Signs of Angina in Women: A Complete Review

In this article you will learn: typical symptoms of angina in women. The main differences between female and male angina. Differences between angina pectoris and arrhythmia, osteochondrosis, heart attack, and other forms of coronary heart disease.

Author of the article: Yachnaya Alina, oncologist surgeon, higher medical education with a degree in General Medicine.

Article publication date: 12/19/2016

Article updated date: 05/25/2019

The main signs of angina pectoris in women:

sharp pain in the heart area,
nausea,
feeling of lack of air,
shallow breathing,
cardiopalmus,
coldness and numbness of the fingers,
the appearance of cold sweat and unaccountable fear of death.

This disease is dealt with by a general practitioner or cardiologist.

What types of angina occur in women?

There are three main types of angina – tension (stable), unstable and variant. Stable angina, in turn, is divided into several classes, depending on the severity:

Class 1, when an attack occurs against the background of severe physical exertion;
Class 2 involves the occurrence of attacks after fast walking, climbing stairs, or even after eating;
Class 3 can occur as a result of minor loads, stress, climbing stairs to the second floor, or even a sudden change in temperature (when going out into the cold, for example);
Grade 4 occurs on its own without significant physical or psycho-emotional stress.

Unstable angina is characterized by progression of symptoms, sometimes pain can occur at night or during complete rest. This type is less favorable, since the heart is constantly experiencing a lack of oxygen.

Classes and signs of angina

In medicine, there are several types of angina. The first type is stable angina, the cause of which may be congenital heart disease, atherosclerotic lesions of the aorta and the inability to meet the increased needs of the body.

In medicine, there are 4 functional classes of the disease:

first . The mildest form of angina. The patient does not suffer from attacks during daily activities. Only excessive physical activity can cause pain in the chest area;
second . The development of this functional class limits the ability to perform daily activities. Even walking quickly or climbing stairs can trigger an angina attack. Signs may also occur in the morning after waking up, in cold weather, or after extreme stress;
third . The patient faces serious problems and difficulties, since the disease severely limits his physical activity. Painful sensations may occur when walking slowly on a flat surface;
fourth . This is the most severe class of angina, in which the patient cannot engage in almost any type of physical activity. An attack of “angina pectoris” can occur even with minor exertion.

Functional classes of angina pectoris

Pain during an angina attack is most often a pressing, squeezing, deep dull pain. Patients describe feelings of discomfort in the chest - tightness, squeezing, burning, accompanied by heaviness and lack of air, sweating, dizziness, fear, and possible shortness of breath. The most typical localization of pain is behind the sternum or along the left edge of the sternum; it can radiate to the neck, lower jaw, teeth, interscapular space, and less often to the elbow or wrist joints, mastoid processes. The attack can last from 1 to 15 minutes and stops either when the cause of angina disappears (physical or emotional stress), as well as when taking nitroglycerin.

On a note! With unstable angina, there is a progression of symptoms, as a result of which pain can bother the patient even during a period of rest. Due to the lack of oxygen experienced by the patient’s heart, this type of pathology is considered less favorable.

The main signs of angina in women

Symptoms of the disease have the same causes as in men, but differ in some features:

The pain syndrome has nonspecific manifestations, so angina in women is often confused with other diseases. So, when an attack occurs, there will not be a characteristic burning and squeezing pain behind the sternum, as in men, but rather a stabbing or throbbing pain. The pain may move to the back, neck, left arm or under the left shoulder blade.

The patient may break out in a cold sweat.
Sometimes there is numbness in the fingertips.
During an attack, women sometimes experience changes in the form of spasm of the coronary arteries. This is confirmed by angiography performed at the height of cardialgia (heart pain). However, this does not deny the fact that angina occurs against the background of ischemia.
Nausea and heartburn are equally nonspecific, but often accompany pain in the heart area.
Cough in women with angina occurs, as a rule, at night and is the result of stagnation of blood in the pulmonary arteries.
Women usually do not experience shortness of breath, but shallow breathing may occur. Taking a deep breath causes pain, so patients begin to breathe shallowly.
An exercise test in women is not very informative, as it can often (in almost half of the cases) give false positive results.

Characteristic symptoms in women

Representatives of the fairer sex tolerate the disease a little easier than men. Angina pectoris in women can develop even when the coronary vessels are in excellent condition . This complicates the work of doctors, since it is quite difficult to make an accurate diagnosis with healthy vessels. An attack is usually accompanied by spasmodic contraction of blood vessels, the condition of which cannot be used to determine the disease.

