Angina pectoris is stable and unstable. The main symptoms of unstable angina pectoris and methods of treatment

Catad_tema ІХС (ischemic ailment of the heart) - statistics

Unstable angina (clinical, diagnostics, treatment)

LITERATURE LOOKING Chernov S.A., Chernov A.P.
Head v_yskovy clinical hospital im. MM. Burdenko. State Institute for Advanced Training of the Ministry of Defense of the Russian Federation.

Unstable angina (NSK) - the most important period of aggravation ischemic ailments heart (ІХС), harvest by development of myocardial infarction (ІМ) and raptor death. NSC - for key manifestations and prognostic values of the loan and the main clinical and morphological forms ІХС - stable anginaі gostrom myocardial infarction. Until now, it has become obvious that the reason for the progressive interruption of the IXC is due to the changes in the side of atherosclerotic plaques, endothelium and thrombocytes. When the size of the plaque is large, it is very important for the development of critical stanіv. It is necessary to have an "overwhelming" plaque, features such as a large core and a thin pokrishka. Factors that can take atherosclerotic plaques can be distributed to external and internal ones. Before the first, you can add: arterial hypertension, Increase in the activity of the sympathoadrenal system, vasoconstriction (spasm of coronary arteries), the appearance of gradients in stenosis before and during type fibrinogen, fibronectin, Von Willebrand factor. Internal officials who take into account the weakened structure of the plaque: overgrowth of the macrophage nucleus, decrease in the number of smooth cells and the synthesis of collagen, increase the activity of macrophages in the middle of the plaque, all of the apothecary Patologoanatomіchnі doslіdzhennya, angiographic danі, the results prizhittєvoї angіoskopіya showed scho at NSC bіlshostі vipadkіv toil Location nadrivi defect poverhnі i, nareshtі, rozrivi aterosklerotichnih blyashok of vihodom Wkra thrombogenic vmіstu, aktivatsіya trombotsitіv, vidіlennya vasoactive substantsіy i utvorennyu trombіv. In some cases, a blood clot forms on the surface, so that it grows over the opening (trough, defect) of the atherosclerotic plaque. Most often, it penetrates into the middle of the plaque, leading to a sharp increase in size. Thrombosis can develop rapt or stepwise by stretching decilkoh days and is a dynamic process. Thrombi can raise the light of the artery for a trivial hour, leading to the development of myocardial infarction. In some cases, there is an intermittent occlusion, in such cases a thrombus, which appears in the education of the judge, does not affect any more occlusion, the blood flow will decrease, as it will be manifested as an NSK clink. Thrombosis is like pristinkov, so occlusion is dynamic, so the blood flow in a certain vessel can be reintroduced and lasted for a short hour.

Non-thrombocytic thrombosis can be caused by microembolism of distal coronary artery disease, necrosis occurs in some of the heart disease. In such a rank, with a wide variety of clinical manifestations, there will also be an indication of the NSC or myocardial infarction without Q wave (deceased myocardial infarction). Oskіlki in some types є necrosis, which can be explained by the adjustment of the level of troponin T, and in some form of creatine phosphokinase.

A thrombus, a yak that does not come out, is replaced by scar tissue, which is produced by smooth blood cells. As a result of this process, there can be a wide range of changes in every chronic occlusion of the judgment and an even partial renewal of this transitoryness. Ostannє, mabut, viznachaє transition of the NSK to the stable camp, ale neeridko zrostannyam functional class.

The presence of non-occlusive thrombi during coronary angiography occurs in 85% of patients with NSC. Otzhe, in a prodigious NSC, the key is a decrease in the integrity of an atherosclerotic plaque, the development of a thrombus. The prisennya viznacha tactics of treatment of the NSC, as well as opening the way for the improvement of thrombosis. Insanely, in the pathogenesis of NSC, such as і ІХС, the role of spasms of coronary sudins, as well as neurohumoral and metabolic factors, is extremely important. There is a great value of genetic schlichnosti, as it can be manifested in the peculiarities of Budov and coronary sudins, as well as in the nature of the reception.

Clinical options for unstable angina

1. Forward, angina pectoris was diagnosed by holding out a month at the moment it appeared. It is characterized by the appearance of attacks of angina pectoris for the first time in life, for example, when the stench grows in frequency, triviality, intensity, and at the same time the effect of nitroglycerin decreases. Debut of Hvorobi MAK KILKA VARIANTIV. The first attack of coronary pain may be susceptible to physical problems and become obscurely stereotyped. The offensive option of attacking nasal angina pectoris rapidly grows in frequency, intensity, and often comes with chest pains in peace. The third variant of angina pectoris is characterized by the appearance of spontaneous attacks of coronary pain, which, as a rule, more than three times from 5 to 15 minutes. The predictive significance of different options for the onset of angina pectoris is not the same. The forecast is the most unfriendly in quiet drops, if there is a progressive interruption with frequent and prolonged attacks of angina pectoris with changes on the EKG.

2. Progressive angina pectoris - an increase in the number and severity of boule during a trivial hour of attacks of angina pectoris. Allow ailments to indicate the day (date) of an increase in the frequency, intensity of pains, which means a decrease in the effect of nitroglycerin, an increase in consumption. Until the end of life and fall, if before angina pectoris it is necessary to have to attack angina pectoris in calm. There are no frequent changes in the end portion of the EKG slurry complex, heart rhythm, Elementi left ventricular failure.

3. Spontaneous angina pectoris - a diagnosis of one or more decilkoch trivial (monday 15 min.)

4. Variant angina pectoris (Prinzmetal's angina pectoris) - for certain types of attack of angina pain, which is in a state of calm, which is supervised by the passing snakes of the EKG. Characteristic is the severity and the triviality of the attack 10-15 and more chilin, when you sing it in one or even an hour, you do not get it too quickly, the heart rhythm breaks down. With the help of the diagnostics of Prinzmetal's angina pectoris after the ST segment on the EKG before an hour the pain is attacked, which shows an enlarged transmural ischemia of the myocardium. The EKG signs are aware of the pain syndrome. In the case of ailments, there may be a number of new options. The main type of angina pectoris is spasm as changes, so in the world of atherosclerosis of coronary arteries. The prognosis of unpleasantness. In most ailments, the transmural IM can develop in the nearest 2-3 months.

5. Postinfarction (reversible, perinfarction) angina (PSK) is a diagnosis of an increase in the frequency of attacks of angina in 24 years and up to 8 times for the development of IM. Often, there is an early and post-infarction angina pectoris. For the first one, the term is cleverly confined to two issues at the moment of development of the IM, for the other - for a longer period of time. Clinical caution testifies to the fact that early postinfarction angina is opposed by the type of spontaneous angina pectoris, at that time, when angina is postinfarction, as a rule, it appears with the activation of the sick. The incidence of post-infarction angina pectoris ranges from 20 to 60% in patients in adult groups. When early PSK is evident, lethality of ailments; they moved IM, stretching 1 rock to move from 2 to 17-50%. The main accelerated ones directly tied with PSK, є enlargement of the zone and necrosis, are spontaneous in 20-40% of such ailments. As a rule, an enlarged zone of necrosis occurs in the basin of the infarction-associated coronary artery (tobto, in fact, often one vessel is indicative of the development of myocardial necrosis and an enlarged zone of infarction). Deterioration of the IM leading to a slight deterioration of the function of the lingering clown and the destruction of the closest and forecasted.

