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Treatment of angina (cardiac angina, breast pang, stenocardia) abroad

Cardiac angina is the clinical form of Ischaemic heart disease or Coronary Artery Disease. Ischaemia means ‘reduced blood supply.’  This manifests itself with an oppressive pain behind the breastbone. The disease affects 15% of males and 5% of women. It can lead to the development of myocardial infarction if lasting for more than two years.

 

Angina pectoris is diagnosed mostly among elderly people. It is observed only among 0.5% of women and 3.5% of men; up to the age of 55.  After 65 years old it is observed among 15% of women and 20% men.

 

Cardiac angina

 

Causes of Angina (cardiac angina)

Angina is caused by when the heart is starved of oxygen. There are two main forms of angina pectoris, which have different causes:

 

Effort angina occurs due to the reduction of the lumen of the coronary vessels (arteries that supply the myocardium). The essence of this syndrome is reflected in the title - the pain occurs at the effort that requires a high level of oxygen supply.

 

This can be caused by a variety of factors:

  • Exercise stress
  • Psycho-emotional burden
  • Sexual intercourse
  • Sensation of cold
  • Hypoglycemia
  • Binge eating
  • Fever

 

Spontaneous or vasospastic angina  affects 3% of patients. It is caused by the functional narrowing of the coronary vessels. These spasms restrict blood supply to the heart, resulting in oxygen starvation of the myocardium.

 

Atherosclerosis is usually the reason for narrowing of the coronary vessels lumen. A deposition of cholesterol plaques on the inner surface of the arteries.

 

Atherosclerosis, in its turn develops because of the following reasons such as:

  • Elevated blood cholesterol
  • High blood pressure
  • Obesity and low physical activity
  • Hypothyroidism, diabetes mellitus
  • Genetic predisposition

 

Angina results when the increased myocardial oxygen demand occurs, but it cannot fully be satisfied due to a weakened coronary blood flow.

 

Cardiac angina symptoms

 

Angina (cardiac angina) - Symptoms

Pressing pain in the sternum is the main symptom of angina. Characteristics of pain:

  • Pain  is usually described as a pressing or compressing (although it may be burning, shooting, stabbing)
  • Typical localization is in the chest, behind the breastbone; rarely - in the epigastric region
  • Possible irradiation in the left shoulder, left arm, left hand little finger
  • Syndrome of "intermittent claudication of the heart" which is signified by a burning pain in the legs. Often a person experiencing such pain is forced to stop while walking, to  remedy the pain

 

Angina attack usually lasts for at least 1 minute, but not more than 20 minutes. Standard duration is from 2 to 5 minutes. After the attack a feeling of weakness or dizziness follows .

 

Cardiac angina diagnostics

 

Angina (cardiac angina) - Diagnostics

Depending on when a person felt the pain for the first time and the dynamics of the syndrome, the following forms of angina are differentiated:

 

First time emerged angina. This diagnosis is made when the chest pain disturbed the patient for the first time no more than 1 month ago. Newly diagnosed angina may behave differently. In the worst instance myocardial infarction will result. The favourable prognosis presupposes the resolution of symptoms.

 

Stable angina is diagnosed when a month has passed, and the attacks are repeated. Stable angina is characterized by the occurrence of pain under the influence of factors that increase myocardial oxygen demand, and the spontaneous disappearance of symptoms in 1-2 minutes after having exercised.

 

Stable angina is divided into four functional classes:

  • 1 - an attack occurs only after intense or prolonged physical exertion
  • 2 - attack occurs when walking on level ground at a distance of 500 m, or when climbing the stairs to the 1st floor
  • 3 - for the emergence of an attack it is enough to pass 100 m on a level ground
  • 4 - minimal physical activity leads to seizures, its appearance is possible also at rest or during sleep

 

Progressive angina. Diagnosis is made when there is a sudden increase in seizure frequency, reduced threshold for exercise tolerance, an increase in the duration of pain and its intensity. The risk of heart attack increases significantly.

 

Spontaneous angina occurs without any exercise.It is caused by a spasm of the coronary arteries. Seizures are usually longer, approximately 10-30 minutes, there are lots of attacks, 2-5 in a row. Among 50% of patients an impaired heart rate is observed during an attack.

 

Instrumental diagnostics methods:

  • ECG is used with physical activity. It allows you to identify myocardial hypoxia. There are no changes in the ECG at rest among 50% of patients.
  • Holter. ECG is recorded continuously during the day, under the management of patient’s traditional way of life.
  • Stress echocardiography. Heart ultrasound is performed after exercise (bicycle ergometry or treadmill test) and sites are violations of myocardial contractility are identified.
  • Coronary angiography allows you to evaluate the degree of coronary artery damage. During the procedure, contrast medium is injected into the vessels, then an X-ray is done.

 

Cardiac angina treatment abroad

 

Treatment of Angina (cardiac angina) abroad

Cardiac angina is treated with the help of conservative therapy. Its main goals are to improve the patient’s life and prevent further atherosclerotic artery damage as well as reduce the risk of myocardial infarction.

 

Surgery is performed in cases of:

  • Significant deterioration in the patient's quality of life, which is observed during stable angina of 3-4 functional class
  • Detected with angiography stenosis of the left main coronary artery (more than 50% of the lumen is closed)
  • The inefficiency of the conservative therapy, when the phenomenons of myocardial ischemia are not eliminated by administering drugs

 

The goal of surgical treatment is to restore normal blood supply to the myocardium. Different operations are done judging on the clinical situation.

  • Vascular stenting. Stent is inserted inside the affected coronary artery (a spiral lattice metal tube) which mechanically affects the vessel, extending it and providing normal blood flow.
  • Coronary artery shunt is indicatedin case of multiple coronary arteries and their branches damage. Blood flow is restored to bypass the affected vessels. For this purpose, the grafts from the patient's own veins and arteries (internal thoracic, radial artery, great saphenous vein of the lower limbs) are taken.
  • Laser Revascularization is aminimally invasive surgery, which is performed with endoscopic access. The multiple holes are made in the myocardium. The operation results in the blood flow into the muscle layer of the heart tissue from the left ventricle. 
  • Atherectomy is only possible if the artery is clogged in one small area. Removal of a blood clot (burning) is performed by means of surgical instrument called the excimer laser.
  • Stem cells therapy isconducted after myocardial revascularization to restore its structure. Stem cells are taken from the patient. About 10 thousand of them are selected and cultured. The result is more than 200 million cells. Part of this population is differentiated in cardiomyoblast (heart cells) .They are introduced into the human body and reach the myocard via the bloodstream. These cells take the place of those that have been damaged as a result of coronary heart disease.

 

Cardiac angina prognosis

 

Angina (cardiac angina) - Prognosis

Mortality is 4% per year for stable angina. The prognosis is worsened by:

  • Myocardial infarction during the last year
  • 3-4 functional classes of angina pectoris
  • Trunk lesion of the left coronary artery (case fatality rate - 28% per year)
  • High blood pressure
  • Hypertrophy of the left ventricle
  • Age
  • Cardiomegaly
  • Heart failure
  • Irregular heartbeat

 

All of these factors significantly affect the outcome. Prognosis can be significantly improved with the help of surgery. In this case, the length and quality of life are determined by concomitant cardiovascular pathology.

 

Five-year survival rate of patients with the spontaneous angina is 95%. Most cases of myocardial infarction in this form of angina (70%) occur within the first three months after diagnosis. Remote prognosis is favourable for this type of angina.

 


 

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