Also, the pain associated with angina pectoris can often be neurological in nature, so standard diagnostic methods, for example, an exercise test, will not give a clear picture, as is often the case with the development of angina pectoris in men. Other symptoms of the pathology are identical to those that occur in representatives of the stronger sex, only not so pronounced.

In women, angina appears almost the same as in men.

How to confirm the diagnosis of angina in women?

Making and confirming this diagnosis in women presents certain difficulties. Due to the fact that the pain syndrome is not as severe as in men, women seek medical help later and often this happens when a myocardial infarction has begun or is imminent. However, taking into account some diagnostic features, it is possible to make a diagnosis of angina in a timely manner:

ECG without load, at rest. Allows you to evaluate the work of the heart muscle and the degree of oxygen deficiency. The ST interval is assessed, which reflects cardiac recovery during diastole. If the level of this interval falls below the isoline, then we can talk about significant myocardial hypoxia.

A stress ECG is performed if no pathological changes are detected at rest. The patient is offered exercise in the form of running on a treadmill or exercise bike. After this, a control ECG is performed.

Echo-CS (ultrasound of the heart) allows you to better determine the degree of hypoxia than an ECG. The same load is carried out, after which the work of the heart as a whole is assessed.

Scintigraphy is performed for those patients who have an unusual course of the disease. The method is based on the introduction of radioactive substances into venous blood. These substances are absorbed by normal, living myocardial cells and begin to emit radiation, which is assessed by the device. Areas that have not absorbed the radioactive substance are in hypoxia or have already died, as in a heart attack.

Angina is a disease caused by insufficient blood supply to the heart. The pathology begins to progress when blood flow to one of the areas of the heart muscle is reduced, which causes oxygen starvation, followed by cell death.

The causes of angina in women can be excessive physical or emotional stress. Representatives of the fairer sex are exposed to the disease when menopause is established. Until this period, their body protects hormonal levels. As a rule, women over 55 years of age are at risk. In this article we will talk about the symptoms of angina pectoris in women .

Representatives of the fairer sex become susceptible to pathology after menopause.

Edema

Peripheral. In the early stages, when angina is just gaining momentum, the feet and ankles suffer. The volume increases slightly, there is no discomfort. The patient is completely unaware of the problem.

Only a doctor can recognize swelling through physical examination (palpation). Further, as it progresses, persistent lesions are formed, the process moves higher, involving the legs. Gradual involvement of the face and hands is possible.

The reason is twofold:

On the one hand, there is insufficient blood circulation and nutrition of the kidneys. Ischemia occurs, the filtering function of the paired organ decreases, its restoration requires long-term therapy, including diuretics.

This is a temporary measure, because the basis is progressive heart failure, an increase in blood volume with a decrease in myocardial contractility.

Attention:

According to statistics, if edema develops, the likelihood of an imminent heart attack is almost three times higher.

Another possible cause is liver dysfunction. In such a situation, in addition to the actual increase in tissue volume, ascites occurs (fluid accumulation in the abdominal cavity), and jaundice is possible. Complications entail an increased risk of death or disability.

Symptoms of the development of pathology

Signs of angina in a woman may appear only after the body stops producing estrogen. Therefore, for women this is a later age compared to men. The main symptom is sharp pain in the chest area, which occurs after physical or nervous stress. It is caused by oxygen deficiency.

Depending on the stage of development, angina is divided into three main types:

Primary	When do angina symptoms first appear in women?
Stable	The disease has a fairly long period of duration, but without visible changes
Unstable	The disease is progressing. This type is considered the most dangerous because it can cause a number of complications: myocardial infarction or even primary cardiac arrest

Women with overweight, obesity, high cholesterol, diabetes mellitus, and they abuse smoking and alcoholic beverages are more susceptible to the disease.

The signs of cardiac angina in women differ from the main symptoms of the pathology in men. The key indicator is cardialgia - pain in the heart is accompanied by neurotic pain. It is this feature that complicates the diagnostic process.

During the examination, violations can only be detected during an attack. At this moment, arterial spasm occurs, which prevents normal blood flow. Even with physical activity, it is not always possible to accurately diagnose. Accordingly, it is quite difficult to study angina pectoris in women.

The first signs of angina in women are very similar to men’s symptoms:

painful spasms in the chest area, which can radiate to the shoulder blade, neck, shoulder;
increased cold sweating;
feelings of nausea, heartburn, possible vomiting;
cough;
increased fatigue, dizziness;
rapid pulse, it returns to normal when the attack subsides;
inability to move your arms normally, numbness in your fingers;
asthmatic manifestations: shortness of breath, difficulty taking a deep breath.

During an attack, women usually feel all of the above symptoms. The duration of the attack can reach half an hour. During this period, it is necessary to call an ambulance and provide first aid.