6. Myocardial infarction without Q wave (debris). Diagnosis in ciches is based on the presence of a typical pain syndrome, alleviation of CPK activity, a decrease in ST segment alterations in the esophagus and inversion of T. teeth. , heart failure, lower in ailments on the IM with the Q wave on the EKG. Lowest prognosis in patients with IM without Q wave is friendly, lower in patients with Q wave. Behind the cordon it has long been known that IM without Q wave is closer to unstable angina pectoris, lower to transmural IM. In our land, there are priests in the field of fire-fighting IM to the NSK, and opponents of the common thought.

7. Angina pectoris, which developed for 1-2 months after a successful operation of CABG or balloon angioplasty.

In 1989 rotsi E. Braunwald proponed the classifikatsiyunestabilny angina pectoris (Table. 1). In this day, the won is widely expanded in our land, which may be of great clinical significance and cardiologists are victorious in their practical activity.

Table 1. Classification of unstable angina * (E. Braunwald, 1989)

* As much as possible, if it is possible, there is also the appearance of either the visibility of the passing changes of the ST segment and (or) the T wave on the EKG, during the hour of an anginous attack.

The proponated classification is based on the Slud provisions:
1. On gravity key manifestations.
2. Chi vrahovuєtsya manifestation or the visibility of extracoronal minds for development.
3. The options are seen from the EKG changes (past) and from the day.
4. Transmission to intensive therapy in the incidence of severity of NSC, primacy or secondarily, walking.

The class of the NSK is seen:
class A - second unstable angina pectoris, scho winikla for a singular extracoronary cause, yak called up myocardium ischemia to make it stronger (div. table);
class B - primary NSC - ailments, in some NSC it developed when there were extracoronary obstructions;
class C - postinfarction NSK - ailments, for some NSKs in the first 2 days of the documentary state standard IM.
The classification of allowing the distribution of ailments of the NSC on the outskirts of the group in the fallowing state has been proponated to the development of the IM standard. So, some of the ailments from the class I NSC can be treated on an outpatient basis, while those who are ill from the class II and III require hospitalization in the intensive therapy unit. In the case of ailments from the NSC class, it is more important to come in, direct to the suspicion of a non-coronary cause, which has caused myocardial ischemia. Navpaki, patients with NSK class B and C require intensive antianginal therapy.

In the rest of the rock in the USA, the proponents of the new term - gostry coronary syndrome... Vin includes unstable angina and myocardial infarction without Q wave. coronary ailments with thrombotic occlusion of the coronary artery, inapparently, the cob period of the IM. In the end of the day, when we are ill with ailments, it is not important to treat it, but it is fundamentally important to start early thrombolytic therapy, with the help of recanalization of the circulated coronary judgment and an increase in the development of this syndrome.

Class I. Recently ear of important or progressive angina pectoris. We are sick with a recent ear (less than 2 m.) Angina pectoris, some angina attacks are important or part (> 3 for good) or ailments with chronic stable angina pectoris, in some winyclas progressed angina pectoris (often became at the mensha, lower earlier, navantazhennya), but in those who stretched out in front of 2 months there were no attacks at peace.

Class II. Angina pectoris calm, pidgostra. Ailments with one or more decilcoma anginose attacks in a calm stretch of the front month, but not a stretch of the last 48 years.

Class III. Angina pectoris calm, GOST. Ailments with one abo decilkoma anginose attacks in a calm stretch of the last 48 years. The diagnosis of unstable angina does not become vicious, if the ailment becomes asymptomatic or angina pectoris becomes stable for 2 months or more.

Klas A. Secondary unstable angina. Ailments, for those who have unstable angina pectoris due to a singular extracoronary cause, they called the myocardium to the strength of myocardium. Price - furnish to change the delivery of O2 to the myocardium or to increase the need for myocardium in O2, (anemia, fever, infection, hypotonia, uncontrolled hypertension, tachyarrhythmia, non-malignant hypoxia)

Klas V. Pervinna is unstable angina. Ailments, in those who have unstable angina pectoris, developed when there is extra-cardiac obstructions, as they cause ischemia of the myocardium (such as those in class A).

Klas S. Postinfarction unstable angina pectoris. Patients who have unstable angina pectoris in the first 2 days of the documentary gost ІМ.

ІМ. In quiet cases, if in ailments of the order of coronary pain є on the ST segment, or the gostra (svizha) blockade of the left lower part of the Gis bundle, it is shown that thrombolytic therapy is inaccurate. We are sick with ST-segment depression thrombolytics are not indicated. Thus, the NSC includes a heterogeneous group of ischemic syndromes; high risik development of state standard ІМ. At the same hour, the NSC є has a non-trivial phase with a pull of ІХС. Even in the 70-80s, the rock was in high esteem, and the triviality of reaching the great and the number of times from 4 to 8 years, then in Danish hour, the excitement of the dreamer, in most cases, to reach the stability of 7-10 days. Іmovіrnіst is the development of the state-of-the-art ІМ naybіlsh visok lasting 48 years. Writing a cob of "hostile unstable angina", for the designation of E. Braunwald. Nadal risik ІМ development decreases.

Diagnostic criteria of the NSK

A. Clinical: in the diagnosis of the NSC, initially, there is a correct and detailed description of the sick person, anamnesis and the causal link of the disease, which develop angina pectoris syndrome. The nature of the pain, її localization, the frequency of pulling out, triviality, irradiation, mind (reasons), in case of any type of disease, the effectiveness of nitroglycerin and other antianginal drugs.

Slide memory, when with angina pain, bear a constricting, oppressive, baking character, localize behind the sternum, in the precordial region, radiate in the left hand, hurt hands, creep, lower cracks, sleepy -3 min. sent to receive nitroglycerin. Some of the ailments may attack angina pectoris by cold weather (especially writing), as well as only when they are first nailed (holinnya, umivannya, vihіd to the robot), and the stench does not appear during the day. Slid of adolescence, for typical angina pectoris, a characteristic singing stereotype of attacks, low triviality (3-5 minutes), Shvidka has a positive reaction to nitroglycerin. It is important to remember about the equivalents of angina pectoris in the presence of paroxysmal dysfunctions, for the sake of inconsistencies, embossing behind the breastbone, the appearance of "breast" in the throat, atypical localization of pain, and some of the type It is important to differentiate criterion for a wide range of links with physical options, read a positive reaction to nitroglycerin.

In case of NSC attack of coronary pains, the frequency, triviality and intensity increase, the tolerance of physical therapy decreases sharply, and the effectiveness of nitroglycerin decreases. To stop the pain, you need to repeat it. In people with ailments, to an acute pain, an increase in the frequency of the heart is fast, breath, pit. Even earlier, attack the bully only for an hour on the physical side, now it stinks to fix the sick person in peace, at night, because of them there are 15 or more sicknesses, they are filled with breath and add to the alcohol for the drugs. NSC is not without coronary pain. The order of the cym z'yavayutsya changes EKG, which were not previously mentioned. Everything is aimed at the progression of coronary insufficiency.

