Vasospastic angina - how to cope with it?

November 1, 2014

 vasospastic angina
 Vasospastic angina is accompanied by bouts of pain in the heart caused by blood vessel spasms. These attacks are spontaneous, that is, they are not connected to any external factors. Danger vasospastic angina in the development of severe complications - cardiac arrhythmias, and myocardial infarction.


Why start vasospastic angina

Similarly, it is not known, since, unlike other forms of angina, organic changes in the coronary vessels in most cases are not detected. But today it is established that under the influence of various external and internal factors are changes at the biochemical level in the cells of the endothelium (the inner lining of the walls) of the coronary vessels. In the smooth muscle of blood vessel walls there is a large number of calcium channels, which contributes to calcium intake and smooth muscle spasm. In addition, endothelial cells stand out substances that contribute to spasm of blood vessels and inhibit the formation of vasodilator substances.


Symptoms vasospastic angina

Vasospastic angina (spontaneous, variant, Prinzmetal angina) may begin suddenly with the appearance of episodes of acute pain behind the breastbone or in the left side of the chest.

Heart attack pain typically occurs at night, at rest, in one and the same patient as it often appears in the same time. Pain can have a classical character: the sternum (in the upper or middle third of it) with irradiation (return) to the left shoulder and left arm.

But this is not always the case. Pain can be located just to the left, right, or even predominantly in the abdominal region, thus giving the lower limbs. Attacks may occur angina and pains, and their equivalents - severe weakness, feeling short of breath, sick and barely make a breath and exhale. Often these attacks are accompanied by dizziness, nausea and fainting.

Vasospastic angina may be complicated by heart rhythm disturbances - that this complication is often the cause of death of patients.

Vasospastic angina peculiarity is that in this form of the disease in the pathological process involves mainly large coronary vessels, which creates a significant risk of developing myocardial infarction macrofocal Myocardial infarction - the most formidable diagnosis  Myocardial infarction - the most formidable diagnosis
 . Predisposition to develop such complications seen on ECG during the attack and within 10 minutes after the film can be seen on symptoms of acute myocardial infarction, which subsequently disappear (which does not occur when the true myocardial infarction).


Treatment of vasospastic angina

Treatment of spontaneous angina Spontaneous angina - the most rare form of this disease  Spontaneous angina - the most rare form of this disease
   It consists of the removal and prevention of heart attacks of pain. To remove the heart aches every patient should always carry nitroglycerin tablets or spray.

Nitroglycerin - a drug from the group of nitrates, providing rapid vasodilator effect, mainly in the veins. This improves the outflow of blood from the myocardium, the load reduction in ischemia Ischemia - when the brain fails to work  Ischemia - when the brain fails to work
 . Nitroglycerin reduces myocardial oxygen demand and inhibits the action of the sympathetic nervous system to the blood vessels (SNA causes vasospasm). Simultaneously nitroglycerin causes vasodilatation of the brain and a sharp headache in some patients.

Most often take nitroglycerin tablets to 0, 5 ml under the tongue. The attack while docked in an average of 1, 5 minutes, the effect lasts from half an hour to an hour. The tablet kept under the tongue until complete resorption, without swallowing. If no effect during the first 5 minutes, one must take one tablet. If heartache is not removed after taking 2-3 tablets, you should immediately call an ambulance.

Nitroglycerin spray comprising 0 to 4 mg per dose. As soon as the first signs of an attack of angina pectoris Angina - oxygen deficiency  Angina - oxygen deficiency
 , Must be applied by spray language by clicking on a monitor - three times (0, 4-1, 2 mg) within 15 minutes. It is better to do it in a sitting position, and be sure to hold your breath (spray should not be inhaled). After applying the spray you should close your mouth. If the pain is not removed, you should call an ambulance.

To prevent attacks vasospastic angina with medication nitroglycerin number of long-acting (kardiket, nitrosorbid). Prevent the development of angina attacks is also using drugs from the group of calcium antagonists, which in most cases are the drugs of choice (verapamil, nifedipine). These drugs cause relaxation of smooth muscles of the walls of the coronary vessels.

Sometimes, if the action of the first two groups of drugs is ineffective, prescribed drugs from the group of alpha-blockers, which suppress the action of the sympathetic nervous system, such as prazosin.