A large number of patients do not experience pain in the chest area, but their back, shoulders, hands, and jaw hurt. In this case, shortness of breath often occurs, a lack of air is felt, and dizziness occurs.

Women who have had an MI or heart attack experience other signs of illness: upset stomach, vomiting, and fatigue. There is no noticeable pain in the heart area.

Although many symptoms are common to both women and men, it is in the fairer sex that the disease is most often asymptomatic.

Clinical picture and its explanation

The first thing a patient with suspected angina faces is pain in the chest. How intense it is depends on the location of ischemia, the individual characteristics of the body, including the sensitivity threshold.

A characteristic sign of coronary insufficiency is that the pain lasts no longer than 30 minutes and is of moderate or lesser severity. Unbearable discomfort characterizes a heart attack rather than angina. This is the main distinguishing feature.

It is not one hundred percent accurate, so you can easily miss an emergency. The recommendation is to call an ambulance if you have heart pain.

Discomfort is localized in the central or left part of the sternum, and can radiate to the stomach, arm, shoulder blade, back, spine in general, collar area (neck), jaw, face.

There is a diffuse (spread out) type of pain; the patient will not be able to show exactly where the unpleasant sensation is located. The nature of the discomfort is burning, pressing. It appears as a heavy stone sewn into the chest.

How to differentiate pain syndrome

Defining heart pain is quite simple. You need to take a deep breath and move. In the absence of changes, the discomfort is most likely of cardiac origin.

In addition, against the background of angina pectoris and heart attack, there are almost no shooting sensations or intense tingling. This is not a typical pain pattern.

Taking Nitroglycerin is considered a good limiting sign, but in case of acute necrosis (heart attack) you cannot drink it, so it is not recommended to take risks. Expansion of the process, its spread to healthy tissue, worsening death and death are possible.

First aid during an attack

If there are any signs of angina, you must take the following steps:

call an ambulance;
lower the patient's legs down, do not allow sudden movements;
reassure the patient as much as possible;
give the patient a whole or half aspirin tablet;
the patient should also take nitroglycerin or a sugar solution;
Aerosol formulations can also be used to lower the pain threshold.

It is important to organize the correct combination drug therapy

In case of severe persistent pain, nitroglycerin must be given again. In total, the drug can be taken three times with an interval of three minutes. In the case of aerosol medications, the break should be one minute.

If headaches occur after taking nitroglycerin, you can give the patient validol or citramon. If tachycardia or arrhythmia occurs, adrenergic blockers are used.

Often, when an attack occurs, a woman feels a feeling of panic and fear, this only contributes to the worsening of the situation. A person next to a patient should make every effort to calm the patient down and restore his peace of mind. It is necessary to ventilate the room and ensure maximum access to fresh air.

Features of the disease

Angina is considered a form of coronary heart disease, which occurs when the blood supply to one of the areas of the heart is disrupted.

In addition to pressing chest pain, the following symptoms are characteristic:

pain radiates to the neck, lower jaw, under the left shoulder blade;
sensation of a foreign body in the sternum;
severe shortness of breath;
nausea, vomiting;
fainting due to severe pain;
panic fear.

The attack usually lasts from 3 to 15 minutes. It is very important to provide first aid to a person so as not to provoke serious consequences.

If the pain does not go away more than 15 minutes after taking nitroglycerin, there is a risk of myocardial infarction.

Prevention and therapy of the disease

Preventive measures when the first signs of the disease are detected consist primarily of correcting your diet. It is worth giving up sweets, fatty, salty foods, and monitoring your blood cholesterol levels. Nutrition should be proportional. It is worth including fish in your diet and increasing your consumption of vegetables and fruits.

To prevent the disease, you should organize a balanced diet

You should definitely monitor the level of potassium and magnesium in the blood, because they prevent the formation of blood clots and maintain the elasticity of the walls of blood vessels. Therefore, it is advisable to take medications containing these substances.

The therapy complex also includes drugs to dilate blood vessels, which serve to improve blood supply to the myocardium. The main drug in this regard remains nitroglycerin, which stops the attack.

In particularly severe forms of the disease, doctors perform coronary angioplasty or coronary artery bypass grafting. Such operations make it possible to increase the lumen of blood vessels and improve blood flow to the heart muscle.

The human body is imperfect, and despite the fact that more and more modern technologies and new inventions appear, humanity suffers from terrible diseases. The mortality rate from cardiovascular diseases has increased several times compared to previous centuries. Both women and men suffer from these diseases. By ignoring simple signals from the body, we allow the disease to take over.