This rank, the head diagnostic criterion of the NSC, is due to the nature of the pain syndrome, its progressive interruption.

B. Electrocardiographic: visibility on EHC sign Myocardial ischemia, which occurs before an hour is attacked by pain and is taken during the period between attacks. Stinks appear in the depression of the ST segment or earlier in the third phase of the izoelectric line, the appearance of high T waves in the chest insertions, or after the change in meaning. Signs of ischemia nestiykі і know about not barring pain when attacking pain, or stretching out for the next 2-3 days. It is not easy for the EKG to get stuck between the norms.

If the EHC is monitored, it will allow the formation of a short period of time, as a result of pain, and painless, to set the number, it was

V. Laboratory. In peripheral blood in patients with NSC, leukocytosis is registered not more than 10,000 per 1 mm 3.

The level of cardiospecific enzymes (CPK, MV-CPK, LDH, ACT) becomes normal, otherwise it does not overtake 50% of the upper limits. Troponin T is a marker of heart muscle loss in patients with unstable angina pectoris. Adjustable level of troponin T (0.55-3.1 μg / l) can be trivial or short-term. Most often it is in the blood of quiet ailments, in some of the rest of the attacks in the calm, spreading out for the closest 48 years, or in the patients with the manifestation of changes in the end portion of the EKG slurry complex, especially the passing snakes of the ST segment. The adjustment of the level of troponin T according to the prognostic significance in the ailments of the NSC is equivalent to the restoration of the changes in the bone part of the EKG slurry complex. When there is a change in the EKG, for example, if there is a lingering complex of changes in the cob, the adjustment of the troponin T is an independent predictor of an unpleasant result.

G. Echocardiography: the deterioration of the decay of the myocardium is not often due to the decrease in segmental rapidity, moreover, the steps of these changes are directly due to the severity of the clinical manifestations of incapacitation. In the world of stabilization, overcoming the IXC, the deterioration of speed is known or change in speed.

D. Radionuclide dosage: scintigraphy of the myocardium with Tc99m pyrophosphate and the possibility of differentiating myocardial infarction and NSK, especially with unconstrained ECG data and enzyme activity. Tc99m - pyrophosphate, vibrating accumulated in the midst of necrosis, making it visible on the site-gram, which allows for the importance of its localization and size. There are two types of radionuclide inclusion: middle and diffuse. Oseredkov - pathognomonic for myocardial infarction. Diffuse - to reestablish at NSC with the same frequency, as for an anginous attack, so the extra-offensive period is longer, less in 80% of patients.

E. Coronary angiography: allowing assessment of localization, steps and widening of atherosclerotic lesions of the coronary bed, documenting spasm, thrombosis of the ventricular arteries, and significantly impaired function of the ventricle (ventricular).

The breadth, nature of atherosclerotic changes, the number of cases of coronary arteries in patients with NSC does not occur in cases of stable angina, for the blame of ailments for the first time in the history of angina, in some cases of low prevalence The most unpleasant in the prognostic plan of the fight against the stovbur of the coronary artery and the multi-vessel disease. Especially rengenomorfologіі coronary arterіy when SFN Je velike number uskladnenih zvuzhen to yakih vіdnosyatsya ekstsentrichnі stenosis of nerіvnimi i / abo podritimі contours іntralyumіnalnogo defects kontrastuvannya, protyazhnі porazki of chedovanіem dіlyanok zvuzhennya i patologіchnogo rozshirennya sudini and takozh Find our vnutrіkoronarnogo thrombosis: pristіnkova zatrimka kontrastnoї rechovini , porous little ones of stenotic artery because of the unevenness of the artery memorization, with the presence of occlusion, the nasty imitation of contrasting speech from the occlusion. Signs of an accelerated strike appear more often than the nearest one to the moment of acute coronary insufficiency of the vicono angiographic dosage. Namely, coronary angiography is carried out for stabilization of the patient, with the help of a sick person, if necessary, a percutaneous transluminal angioplasty (PTCA) or aortocoronary bypass surgery (CABG) is performed.

Likuvalny tactics for unstable angina pectoris

All ailments of the NSC are kept in the hospital wards (blocks) of intensive care and treatment. At the same time, the EKG is recorded in the dynamics, zagalny analiz blood, cardiac specific enzymes, according to the ability of EchoKG, myocardial scintigraphy. Tsіlodobove klinіchno і monitorial caution.

Heads of treatment є control of pain syndrome, prevention of repeated attacks of angina pectoris, improvement of the development of a healthy IM and those associated with him more quickly. In connection with cysts, the tactics of NSC are triggered by the main pathogenetic mechanisms of development. As already mentioned, the main mechanism in a large number of cases is the destruction of the integrity of atherosclerotic plaque, which leads to the activation of platelets, the formation of a thrombus, and the cause of frequent vascular blockage and even Tom likuvannya next to fix the received aspirin. The anti-thrombotic action of ASK is primed on non-vial ingibuvanny cyclooxygenase and thrombocytes. In addition to thrombocytes, they consume the ability to synthesize thromboxane A2 (TXA2), which induces an aggregation of thrombocytes and volodynas by sounding powers. As a result, the possibility of platelet aggregation and the formation of a thrombus decreases.

Aspirin is given in the first single dose of 325 mg, the tablet starts up with a quick soak and an early antiplatelet effect, which is infused after 10-15 khilin. At the beginning of the day, aspirin is taken at 160 mg / day. drink a lot of water. With an early start, the number of growths of IM decreases by more than 50% in terms of placebo. Aspirin is used in all NSC ailments when there is a problem. Seemingly, that the most widespread aspirin is surrounded by a hundred shortcomings - the last victory of the slime slurry from the ignition reaction, the approval of the erosions and virazok. The problem is positively viral, a new form of the drug - aspirin-cardio, of the company "Bayur". Winning the coating with an interosolubil shell (aspirin EC), it can be trapped in the intestines, so the slime of the slurry is stolen from the active speech. With vicorian aspirin EC, the maximum dose is infused in 3-4 years or after it is received in the middle. The first dose is to become 300 mg (3 tablets of 100 mg each, or 1 tablet - 300 mg); First a dose of slіd rozzhuvati with a shvidkogo vmoktuvannya in an empty company, with a whole antiplatelet effect infused after 15 min. The onset of the days will be taken in an incremental dose of 100-200 mg / day.

