Unstable angina - angina is accompanied by a constant risk of serious complications, mainly myocardial infarction. In unstable angina is almost always trauma cholesterol plaques of the coronary vessels and blood clots.
What is unstable angina
Angina - a sudden onset of sharp pain in the heart, associated with myocardial ischemia
Myocardial ischemia - the effect on the functional activity of the heart
. That is the pain associated with impaired oxygen supply to the heart muscle. The cause of angina in most cases is coronary heart disease (CHD), which develops against the background of atherosclerosis. In the walls of blood vessels are formed atherosclerotic plaques, soldered with the vessel wall and reduces the lumen, and therefore delivery of arterial blood to the myocardium.
In most cases, angina is initially stable, i.e. depending on the degree of physical activity of the patient. But at some point it becomes unstable angina and depends not only on the physical activity, but also on other factors. Unstable angina - a form of angina, which is intermediate between stable angina
Stable angina - one of the manifestations of coronary heart disease
and acute myocardial infarction.
The primary cause of unstable angina
Unstable angina - alarm organism
is the injury of atherosclerotic plaques by external or internal factors.
The external factors may include high blood pressure, increased activity of the sympathetic nervous system (for example, against the background of constant stress), high blood lipids, and so on. The internal factors include changes in the structure of cholesterol plaque due to various pathological processes, including the inflammatory disorders.
Under the influence of these factors atherosclerotic plaque (and with it and the wall of a blood vessel) is injured, it activates the process of thrombus formation, by which the body is a "patchwork". In the injured plaques formed thrombus, which further narrows the lumen of the vessel. In the future, or a blood clot may dissolve completely, or break off and "travel" through the circulatory system trombiruya small coronary arteries and causing mikoinfarkty. A blood clot can also be organized, that is to germinate connective tissue and enter the structure of the vessel wall, steadily reducing its lumen.
Sometimes unstable angina and not developing on the background of atherosclerosis. The reason for it in this case are biochemical changes in the cells of the inner shell (endothelium) of the coronary vessels, which leads to increased formation of vasoconstrictor substances and the development of sudden (spontaneous) strokes.
Possible symptoms of unstable angina
There are several options manifestations of unstable angina.
For the first time emerged angina - is characterized by the appearance of angina attacks no more than a month ago. It may be seizures, which appeared for the first time or after a long break. Since the causes of angina and the nature of its intended course still unknown, patients are usually observed and assign them active treatment.
Progressive angina - increased number and severity of available long-term angina attacks, occurring under the influence of earlier exercise tolerance. Angina attacks worse may be removed by nitroglycerine, for their removal requires more than before the dose of nitroglycerin.
Spontaneous (vasospastic, Prinzmetal) angina - the occurrence of angina attacks spontaneously, regardless of physical activity, usually at night. Seizures are long (up to 15 minutes) are not always removed nitroglycerin and accompanied by changes on the ECG.
Postinfarction or postoperative angina - or more frequent occurrence of angina attacks in 24 hours and for 28 days after myocardial infarction, or within 4-8 weeks after the successful surgical treatment of coronary heart disease.
Diagnosis of unstable angina is based on a thorough questioning of the patient and the analysis of its claims data in conjunction with the diagnostic examination. The main feature of unstable angina is the changing nature of attacks, increasing their frequency and duration.
ECG unstable angina may occur signs of ischemia
Signs of ischemia - everything depends on the organ injury
infarction occurring during the attack and saved in the interictal period soon after the cessation of pain or in the next 2-3 days.
But quite often the ECG is normal, therefore, to confirm the diagnosis is carried out daily (Holter) ECG monitoring that can detect cases of myocardial ischemia and to correlate them with patient complaints.
Coronary angiography - X-ray examination of the vessels with contrast to evaluate the location, extent and prevalence of atherosclerotic lesions of the coronary vessels. With this study can reveal spasm of the coronary arteries, the presence of thrombi.
To confirm the diagnosis is also carried out to determine the level of activity of cardiac enzymes in the blood (creatine kinase, CK-MB, LDH, ACT), echocardiography (ultrasound of the heart), myocardial scintigraphy (radionuclide study) and some other studies.
Unstable angina requires serious consideration by both the physician and by the patient.