Let's look at the symptoms of cardiac angina in women, first aid methods, and find out what folk remedies can help the body cope with this disease.

Angina: what is it?

Angina is a clinical syndrome characterized by discomfort or severe pain in the chest, the main cause of which is a violation of the coronary blood supply to the heart muscle.

The name is associated with signs of the disease, which manifest themselves in a feeling of pressure or compression (narrow - stenos from Greek), a burning sensation in the heart area (kardia), behind the sternum, turning into pain.

As a manifestation of coronary artery disease, angina pectoris occurs in almost 50% of patients, being the most common form of ischemic heart disease. The prevalence is higher among men - 5-20% (versus 1-15% among women), and its frequency increases sharply with age. Angina pectoris, due to its specific symptoms, is also known as “angina pectoris” or coronary heart disease.

Symptoms of angina appear due to atherosclerosis of the coronary arteries, a disease in which cholesterol is deposited on their walls and atheromatous plaques form. Over time, the lumen narrows, and complete blockage often occurs.

Angina disease

Lack of blood supply to the heart muscle, causing pain in the heart area, is called angina pectoris. This disease is often called angina pectoris because the pain spreads behind the sternum. This is not a separate disease, but a set of symptoms that are a manifestation of coronary heart disease.

An acute deficiency of blood supply to the heart muscle is called ischemia. As a result, there is a lack of oxygen, which leads to heart pain called angina.

Since ischemia is a chronic disease, angina pectoris as a symptom can persist for many years. Thus, angina pectoris in women has almost the same symptoms as the same disease in men, but there are some peculiarities.

At rest, attacks practically disappear; in case of emotional or physical stress, they can worsen and occur even several times a day.

It is imperative to remember that if an attack of angina occurs, this indicates that the heart muscle is experiencing oxygen starvation. You need to see a doctor.

Diagnosis of angina pectoris

The diagnosis of “angina pectoris” often occurs the very first time a person complains to a specialist. At the same time, to reject such a diagnosis, the patient’s condition should be monitored for a long time, a series of examinations should be carried out, as well as a thorough interview of the patient.

In the process of diagnosing angina, an ECG study is used, as well as stress tests, myocardial scintigraphy, two-dimensional echocardiography, radionuclide ventriculography, coronary angiography and other techniques. While examining a patient using an ECG, a specialist can observe the presence of specific signs that indicate that the patient has myocardial ischemia . True, during the diagnostic process one must take into account the fact that such signs are not observed at rest, so when performing a standard ECG it is not always possible to establish the correct diagnosis.

To detect such signs, a patient with suspected angina undergoes Holter monitoring . This technique consists in the fact that over a certain period of time, usually a day, an ECG is continuously recorded. The person continues to live his normal life. Thanks to this technique, it becomes possible to record the manifestations of ischemia, determine how dependent they are on various types of stress, find out how effective the treatment is and whether the pathological changes are severe.

With the help of stress tests, in which a situation is simulated when the myocardial demand for oxygen increases, it is possible to determine a number of points that are important in the diagnostic process. Such tests are carried out exclusively under the strict supervision of a specialist; during their implementation, signs of ischemia are recorded. It is important to note that such tests are not performed for unstable angina and myocardial infarction. Also, a contraindication to the use of this method is severe arrhythmia , the presence of cardiac and respiratory failure , arterial hypertension with high blood pressure, and severe tachycardia .

Today, three types of stress tests are used: physical loads on a bicycle ergometer and treadmill, pharmacological tests, and electrical cardiac stimulation.

Using any of these methods, one of the following methods is used to record ischemia: ECG, scintigraphy, echocardiography. The most commonly used tests are physical exercise on a bicycle ergometer (special exercise bike) or on a treadmill (treadmill) using ECG monitoring. Using special tables that take into account gender and age, the permissible load level is calculated. The test stops after reaching this value. If there are no symptoms of ischemia, then the test result will be negative and the person does not have angina. If signs of ischemia occur, then the person has angina. If a certain case seems very difficult to specialists, then coronary angiography may be used. This method is highly informative. During such a study, selective contrast and visualization of the coronary arteries is performed using X-ray equipment. Coronary angiography allows you to determine the presence of stenotic areas of the arteries and the degree of their narrowing.

Types of angina

There are several types of angina in men and women.

1. Stable angina, or exertional angina, is divided into classes according to the degree of severity:

1 class. The development of an attack is characterized by the occurrence of pain in the heart area as a result of too much stress. It appears extremely rarely.
2nd grade. May be aggravated by fast walking, climbing stairs, or after eating.
3rd grade. It develops during normal walking, when climbing even to the second floor, after stress or excitement, sometimes it is enough to go out into the cold.
4th grade. The development of an attack without any stress, be it emotional or physical, is typical.