With the presence of coronary pains at the time of the need for a sick person, nitroglycerin 0.5 mg per day is given, after 10-15 minutes. yogo can be repeated. In case of insufficient efektі, neuroleptanalgesia is carried out, as with IM. One hour, internal infusion is recognized as nitroglycerin and heparin. The pochatkova dose of the drug in nitroglycerin (1% rosin for nitroglycerin, perlinganite, or isosorbite dinitrate-isoket) is 5-15 mcg / hv, the skin is 5-10 min. the dose is increased by 10-15 mcg / hv. rt. Art. In case of severe hypertension, a decrease in systolic arterial vise is carried out in the inter-areas of 15-20%. Infusion nitroglycerin is carried out for 1-2 dib. Without interruption, heparin infusion is carried out for 48-72 years with a stepwise change. On the cob, a bolus of 5000 OD is injected with heparin, at a time of 1000-1300 OD / year before the control of an active unit thromboplastin hour (APHT), increased by 1.5-2.5 times. The APTCH will start after 6 years from the cob introduced with heparin, until the APTCH will be reduced by 1.5-2.5 times in two last analyzes, given 1 time to add. In case of ill-feeling of vikoristovuvati without interruption of infusion of heparin, it is permissible to inject 5000 OD 4 times per dose. It means that the combination of aspirin with heparin gives more favorable results.

Beta-blockers are more important in the treatment of NSCs. It smells like a loss of myocardial ischemia, it will catch up to the growth of hemodynamic changes, change the rate of loss of life, galvanize the adoption of old plaques, by prophylactic agents for the growth of diseases before the loss Reconstruction of beta-blockers with aspirin, heparin gives a good effect.

Better the intake of beta-blockers in combination with aspirin, heparin, you can use it in quiet drops, if in ailments with NSC є the hyperactivity is sympathetic nervous system, How to appear tachycardia, hypertension, broken rhythm. Beta-blockers can be used for intravenous administration and can also be recommended for intravenous administration.

1.propranalol (inderal, obsidan, anaprilin) intravenously (2 minutes) 3 doses of 2.5 mg at an interval of 5 minutes, with a further transition to a dose of 40-80 mg / s with a further selection of individual doses ...

2. Metoprolol (betaloc, spesikor) intravenously 5 mg by dose with an interval of 5 minutes., Three doses, an external dose of 15 mg for 15 minutes. We'll drink 50 mg each and 2 times for doba.

3. Atenolol intravenously by volume with a stretch of 5 minutes, 2 doses of 5 mg each, with an interval of 5 minutes, Zagalna dose of 5-10 mg for 10 minutes. with the transition to the reception vseredin 50 mg skin 12 years.

Thus, in case of NSC options with progressive interruption (first of all acute angina pectoris; progressive angina pectoris; postinfarction angina pectoris; myocardial infarction without Q wave; angina pectoris, therapy of successful progression of 1-3 months take aspirin, infusion nitroglycerin and heparin, or add aspirin, heparin and beta-blockers. For the stabilization of coronary blood circulation, the planned treatment is carried out with aspirin in combination with beta-blockers and / or nitrates. In case of coronary syndrome with ST segment pidyoma or a gastrointestinal (new) blockade of the left lower part of the Gis's bundle, intensive therapy includes the cob injection of thrombolytics.

In case of spontaneous angina pectoris, angina pectoris of the Prinzmetal type, calcium antagonism occurs, from which the dihydropyridine group is nifedipin of the testimony only in case of a wide variety of NSC. To stop the attack of coronary pains, nitroglycerin is given, with a lack of efficacy - nifedipin, which is given to the ailing tablet to chew up for a short period of time in the empty company. For the prevention of attacks, neutrality or antagonism of calcium is predominantly prolonged (amlodipin, lomir and in).; You can vikoristovuvatisya verapamil, dilgiazem. Beta-blockers of "pure" vasospastic form of NSC can destroy coronary blood flow. Beta-blockers are contraindicated in quiet patients with spontaneous angina pectoris, in those with spasm of the great coronary arteries of documents during coronary angiography for an additional test for ergometrine.

In vipads, if until the moment of hospitalization they were not given for the progression of the NSC, especially, if the attack of angina pectoris was stopped after 48 years, there were no changes on the EKG, there was no indication of cardio-specific enzymes, abo nitrates. In a number of vipads, there may be calcium antagonists - veripamil, diltiazem, ale not nifedipin. Especially in quiet drops, if beta-blockers are contraindicated. The assigned calcium antagonisms can be combined with nitrates.

When the heart rhythm is broken, antiarrhythmic therapy is performed, including electro-pulse therapy.

In the last few years, a new class of antiplatelet agents - blockers of platelet glucoprotein receptors II beta / III alpha (BHR II beta / III alpha) - are intensively implanted in patients with NSC. BGR II beta / III alpha induces platelet aggregation in the Chinese stages, independently of the cause. Until the present hour, a series of additional medications have been carried out with the drugs of the whole group - Reo-Pro, lamifiban, Integrelin and In., In addition, with aspirin, heparin, and also in the form of monotherapy, rejection of positive results. Prescribed drugs are administered intravenously, without a high antiplatelet effect and a quick release after the end of the introduction. Happy birthday BGR II beta / III alpha, designated for the accepted vseredin (xsemilofiban, lefradafiban, orbofiban). Mabut, in order to clarify its efficiency, the stench of the nearest hour will be in widespread practical practice.

Step, mabut, promising drugs for the treatment of NSC can be low molecular weight heparin (fraxiparin, dalteparin and in.), Yak galvanize the cascade of laryngeal blood on the level of factor Xa. Stink may have a number of positive characteristics in porcine heparin. Bioavailability for pediatric administration significantly changes the bioavailability of unfractionated heparin, the odor is greater in terms of anticoagulant effect, and is subject to less laboratory control. On the basis of the current results and the progress of IM, in cases of death and revascularization procedures.

The transfer of ailments from BIT to a lazhkogo viddіlennya zdіysnyuєtsya zvivyay 2-3 dobu, according to the stabilization stan. At 10-15 to achieve a stable overcoming of the ailment and mastering the out-of-pocket regime, everybody is sick, as long as it is indicated, for the purpose of establishing tolerance up to the physical pressure of the coronary reservoir, to check the bicycle speed measurement and to reach the endurance.

In vipads, if they are 48-72 years old, unaffected by active therapy, attacking angina pectoris does not change the intensity and triviality, it is indicated for the examination of term coronary angiography and nutritional discussion about surgical treatment. CABG surgery is indicated when there is a 50% or more stovbur stenosis in the coronary artery (LCA); lesions of the two main coronary arteries with the lesions of the anterior midshlunochkovo hilka (PMZHV); lesions of the three main coronary arteries in the event of dysfunction of the wikidu fraction - 35-50%. 80% of the sick get sick klinichny camp And 63% had angina syndrome. At the same time, PERIOPERATSIYNO ІМ develop in 4.8-9.3% of patients, lethality - 0.9-1.8%.

An alternative to the surgical treatment of the NSC in a given hour є PTCA and intracoronary prosthetics with intravascular prostheses (stents). Shown until the її vikonannya to serve proximal single-vessel stenosis not less than 50% to the education of the judge. So, in 3-9% of patients with ailments before an hour of PTCA, it is possible to develop an antihypertensive, having opened the coronary artery, and an operative treatment is indicated. In connection with the cym, one of the minds of the evaluation of angioplasty є the readiness of the cardiac surgery for the evaluation of the emergency coronary artery bypass grafting. It is necessary before the front of the sick year on operatively in case of failure of the PTCA. Good bezposredny results of percutaneous transluminal coronary angioplasty (PTCA) are estimated in 85-90% of patients, 60% have symptoms of ІHS. 5-7% develop IM, lethality is less than 1%.

