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.
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:
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:
Angina results when the increased myocardial oxygen demand occurs, but it cannot fully be satisfied due to a weakened coronary blood flow.
Pressing pain in the sternum is the main symptom of angina. Characteristics of 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 .
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:
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:
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:
The goal of surgical treatment is to restore normal blood supply to the myocardium. Different operations are done judging on the clinical situation.
Mortality is 4% per year for stable angina. The prognosis is worsened by:
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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