2. Unstable angina. It is characterized by the following:

Progressive attacks of angina pectoris, the severity and frequency of attacks increases. The occurrence of attacks at night is typical.
The first attack of angina pectoris recurred less than a month later.
It can even be caught at rest.
Attacks of the post-infarction period, in this case, angina pectoris overtakes a person within two weeks after a heart attack.

3. Variant angina. This species typically manifests itself in the morning or at night when at rest. The attack lasts about 2-5 minutes, in this case Nitroglycerin is effective.

If signs of unstable angina appear, you must immediately call an ambulance because urgent hospitalization is required.

For an attack of stable angina, one Nitroglycerin tablet is enough, but for unstable angina, this drug is ineffective, especially since it lasts a little longer.

What are the symptoms of angina pectoris in women and the causes of their occurrence? We need to get to know this in more detail.

Diagnostics

Cardiologist conducts diagnostic research in several areas - questioning and examination of the patient, instrumental and laboratory tests.

Interview and physical examination. The doctor assesses the dynamics of the disease, asks about bad habits and concomitant diseases. Then the localization, duration, and nature of pain are assessed. During the examination, attention is paid to the manifestations of atherosclerosis - the presence of lipid formations on the body and face, pallor of the skin, puffiness. Listening allows you to evaluate your heart rhythm. Pulse and blood pressure are measured.
Electrocardiogram. An ECG evaluates the frequency of contraction of the heart muscles and diagnoses arrhythmia (pictured). At the time of an attack, the procedure reveals a decrease in the ST interval. Daily ECG involves the patient wearing the device throughout the day. In this way, spontaneous or exertional angina is detected.
Echocardiography. This is an ultrasound research method that evaluates heart contractions, pressure in the chambers, and records pathological changes in areas of the heart affected by circulatory disorders.
Coronary angiography. Coronary airography is indicated to assess the degree and extent of damage to the cardiac arteries.
Blood tests. Determines glucose level, creatinine concentration, fat level. Angina is determined by the presence of anemia, excess glucose and cholesterol.

Differential diagnosis with neuroses, intercostal neuralgia, diseases of the lungs and gastrointestinal tract is required.

The goal of therapy is to reduce the severity of symptoms, improve the patient’s quality of life, prevent attacks, progression of the disease and the development of a heart attack. Treatment of patients with coronary artery disease should be comprehensive, that is, include, in addition to drug therapy, a special daily regimen, a properly selected diet (table No. 10) and dosed physical activity.

First aid for an attack

An attack of angina often occurs unexpectedly due to physical exertion, stress, hypothermia or overheating, as well as at rest, for example during sleep. First aid can be provided not only by specialists, but also by people who are near the person at the time of the attack.

What to do in case of a sudden attack:

call doctors;
sit down and calm the patient;
take nitroglycerin - the instructions indicate that 1-2 tablets are enough, otherwise the pressure will drop sharply;
open the window for air flow;
apply warm heating pads to your feet;
in a state of excitement, offer sedatives - Corvalol, Valocardine in a minimal dosage.

A specialist will tell you more about the first aid algorithm in the video in this article.

Basic treatment

Symptoms of angina in women and the treatment of this pathology are directly interrelated. The basis of therapy is taking medications. Several pharmacological groups of drugs are used, the purpose of which is to influence the pathogenesis and symptoms of pathology.

Nitrates. The main group of drugs for cardiac ischemia. Used to relieve seizures. The most common drug is Nitroglycerin. It is taken when pain occurs under the tongue in tablets or in the form of a spray. A significant side effect of the drugs is headache. Nitroglycerin helps to expand the spasmodic vessel, reducing the ischemic area and thereby eliminating pain.
Adrenergic blockers. The drug Anaprilin reduces the heart rate, reducing its need for oxygen. This helps reduce ischemia. Used for continuous use, the dosage is determined individually.
Calcium channel blockers. These include the drug Diltiazem, or Verapamil. This medicine reduces the load on the myocardium, preventing the occurrence of an attack. Appointed for permanent appointment.

Treatment of cardiac angina in men follows the same principles. The drugs are inexpensive and are available from pharmacies with a doctor’s prescription.

Symptoms of angina may present differently in women and men. But what they have in common is that they may be a sign of the development of a more serious disease. Competently provided assistance and timely treatment will protect a person from the serious consequences of pathology.

Causes of angina

Let's look at the reasons that can cause an attack; they also affect the symptoms of angina in women.