In such a rank, the last of drug visits during the treatment of NSC can be represented by the following rank: hospitalization in BIT, assigned to aspirin, nitroglycerin, heparin, beta-blockers; with vasospastic variants of NSC - nitroglycerin, calcium antagonism; in patients with coronary syndrome with ST segment pidyoma or with blockade of the left lower bundle of the Gis - thrombolytic drugs. Prospects for the intake of blockers of platelet glucoprotein receptors II beta / III alpha and LMWH. In case of ineffectiveness of drug therapy - surgical treatment (CABG, PTCA, intracoronary prosthetics - stents). Dal went on the plan of the test for the adopted methodology for chronic IXC.

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It is a critical period for the development of an ischemic ailment of the heart, which is characterized by a high degree of malignancy in case of myocardial infarction or death. Unstable stenocardia supravodzhuetsya by a plin of changes for the form and nature of stenocardia attacks. Show pathologies allow them to respect both the myocardium and angina pectoris, even at the same degree of ischemia deficiency, which is the cause of myocardial necrosis.

Stable and unstable angina pectoris - evidence

Stable angina pectoris, as a result of the singular physical nascence. For example, the ailment knows how to see nezduzhannya, having passed the pivkilometer. Win also knows that it is possible to overcome the pain syndrome by taking nitroglycerin.

A special feature of unstable angina pectoris є those who can show signs of themselves, if people are in an uncomfortable state, and if you take two tablets of nitroglycerin, you cannot be bothered with pain. Until the beginning of the form, stenocardia can be diagnosed as well.

Zagalom, the form of the ailment is unstable є stun,. That is why angina pectoris can be either oozing or myocardial infarction.

Unstable angina - classification

Most often, when looking at a sickness, one cries out with the classification, broken down of Braunwald, who saw three stages of development of ailment. With the whole, who is a class, Tim Virogidnishe poyavva accelerated:

The first manifestations of unstable angina pectoris appear in two months.
Angina pectoris calm, a turbulent stretching of the last month of the last 48 years.
gostra uniform angina pectoris in the last 48 years.

Unstable angina - symptoms

If you get sick with attacks, however, if you have anamnesis, you can see signs of unstable progressive angina pectoris:

more frequent attacks and changes to the nature of their countermeasures, as it was mentioned in the last two months;
Winning attacks at night and in a calm camp;
about the first time she showed herself stenocardia to speak with attacks;
Previously, add nitroglycerin to the detriment of efficiency.

Treatment of unstable angina

Evidence of symptoms of illness of transferring to the term hospitalization. We are averse to priznachayut EKG, blood donation for analysis, myocardial scintigraphy. The process of lіkuvannya is guilty, it is known for a simple visual lіkarіv.

Likuvannya pathology polyagi in the relief of pain, the new signs of unstable angina pectoris and myocardial insult. Oskіlki the cause of ailment is most often є the destruction of plaques and the development of a thrombus as a result of atherosclerosis, then the patient, for everything, prescribe aspirin, beta-blockers, nitrati.

Nitraty is actively vicarious since the end of the 19th century. With help, expand the veins, lower the grip, try to try the ventricles. The speech may also lead to coronary artery disease and the formation of blood clots.

Stagnation of beta-blockers allows you to reduce the number of heart beats, by themselves having passed the need for sourness, so that they try to get myocardium. Also, the drug improves the triviality of coronary perfusion, as well as the normalization of blood circulation in the myocardium.

Aspirin is brought to the robot of cyclooxygenase, to produce thromboxane, speech, which is very powerful. When the aspirin is consumed, the blood clotting rate will speed up.

Unstable angina pectoris (NS) is one of the forms of coronary artery syndrome (GCS), the cause of the diagnosis of a fragment of an atherosclerotic plaque, which can be produced until the artery is blocked. Only in case of HC, on the occasion of myocardial infarction (the form of ACS), the vessel is blocked in general, and local necrosis of the heart is not observed.

When you are in non-communicable situations, you can often endure in peace, but symptoms of unstable angina pectoris appear - this is the reason for extreme brutality for medical assistance.

📌 Read in the tsy statty

Angina pectoris is also unstable

Angina pectoris is "unstable", if sometimes it is possible to transfer it, it is typical for "pending" stable angina pectoris.

If, with a stable form of an attack, you should be in a period of physical activity, emotional stress, or be it overstrain, then signs of unstable angina may be in a calm state. NS can win an hour to sleep.

Besides, on the basis of stable angina pectoris, the triviality of it is more (as a rule, I change 15 heaps), and it is often ineffective to eat it.

It is even more important to remember: if the patient has stable angina pectoris, then this does not mean that you cannot go to the NS. If the attack is found more often, it’s triviality to get involved, to get involved in the ringing with the trigger triggers, so that sometimes it’s not transcended — all are signs of the transition of one angina pectoris into one.

The reason for the appearance of unstable angina pectoris, such as in the case of other forms of coronary artery syndrome, is due to the formation of a fragment of an atherosclerotic plaque and a blockage of the vertebral column, which can live in the heart. Ale, on the view of myocardial infarction, there will be a part of the blockage of the artery, so that because of the blood there is no overturned blood.

A blood clot in the education of a judge is either growing, then clutching, angina pectoris in "unbearable" situations, so as not to lie down due to physical stress or emotional stress, which, as a rule, to exercise stenocardia when stable. If there is a blockage, then it is possible to create an invalid shkodi heart mucus.

Mechanism of development of unstable angina

In other words, іsnu rizik іnіknennya gosti іnfarktu myocardium. According to statistics, in 6 - 8% of the cases of the National Assembly may end. For the third time, when the symptoms of unstable progressive angina pectoris have come to light, this is the result of a secret brutality behind medical aid.

Yak to suspect pathology

The onset signs of guilt of the patient's alertness, who have a history of ischemic heart ailment, in the future may appear in a new NS:

ailing feelings behind the breastbone became a vinaigrette with a greater low physical capacity;

the triviality of the attack became worse;

a large dose of nitroglycerin does not allow the attack;

Epizodi began to appear at night.

For the first time, Vinik Epizod NS do not expect to show yourself with a terrible pain. It is not acceptable to press the character behind the sternum, as it is often not a matter of people to eat up a lot of people, - not a rarity for a whole pathology. In addition, most of the vision can be seen in the back, stomach, shoulders. You are welcome to the situation, if it’s boring, or if you just feel the ovens and the manifestations of the disease.

Localization of pain in angina pectoris

Be it a human being, if he suspects the symptoms of this pathology in himself, then he turns to the doctor. The increase in medical assistance in case of unstable angina pectoris is often brought to the level of serious disability. Likuvannya will attack, as a rule, in the state hospital.

Yak is diagnosed

In case of any form of acute coronary syndrome, when diagnosing unstable angina pectoris, it is critically important to correctly interpret the symptoms. Zokrem, if the patient has one or more of such three signs, then this is a serious argument for a drug addict for staging a diagnosis of whether a form is:

the pain appeared in calm, especially as the stench smells more than 20 khvili;

vper vinyk attack, which significantly accelerates the physical activity of the patient;

Epizodi of stable angina pectoris become frequent, trivial, and also appear at the least equal stress (physical or emotional).