Vasospastic angina should be treated under the supervision of a specialist.

Galina Romanenko

Article Tags:
  • angina

Variant angina - severe and under-studied form

November 1, 2014

 variant angina
 Variant angina - a form of angina, which was first recorded in the middle of the last century by the American cardiologist M. Printsmetalom, after whom it is called, and still. It is also known as spontaneous and vasospastic (angiospastic).


Why and how to develop variant angina

Angina - a disease characterized by acute attacks of short-term pain in the chest caused by lack of oxygen in the cells of the heart muscle - the myocardium. Myocardium - a muscle that never rests, so she constantly need oxygen. In its absence, or severe restriction for several minutes myocardial cells begin to die, that is, developing myocardial infarction.

The main cause of angina is atherosclerosis - a disease in which the blood vessels are deposited cholesterol plaque, which leads to a narrowing of the vessel lumen. When atherosclerosis affects the walls of the arteries that carry blood to the myocardium (coronary arteries), then talk about coronary heart disease (CHD). In most cases, angina develops against the background of coronary artery disease. Starting torque at the same time are the physical and psychological stress.

But about 60 years ago, it was first identified form of angina, virtually unrelated to atherosclerosis Atherosclerosis - a chronic disease of the arteries  Atherosclerosis - a chronic disease of the arteries
 . It is called variant, spontaneous or vasospastic. All of these names reflect the characteristics of this form of angina. Variant - one of the infrequent variants of the disease, spontaneous - the beginning of the attack is not associated with any provoking factors, vasospastic (sometimes called angiospastic that the same thing) - associated with coronary vasospasm.

Variant angina - a form of the disease is not fully studied until now. It is believed that the reason for its development is due to different factors hypersensitivity endothelial cell (inner shell) of the walls of blood vessels to various internal factors. That is, under certain conditions in the body to produce substances causing a spasm of the coronary arteries and suppresses the precipitation of substances that facilitate their expansion.

Recent studies have revealed that variant angina is largely developed due to the fact that the smooth muscle walls of the coronary arteries have a higher amount of calcium channels, while calcium activates the process of smooth muscle contraction and activates the process of thrombosis.

There are other mechanisms for the development of variant angina, including some researchers believe that the cause is often not identified atherosclerosis - flat plaques that are difficult to detect.


As shown variant angina

The current variant angina has several features. Attacks of angina pain do not begin under the influence of some external factors, and spontaneously, usually at night or early in the morning when the patient is still asleep. Typically, seizures begin at the same time.

The patient wakes up from the pain, which is often accompanied by the fear of death. The pain is sudden, but growing character. It is an urgent, pressing or compression, takes place rather quickly, within 10-15 minutes, even without treatment. However, to endure the pain in no case be: prolonged ischemia Ischemia - when the brain fails to work  Ischemia - when the brain fails to work
   (lack of oxygen) can lead to extensive myocardial infarction Myocardial infarction - the most formidable diagnosis  Myocardial infarction - the most formidable diagnosis
 As in variant angina affects mainly large coronary vessels.

The second feature of the attack variant angina is the frequent development of its background of cardiac arrhythmias. This threatens the symptom that most often leads to the death of patients.

Finally, another feature of spontaneous angina Spontaneous angina - the most rare form of this disease  Spontaneous angina - the most rare form of this disease
   It is that the ECG during an attack, you can see the symptoms of acute myocardial infarction, which disappear after about 10 minutes after the attack.


How to identify variant angina

Variant angina is not so easy to identify, particularly if there are no signs of atherosclerosis. One of the most effective ways of diagnosing a heart condition study by ECG during the day (Holter ECG), followed by a comparison of patient complaints and ECG data.

Enough effective as coronary angiography - the study of heart vessels using contrast agent and X-rays. Thus it is possible to identify the vessel spasm, which occurs in response to the introduction of a foreign object (catheter), a contrast agent or drug into a special coronary artery.

Variant angina is dangerous for its complications in the form of cardiac arrhythmias and extensive myocardial infarction. Therefore, such patients should be under the constant supervision of a cardiologist.

Galina Romanenko

Article Tags:
  • angina