Atherosclerosis of heart vessels.
Post-infarction cardiosclerosis.
Spasm of sclerotic coronary arteries.
Heart disease.
High blood pressure.
Acute tachycardia and tachyarrhythmia.
Exacerbation of gastrointestinal diseases, cholelithiasis.
Acute and chronic bronchopulmonary diseases.
An attack of renal colic.
Osteochondrosis with radicular syndrome.
Climacteric neurosis.
Psycho-emotional overload and stress.

We can conclude that there are many reasons for the development of the disease.

Causes of the disease

Narrowing of the coronary arteries of the heart can occur for a variety of reasons, but the main and most basic one is atherosclerosis. If you eat improperly, fatty plaques can form on the walls of blood vessels. If the deposits are greatly increased in size, they can greatly narrow the lumen in the blood vessels, preventing the normal flow of blood.

A blood clot that breaks away from its place can be carried by the blood stream into any thin vessel, which will entail complete or partial blockage of this area. As a result, blood flow is significantly reduced, oxygen and important elements do not reach the necessary areas, tissues experience oxygen starvation and then die.

There are other causes of angina in women. One option is vasospasm. This is likely due to smoking and severe stress.

As a rule, angina is the result of heredity and a sedentary lifestyle, complicated by smoking and alcoholism. To prevent this disease, you should mainly eat right, eliminate bad habits, exercise regularly, and also reduce the amount of stress in your daily life.

Features of angina in women

The disease is the same for everyone, but due to gender differences there are some peculiarities in the course and development of such a disease as angina pectoris.

The first symptom of angina is pain. Due to the characteristics of the body, the symptoms of angina pectoris in women are expressed somewhat differently than in men. This may also depend on the pain threshold, but in this case we are talking about the dislocation of pain. Thus, complaints of chest pain in women do not always confirm the diagnosis of angina pectoris, although they complain more often than men. It has also been proven that most women do not experience arm pain or shortness of breath with angina. And the pain sensations are most often stabbing and pulsating, and not squeezing, as is typical for angina attacks in the stronger half of humanity.

For the female body, abdominal pain and nausea may occur.

Most likely, this is due to the different origin of the angina attack. In women, the most common cause is coronary spasm, and in men, it is a narrowing of the lumen of the coronary vessels, plaque or thrombus.

Age is of great importance for a woman when it comes to a disease such as angina pectoris. Before menopause, angina pectoris in women over 40 years of age has a significantly lower risk of developing angina than in men of the same age. Since estrogens reliably protect the female body from the development of various kinds of diseases, including diseases of the cardiovascular system. After menopause, the risk for women becomes the same as for men.

Causes

The main factor contributing to the development of angina is insufficient blood flow to the heart muscle as a result of vascular atherosclerosis , due to which the heart muscle cells do not receive the necessary nutrients.

Angina in women

Factors contributing to the occurrence of IHD include:

disruption of the thrombus formation process;
development of atherosclerosis;
severe stress;
smoking or other bad habits;
passive lifestyle;
unbalanced diet
carbohydrate metabolism disorder (diabetes mellitus);
arterial hypertension, etc.

This is not the entire list of reasons for the development of coronary heart disease, but the main ones come down to lifestyle. If a woman works in a stressful job, eats poorly and leads a passive lifestyle, then she is likely to have problems with the functioning of the cardiovascular system.

Angina pectoris. Risk factors and prevention

Symptoms of angina

In women and men, the main symptoms of angina attacks can be identified:

Pain in the heart area.
Pain in the forearm, neck or back along with chest pain.
Dyspnea.
Increased sweating.
Dizziness.
Anxiety, fear of death.
Feeling weak and tired.

The following symptoms of angina pectoris in women may also occur:

Cough is a common occurrence with angina. It most often occurs at night when lying down. This is due to stagnation of blood in the pulmonary circulation. It should be borne in mind that when such a symptom appears, pain and the manifestation of other signs may decrease, but weakness will remain.

Insomnia

Not everyone develops it. Usually outside the attack period, with chronic coronary insufficiency.

Both the main cause of the ischemic process and the actual inadequate blood circulation to the brain are affected.

Available in several versions. The main one is sudden awakenings 10-20 minutes after falling into unconsciousness. The patient feels unusually alert for a while, then fatigue sets in again.

Another clinical variety is constant awakenings during the night. As a result, rest is not satisfying, fatigue and weakness arise.

Violations of blood pressure against the background of general asthenia of the body further aggravate the course of angina pectoris and increase the likelihood of an attack.

Correction of the condition is necessary under the supervision of a somnologist, including the possibility of taking mild sleeping pills at first. To restore natural biorhythms.