In addition, since the patient has suspected coronary syndrome, an electrocardiogram and a specific blood test (markers of heart disease) are indicated for diagnostics.

Unstable angina EKG-signs - "ST segment" in the norm. Daily change of serological markers.

It’s not possible to display on the electrocardiogram before the ST segment (as well as on those that the artery is blocked again), but the serological markers of the onset (to inform about the loss of the heart tissue), then the number of such titles

If there is a presence of serological markers in the ST segment, then talk about the "great" myocardial infarction (that is, myocardial infarction with ST segment infarction).

Myocardial infarction without ST-segment infarction and unstable angina pectoris, symptoms and symptoms of which practically do not occur, are indicative of a "great" infarction. Smell vkazuyut on those who are placed in the form of a fragment of atherosclerotic plaque, which is partly distorting the artery. Accept malium because of blood savings, as well as during the rest, if there is necrosis of the myocardium. As soon as you can see the love, then you can uniquely.

Options for coronary syndrome

lykuvannya

Patients who suspect NS, as a rule, receive hospitalization. Such a pidhid is allowed in a short term, the situation of a sick person, will prevent the development of serious acceleration.

Antiagreganti (build shelter likarski zasobi) Widely freeze for the treatment and prevention of unstable angina. To that, if Luda suspected an attack of angina pectoris, before receiving quality medical assistance, you can take one tablet of aspirin or clopidogrel. Dani likarski in the camp to change the development of myocardial infarction.

When hospitalization on the cob stages, initiate an offensive therapy:

heparin (or an anticoagulant) and nitroglycerin (intravenously);

lykarski zasobi, scho allow me to control my suppression, for example, a broken heart rhythm, anxiety (sedation), hypercholesterolemia (for example, such a drug, like statini).

Surgical manipulations, such as angioplasty and stenting, stagnation, widening, enlighten the partly blocked or sounded artery of the heart.

angioplasty- a minimally invasive endovascular procedure, performed behind a catheter aid, a balloon expands at the end of the retouching, the coronary artery is unblocked.

balloon angioplasty

stenting- Surgical manipulation, similar to the description of food, only to be supplemented by the installation in the middle of the education of the judge of a special pipe. Tse zapobigє re-ringing artery.

stenting

Coronary bypass surgery can also be used as an operation, which allows the blood flow to be renewed by bypassing the sound of a shunt for an additional bypass.

prophylaxis

Bagato klinіchnі doslіdzhennya was brought, so modifying the way of life is good for the general "smitten". This is a common way of preventing ischemic ailments of the heart. Tom likar
recommend:

ogryadny people will get used to them from the taken kilograms;

do not smoke;

study regularly;

live alcohol in small quantities;

dotrimuvatisya with a lot of vegetables, fruits, whole grains, ribs and lean meat.

Patients with such weaknesses, such as a high blood pressure, adjusting tsukru or cholesterol, are recommended to take trimatio with control, regularly take the proponated tablets.

Yaksho among people є one or more factors in the development of the development heart-and-heart disease Then you will then consult with the doctor about the drive of the received aspirin and other medicines.

For some people, take aspirin (from 75 to 325 mg per day), for such drugs, yak, ticagrelor or prasugrel, will become a good way to prevent the manifestations of severe coronary syndrome. Ale in front of tim, as you accept, it is necessary to be pleased with the lykar.

About those who also have angina pectoris and how are they fighting against a pathology, wonder in a whole video:

cause sickness

The reason for unstable angina pectoris in case of ischemic heart disease is the development of fibrous plaque previously approved in the development of coronary artery. Tse to produce a blood clot to the end, which will lead to a reduction in blood flow to the myocardium of the heart. The result is hypoxia of the heart meat. Improving the integrity of the plaque can be found in viclicano:

too much fatty tissue without the middle of the plaque itself;
fired;
unsteady collagen;
vіdhilennymi, there are hemodynamics.

The development of unstable angina pectoris may be:

The unstable angina pectoris can be provoked by the onset of the disease and the body:

Diabetes mellitus;
genetic intelligence, as the ІХС was established in the relatives of the bull;
stable adjustment of the arterial grip;
changes in the quality of blood and thickening;
the appearance of a busy vagi;
high / low blood cholesterol level;
a little rude way of life;

the manifestation of cholovich gender signs in women;
nikotin deposit;
old age.

It's joy! The treatment of this pathology of the heart is always carried out on a stationary basis.

Forms of unstable angina

Physicians carry out a proper internal gradation of the given heart pathology:

Angina pectoris For her, it is characteristic that she periodically has a hard time to squeeze pains. Viddavati stench can in the left hand, the area of wide and lower cracks. Inodi to the region of epigastria.
Progressive angina pectoris. For the whole pathological camp of the authorities, I will attack for an hour, as well as the improvement of this ailment. Cardialgia does not form only with advanced physical activity, albeit with lesser new options. Inodi in peace. Supravadzhuyu zadishkoy and marriage fortunately.
Postinfarction and postoperative angina pectoris.

Braunwald's classification is also possible. In the whole range of unstable angina pectoris, a class is assigned. І chim vіn vishchy, tim іmovіrnіshe formulate be-like speed:

1 class - angina pectoris, diagnosed for the first time, or improved already obvious pathology of the heart;
2nd class - angina pectoris calm, scho appeared for the last month;
Class 3 - angina pectoris calm, scho appeared in the left side of the door.

Symptoms of unstable angina

Typical unstable angina pectoris is manifested by symptoms characteristic of ІХС. The growth of symptoms is to talk about the progress of the ailment. Main symptoms:

It's joy! Symptoms ІХС, scho turbuyuyu lyudin stretching out for an hour, can become the reason for the development of the heart attack.

Peculiarities of overcoming unstable angina pectoris

Unstable angina pectoris appear key symptomІХС - we are sick in the area of the heart. The triviality and intensity of the cardialgia was felt with the skin at once to improve.

Practically, it is necessary to increase the area of the pain, and the cardialgia itself will fix the sickly character: it periodically subsides and again becomes feasible. Unstable angina pectoris develops as a result of the stable variant; however, in order to stop the attack, it is necessary to take an adjusted dose of proponated before taking the drug.

To achieve often unstable angina pectoris is the result of a physical or physical response. In the world of progressing pathology of the heart, the IXC can be victorious and at the same time minimal psycho-social and physical adaptation. Not onset and cardialgia ІХС at dear ones, For example, grips, GDVI meager

diagnostics of pathology

Diagnostics of angina pectoris, which is counter-unstable, is carried out in two directions:

sleepy sleep і lykarskiy look around;
laboratory and instrumental advances.

First for everything, to be carried out asleep, in the course of which the doctor will take the following information:

Likarsky examination of the breast tissue is regularly carried out, including:

vislukhovuvannya;
idle talk;
obmatsuvannya region of the heart (the procedure for additional assistance in the cases of vyaviti vyaviti zbіlshennya vyvitelnaya razmіrіv lіvogo shlunochka to the body).

