possibility of the use of angioplasty is still cause for much debate, as well as under long-term studies and to our data, this procedure but less secure, but less effective than transplantation of coronary shunt. Transplantation of coronary shunt Until recently it was believed to be the most preferred method for complex surgery. Cardiosurgery examines the heart, is stricken vessel and removes the blockage with the help of the veins taken from the legs of the patient. This operation is dangerous, but, without doubt, provides significant short-term effect. Unfortunately, the results of transplantation have not been so encouraging, and in most cases, this procedure is not able to extend the life of the patient. RECOMMENDATIONS • Before deciding on any surgery, make sure that all other avenues of medicine (both traditional and alternative) have been exhausted. • Traditional medicine hastened to reject the possibility of the use of chelate therapy, but the results of the studies, it may be a suitable alternative to the not-too-successful methods of surgical intervention. Chelate therapy Word helatirovanie (chelate therapy) is derived from the Greek Chela, which means «a crab claw or Omar». It indicates the way in which certain elements, interacting with each other, form a connection. With regard to medicine it is the chemicals that bind the toxins, especially heavy metals and deposits of cholesterol in the arteries, known as the atherosclerotic plaque (atheroma). In medicine used for the ethylene-diamine-tetrauksusnuyu acid and used for the treatment of atherosclerosis, hypertension, angina, vascular disease, rheumatoid arthritis and cancer. While there is scientific justification and the results of research the mechanism of action of ethylene-diamine-tetrauksus-term acid, disputes are still ongoing. RECOMMENDATIONS • If all the above-mentioned diseases can help the application of chelate therapy. • In my opinion, before you talk about the need for operations on the coronary arteries, should be treated chelates. • You must be sure that a doctor who offers the use of chelate therapy, is highly qualified and has many years experience in the treatment using this method. http://medportal.kz/enc_zdor/38.htm Also I found on the Internet different methods for the treatment of angina pectoris, which is proposed to: Treatment of angina pectoris using Buteyko. Treatment of angina pectoris with the use of Buteyko method allows the first days to stop attacks and to prevent their occurrence (or reduce the frequency of attacks anginalnyh) Massage with angina pectoris. The challenge with massage strokes to normalize vascular reaction, remove the spasms in the cardiovascular system, improve metabolism, the body adapt to physical stress. The massage is carried out daily or every other day, once or twice a day. Time for a session - 15-22 minutes. Biryukov, AA Massage Therapy. 2000 "Soviet Sport" Compresses with angina pectoris. For warming during the 20-30 minutes of hot compresses back of the neck. At the first sign of attack to put on the area of heart sinapism, but on the back - banks (mustard plaster). If possible, lie still. You can put radiators in his hands and left scapula. During the attack vkrutuyu boiled egg, cut in half. Both halves shall immediately attach to the place where the most pain is felt. Hold until the egg is not cool. Samomassazh. Assists in the sense raspiraniya or chest pain. Stroking his chest. Palm to grind hot. Right palm firmly squeeze to the left breast. Massage in the direction from top to bottom or front of the heart in the direction of clockwise, only 200 times. Samomassazh you can do with the balm Karavaeva "Somaton. Before the massage, you can make in 1 minute, to the pain area iplikator Kuznetsova or scratchy healer. " When you pour on the attack of angina pectoris palm oil 5-6 drops of fir. Rub in the region of coronary vessels (below the nipple). To prevent doing 3-4 times a day. When you attack stenocardia nateret breast chopped and done with butter or pork fat, garlic. Pat. Helps eliminate raspiranie and chest pain. Right-hand or half compressed in a fist tap in front of the heart, only 200 times. Clap, first lightly and then all the stronger. Due to decide on their own feelings. http://health.mpei.ac.ru/herz.htm Health-MEI 2004 Is it in order to eliminate the attack of angina does not come up with anything better than soup? When medicines do not help, but only on the operating table to the cardiac surgery? Of the reading, we can conclude: Leading cardiologists and cardiac surgery in Russia and Europe can offer patients angina, ischemic heart disease are only two ways of treatment: 1. Medication 2. Surgical treatment 3 .............................? Is there a third way the way of treatment and blocking the development of angina pectoris, ischemic heart disease? January-March 2008. |