Angina attack

The question often arises about whether women have angina, what to do during an attack and how dangerous it is.

An attack of angina can start completely unexpectedly and end the same way. Its duration is from 1 to 5 minutes or a little more. If it continues for half an hour, there is a risk of myocardial infarction.

Studies have shown that if it occurs, 50% of women die; in men this figure is slightly lower.

After suffering an attack of angina, 38% of women die within 12 months, while in the male population this figure is 25%. 46% of women remain unable to work, and only 22% of men. Based on these sad statistics, we can conclude how dangerous angina is in women. First aid should be provided immediately, preventing the attack from developing into a myocardial infarction.

Complication and first aid

Angina pectoris usually occurs in a chronic form; attacks can be both frequent and rare. If an attack lasts more than 20 minutes, it is fraught with serious consequences.

Complications:

cardiosclerosis;
heart rhythm disturbances;
myocardial infarction.

In difficult cases, death cannot be ruled out, so it is very important to promptly provide first aid to a person during an angina attack.

Actions:

Have the patient sit down so that their feet touch the floor. Don't let it rise.
Provide air flow.
Give nitroglycerin: 1 tablet under the tongue. This way the medicine goes directly to the coronary vessels, and the attack passes in 15-20 minutes. If relief does not occur, give another tablet.
If there is no positive effect, call an ambulance.

Emergency help

A disease such as angina pectoris in women over 40 years of age is much less common. The photo clearly shows the localization of pain that characterizes an attack in this disease. There are some steps to take if you have symptoms of angina. :

You need to call an ambulance if:

The pain does not stop within 5 minutes or gets worse.
The condition worsened, weakness, vomiting appeared, and breathing worsened.
There is no effect from the resorption of Nitroglycerin.

While waiting for an ambulance, you need to do the following:

Help the patient sit down and ensure complete physical rest.
Minimum movements. The best body position during an attack is reclining.
It is necessary to calm the victim, otherwise nervousness may worsen the attack.
Provide air access if this is a room, and unfasten or remove tight clothing.
The victim should breathe evenly and deeply, remaining calm.
Give a Nitroglycerin tablet and, if available, half a tablet of Aspirin. Place medications under the tongue. If the medication does not have the desired effect within 5-15 minutes, you can repeat taking the medication.

First aid

At the first symptoms of an angina attack in women, you need to follow clear instructions:

call the doctors;
position the patient so that the legs are down;
avoid sudden lifting or any movements;
Place an aspirin tablet under the patient's tongue;
repeat the procedure if the symptoms of the disease do not go away.

Important! You should not take medications for angina attacks more than 3 times, as this can lead to a sharp decrease in blood pressure.

First aid for angina

Often, after a patient takes nitroglycerin, he will develop a severe headache. This is a normal reaction of the body, so there is no need to worry about it. Give the patient some hot tea.

Treatment methods for angina pectoris

We looked at first aid and symptoms of angina in women.

Medicines for the treatment of this disease are primarily intended to stop attacks, reduce their frequency and number, and also to prevent the development of myocardial infarction.

In addition to Nitroglycerin, drugs are prescribed to reduce thrombosis:

Medicines that reduce oxygen deprivation:

Statins are also used:

Not only drug treatment relieves the symptoms of angina pectoris in women. Treatment with folk remedies receives quite good reviews.

Hyperhidrosis

Increased sweating. It is a consequence of excessive stimulation of the hypothalamus. As a result of malnutrition of the myocardium, the contractility of the heart decreases.

There may be an increase in heart rate, but the productivity of systoles (contractions) is minimal. Therefore, blood output decreases, which means that the brain does not receive enough oxygen and nutrients.

The hypothalamus, under conditions of ischemia (oxygen starvation), begins to send chaotic signals to the entire body.

Since it is in this structure that the center of heat production and release is located, angina pectoris subjectively manifests itself as a feeling of cold, while the peripheral vessels dilate. The body is actively cooling. Then the reverse process is possible and so on in a circle until blood circulation is restored.

Folk remedies

Therapy with honey and garlic has become very effective in home treatment.

The following recipes can be recommended:

A head of garlic is grated and mixed with the juice of three lemons, 200 grams of honey are added. Leave the mixture for 3 days in a dark place. You need to take 1 teaspoon in the morning and evening.

Representatives of the fairer sex are very vulnerable and emotional, so you always need to be on guard so as not to miss the alarming symptoms of angina in women. Treatment with folk remedies is aimed at strengthening the heart muscle, nervous system and immunity in general.