Laboratory and instrumental dosage

When we carry out an oral study and look around at a car, it is a sign of an offensive analysis:

Zagalny doslіdzhennya blood. The analysis is so easy to pass through the body. In general, there is an increase in the number of leukocytes and the adjustment of SHOE.
Doslіdzhennya sechі. For detecting suppressive ailments.
Biochemistry of blood. Here the main emphasis is on the level of cholesterol, fractions, blood sugar. It is possible to assess the development of atherosclerosis of the Sudin.
Carrying out additional enzymes in the blood.

It is also necessary and necessary to carry out singing and instrumental sounds. tse:

EHC procedure. Allowing the heart to serve the robot. With unstable angina pectoris, ST segment shifts and T wave tend to occur.
Echocardiography (EchoEKG). Ultrasound dosage heart. Allows for the life of all possible changes in the robot, as well as the appearance of myocardial ischemia. Ale inodi navita povna norm of ultrasound of the heart does not affect the manifestation of unstable angina pectoris.
Dobove doslіdzhennya on Holter. Here zyattya elektrokardіogrami carried out by pulling out. The robot's heart is fixed with a special attachment (a holter monitor). Also, it is allowed to manifestly manifest ischemia, cause it to appear, to see it in the rhythm of the heart, etc.
Stress echocardiography. The technique is based on one-hour physical examinations and one-hour EchoEKG. The indicators of the heart are known in three positions: the camp is calm, at the moment it is ready, for an hour to be adjusted. Before the end of the day, allow the appearance of the posed zone and myocardium.
Myocardial scintigraphy. Radioactive drugs are injected into the human organism, allowing the image to be removed and the heart is empty.
Coronary angiography. Radiologic dosage of the coronary bed. The procedure can be recognized if agreed surgical treatment. Yes, there is the possibility of detecting thrombosis and ringing of the Sudin.

Treatment of unstable angina

Patients who are diagnosed with unstable angina pectoris, who are guilty of being eliminated permanently. At the same time, the institution of hospitalization is indicated.

non-drug treatment

A person who is sick is recognized as the most important postal regime. Yogo attention is necessary right up to the moment of renewal of stable blood circulation in the coronary arteries of the heart.

Lykarska therapy

The treatment of unstable angina of the heart is directed, for everything, at the weakening of attacks of the cardiac, as well as the improvement of the development of such a serious stance, such as myocardial infarction. Drug therapy for unstable angina pectoris is represented by advanced drug categories:

For relief of pain. Here, the preparations from the nitrate group are up to the reception. The stench perfectly copes with pains in the heart, but does not pour on the heart rate and indicators arterial vise.
Medicines to reduce the need for myocardium in acid. Beta-blockers - you can use the expanded education in the heart, the heart rate is very fast and you get pain in the heart. Most often the antagonism of calcium is vicious.
Blood thinning drugs. There may be a sign of disaggregation (like, lowering the gluing of platelets) or direct anticoagulants (drugs are used to reduce the larynx of blood, which prevents blood clots from forming).

It's joy! The technique of neuroleptanalgesia is often used in the process of treatment. In the whole of a sick person, an anti-sick drug is injected internally. Lyudin at a time will be lost in the experience of witness, and even now he will spend an hour on the welfare of being aware of the emotions.

Approximately 80% of all success stories drug treatment pathology allows to eliminate the necessary therapeutic effect - stabilization of the blood flow of the coronary arteries. When there is a positive dynamism, the sick person is recognized to have a surgical treatment.

surgical treatment

Lіkuvatіsya in the whole range of unstable angina pectoris due to the help of the offensive techniques:

Coronary angioplasty performed with additional stenting. The essence of the method of polyagaє in the introduction to the judgments enlightens the shkodzhenoi judge of a metal tube - a stent. The judgment itself will be taken care of, and the function of the judgment is allowed to pass through to the required norms.
Vykonannya of aorto-coronary bypass. The Qia technique is vicarious in two ways: in case of a head coronary artery, if all coronary arteries have burst. Here a new channel of the Sudin is led by a piece route. The first roof is already delivered to the myocardium dilenka.

Ymovirni inheritance and acceleration

If you don’t think about the treatment for an hour, then such a camp can be the reason for such an acceleration:

Prevention of unstable angina

Preventive entry of unstable angina pectoris in the offensive:

In general, there are many types of culinary and alcoholic beverages.
Vinatok of high psycho-social stress.
Pidtrimka your vagi in the boundaries of norms.
Physical activity.
Respectful control over the indicators of arterial vise.
Harchuvannya maє buti is balanced.
It is necessary to control the level of blood cholesterol.

Unstable stenocardia is a serious camp, which is not a secret for medical help. I showed up characteristic symptoms- a clear lead for the beast to the lykarya-fakhivtsya. Oscillations are only adequate, and every hour you can spend your life.

Angina pectoris is a pathological camp, when a person sees severe pain in the breasts, which extends to the area of the shoulders, shoulders, and sometimes - the upper symptoms.

Such a problem is overwhelmed by the lack of blood loss of the heart and called stable angina pectoris.

At the end of the day, the form of angina pectoris is unstable - in the region it is not transferred to the development of the disease. It is possible to provoke a heart attack without specific specific factors, which is of particular concern for human life.

Find out all about the symptoms of unstable angina pectoris, diagnostics and tactics of treatment from the statistics.

The main development of ischemic ailments of the heart is the manifestation of atherosclerosis, when cholesterol is deposited on the walls of arterial vessels. All blood-bearing judges suffer from atherosclerosis organism, ale the very coronary arteries, roztasovani in the heart, in the greatest world, to a negative infusion of pathology.

With the help of cholesterol plaques grow, decrease the level of blood flow. Yakshcho lyudina is spokiyna, the impairment of blood circulation may not show herself, ale in case of a nervous or physical imbalance in the heart, the rhythm of the rhythm And the shelter has begun to go shvidshe to go through the vessels.

The splinters of the judgment sound, the oversupply of the blood becomes more difficult, as a result of which the myocardium fails to sour. Hypoxic processes change the amount of non-refined products in the exchange of words, and the appearance of more visions in the heart... Such a camp is called an attack of angina pectoris.

A stable type of engulfment can be successfully controlled - DO NOT overwrite oneself physically, uniquely stress, take nitroglycerin for an hour. The form of the ailment is unstable to manifest itself in a different way.

Tsya pathology of a disease in case of rapid destruction of coronary blood circulation - a sudden strong sound for a short hour, which is an attack.

Unstable stenocardia can be inflicted with a side-by-side camp and an unstable disease in the robot's heart and such a threatening phenomenon as myocardial infarction. Given the pathology, without the need for immediate medical assistance, it can lead to the development of a hospitable infarction, to that in the state of the term hospitalization and post-mortem likarsky glaze.

Do you like to get sick of a heart ailment? Z'yasuyte tse.

Causes and factors of rizik

Angina pectoris takes on an unstable form in that case, if it appears in the coronary artery cutting out fibrous plaques with a thrombus that has been confirmed, which has transformed the normal blood loss of the myocardium.

Fibrous plaque can be enlarged for as long as possible ignition processes, An excess of fatty deposits, a breakdown of hemodynamics or an unstable collagen.

The main reason for the diagnosis of unstable angina є ІХС... Won’t show up when you buy fat deposits on the walls of the arteries. When the court enlightens the sound, the heart ceases to trim enough sourness, to bring it to the point.

The main reasons for the development of pathology are:

cutting the capillaries with a little bloodstream into the plaque;
increased platelet health before gluing;
wikid serotonin, or a vasoactive agent in the blood, in case of any increase in the development of the formation of coronary vascular disease;
Change of antithrombotic powers of the clitin endothelium.

There are also a number of factors that can provoke the formation of this pathology: an increase in cholesterol levels, diabetes, hypertension, genetic strength, excessive vagina, curiosity, a low-spirited way of life.

Classification of species

There are 4 main types of unstable angina pectoris:

pervinna, When there is a sickness, the wiklikє is calm with a stretch of a month.
postinfarction If you come across as attacks in the first 2 days after myocardial infarction is transferred, or with a hand to the period, which will be trivial for nearly eight times.
progressively When you lose self-esteem and increase the frequency of attacks on the build-up, extending the month.
When judging occurs, it sounds as a result of spasms, and not through atherosclerosis.

Also, they add up to the old and the stage of gravity:

1 step... The ailment died less than 2 months ago, it is important, it is progressing rapidly, it manifests itself in a calm state.
2 steps... It is carried out until the adolescent phase of illness, when the symptoms appear first, and more can be more than two days.
3 steps... Most seen last 2 days.

Regularly, from the clerks, the most important paintings are divided into three classes:

1 class... Painful syndrome is often found in high navantages, in the lower ones - with minimal ones. The number of attacks increases per hour. The first attack - not earlier, not 2 months ago. The attack may not appear in the quiet camp for 2 months.
2 class... Characterized by persistent pain in the spoky stan. The first attack will attack the registrations not earlier than 2 months ago.
Class 3... Until now, the gostr's stenocardia in the camp is calm, like a winner for the rest of the dvi dobi.

Three reasons for the formation of ailments are classified into three groups:

Group A- attack through the ailments, as they do not seem to the heart - thyrotoxicosis, hypoxia, incomplete disease, gostra infection.
Group B- angina pectoris develops on the smallest heart problems.
Group C- pov'zhennya ailments are tied with the transfer of an infarction.

Diagnosis of unstable angina pectoris is determined on the basis of the classificationі viglyadaє approximately as follows: "angina pectoris is unstable, 1 A class". According to the characteristics, it is possible to see that the attack is not too large for 2 months, and the patient is ill, provoking the ringing of the coronary vasculature.

Nebezpeka and accelerated

Angina pectoris is unstable when there is no illness can wiklicati such problems:

gostry myocardial infarction;
thromboembolism of the leg artery;
cutting the fibrillation of the heart with an offensive fatal result;
gostra sertseva lack, which is supervised by a lot of legends.

With an increase in the frequency of painful attacks and in the absence of unresponsive earlier symptoms, later on, they turn to a doctor. As soon as the patient is directed towards the treatment in the stationary, if he is aware of it, he will take on himself the perception of his life.

Клініка: signs and symptoms

Ailments can be brought down smoothly, some of the symptoms of the whole ailment can be brought down to some other heart pathologies.

Visually unstable angina pectoris may occur, as well as the following signs:

Symptoms change: the frequency and triviality of large attacks increased, nitroglycerin additionally helps less, if it tries and expands on the adjoining part of the body, attacks occur even with less early attacks.
I have an attack of pain, which is more than 10 hvili, I do not know nitroglycerin.
The attackers pochali turbuvati a month ago or a little more.
More symptoms in the breasts before the hour of the post-infarction stun - this is a sign of the formation of a new blood clot in the affected vessel.
Attack pochali winikati in the camp of calm.
The emergence of symptoms during the operation of coronary artery bypass surgery, carried out less than three months ago.

Prinzmetal's angina pectoris has its own specific symptoms:

the most frequent attack by the shrewd young people;
most of the ideas are not tied to physical options;
attack more often than not, dobi in the last hour;
Visoka The effectiveness of treatment for additional antagonists of calcium and drugs from the group of nitrates.

Stenocardia Prinzmetala has a very unpleasant prognosis. Such a form of getting sick in bagatokh vipadkah produces a rapid development of myocardial infarction.

Oskilki given pathology to become a great need for the life of the people, with the appearance of the first symptoms, go to the cardiologist... People who suffer from ischemic ailments of the heart and angina pectoris need to regularly check with the doctor and undergo treatment.

diagnostics

To make a diagnosis, the following types of diagnostic procedures are stagnant:

zalny look at the patient, Listening to heart tones, inducing symptoms and anamnesis;
blood analysis, Allowing the ignition of the processes;
analysis of the section- necessary, schob to include other pathologies;
EHC- for the recovery of ischemic ailments;
holterivske EKG- stagnate for the value of minds, frequency and triviality of processes;
Vidlunnya-EKG- it is necessary for the implantation of the structure and size of the heart, and also I will become valves and blood circulation;
coronary angiography, Yaka allows the blood to flow in the heart vessels;
Stress-Luna-EKG- to carry out for the identification of areas of hypoxia of the myocardium for the minds of physical nurturing;
scintigraphy, Scho permits to vivchit stinok and empty heart.

Tilki took over the knowledge of all the conditions, put a definite diagnosis.

How do you see tonometers for vimіryuvannya arterial vise in home minds? You can read about them.

therapy tactics

In case of unstable angina pectoris, it is indicated that there is an extraordinary hospitalization, as well as drug therapy. In the case of lіkuvannі zasosovuyut like this:

diseases of the disease - neuroleptanalgesia, nitroglycerin;
drugs that allow the polypathy of blood circulation - antiagreganti and direct anticoagulants (clopidogrel, prasugrel, aspirin and іnshі);
drugs that reduce the need for myocardium in acid - calcium antagonism, beta-blockers.

If there is a positive effect of drug therapy, it may be indicated hirurgic path lykuvannya ailments:

angioplasty... At the sound of the vessel, a stent (metal tube) should be inserted, which will reduce the size of the vessel from the cracking and prevent normal blood flow.
Coronary artery bypass... Such an operation stagnates, if the head coronary artery is affected, or the part of the coronary artery is large. At the end of the day, there is a pre-existing channel in the obh_d urazhenih sudin, yak will ensure the delivery of blood to the heart.

After the performed examination and polypsy, I will become a patient, call for a cardioreabilitation sanatorium, which is necessary for the improved stabilization of the coronary blood flow.

Forecasts and come prophylactics

The prognosis of ailments to lie down in the stage of gravity, trivial development and other pathologies. Schob zapobigti attack angina pectoris, it is recommended to visit:

vidmova vid kurinnya;
the fight against the waggle;
doing sports;
pomirne vzhivannya alcohol;
There is a great number of fruits, ribs, vegetables, whole grains and meat in the races.

Besides, slid free of charge grip and the sound of arterial vessels... Taking an aspirin tablet per day can speed up the number of painful attacks and reduce the development of myocardial infarction.