Classification

Currently, based on the characteristics of the clinical course, three main types of angina are distinguished:

Stable angina

Stable angina means that the patient has had attacks of chest pain of approximately the same intensity over the previous month or longer. Stable angina is also called exertional angina, since the development of attacks is associated with overly intense work of the heart muscle, forced to pump blood through vessels whose lumen is narrowed by 50–75%.

Angina is divided into 4 functional classes (FC):

Attacks of chest pain occur rarely, only with maximum physical and emotional overload. ECG changes are rarely detected. The lumen of the coronary arteries can be narrowed by 50%. Perhaps only one of them is affected by atherosclerosis.
The second functional class causes attacks and pain when climbing stairs, walking at a brisk pace, and after a heavy meal. The provoking factors here are often frosty weather and wind.
In FC 3, severe limitation of physical activity is diagnosed. Angina makes itself felt when moving calmly on a flat road at a distance of one hundred to two hundred meters, or when climbing to the first floor. Attacks become more frequent if the patient smokes. Such patients have angina at rest in the supine position after a nervous shock.
With FC 4, any slightest load causes pain and discomfort. Often in the history of a person with this type of angina, one can find a heart attack or heart failure in the chronic stage. Often, angiosis syndrome occurs at complete rest or even at night.

Unstable angina of the heart

What it is? Unstable angina is characterized by painful attacks of varying intensity, duration, and unpredictable occurrence, for example, at rest. Pain syndrome is more difficult to relieve when taking nitrates (nitroglycerin). The risk of developing myocardial infarction is higher, in contrast to the stable form of this pathology.

Unstable angina is divided into:

New-onset angina - the first attack occurred no later than 30 days.
Progressive – the severity, duration or frequency of pain attacks increases.
Spontaneous (Prinzmetal or vasostastic) - occurs as a result of spasm of the coronary arteries.
Early post-infarction angina - in the period up to 14 days after a heart attack.

There is also the so-called variant angina, which most often manifests itself at night or in the early morning. Attacks occur when the patient is at rest. They last on average about 3-5 minutes. They are provoked by a sudden spasm of the coronary arteries. In this case, the walls of the vessels can be loaded with plaques, but sometimes they are absolutely clean.

To distinguish between stable and unstable angina, the following factors must be assessed:

What level of physical activity provokes an angina attack;
Duration;
Efficacy of Nitroglycerin.

With stable angina, the attack is provoked by the same level of physical or emotional stress. In an unstable form, the attack is provoked by less physical activity or even occurs at rest.

With stable angina, the duration is no longer than 5–10 minutes, and with unstable angina it can last up to 15 minutes.

Prevention of angina

Prevention is necessary for all adults, not just the weaker sex. To avoid a diagnosis of angina pectoris in women at the age of 45, you must adhere to some recommendations:

Stop smoking.
Promptly detect and treat arterial hypertension.
Change your diet. Limit salt, fats, baked goods, and increase the intake of vegetables and fruits.
If you have diabetes, you need to keep your glucose levels under control.
Control blood cholesterol levels.
Dose physical activity.
Avoid emotional stress.
Moderate exercise is recommended after consultation with a doctor.
Walk more and experience only positive emotions.
It is recommended to do breathing exercises according to Buteyko. Thanks to it, the body gets rid of excess carbon dioxide, replacing it with oxygen.

By following these simple rules, you can be sure that angina will not soon visit you. In women, symptoms cannot be ignored due to the high mortality rate from cardiovascular diseases.

Prevention

You can protect yourself from “angina pectoris” using well-known prevention methods:

Stop smoking.
Introduce foods rich in Omega-3 into your diet: red fish, avocado, oils, limit the amount of salt and fat.
Steam, boil or bake dishes.
Choose moderate loads.
Control your weight.
Avoid stress.
Alternate work and rest.
Sleep at least 8 hours.

This video presents a program about angina pectoris. Everything about its causes, symptoms, treatment and prevention. Well-known doctors give the answers.

Angina requires special monitoring from both the patient and his relatives. If attacks are frequent, it is advisable not to leave the person alone for a long time, and to keep all the necessary medications in the first aid kit. At the first signs of illness, you should consult a doctor who will help you choose the optimal course of treatment.

Methods of prescribing drug therapy

Considering the fact that it is necessary to treat angina in each case individually: taking into account the characteristics of the body, the form of the disease, the severity of its course, there is no universal therapeutic agent. The doctor prescribes tablets for angina pectoris based on one of the methods:

Depending on the class of IHD - if the disease is easily tolerated and has no complications, one medicine is prescribed, for example, nitrates or adrenergic blockers. In advanced or severe cases, you will have to take a whole range of medications;
The pharmacological picture is taken into account - how effective the drugs will be for a particular patient. This is done through examination, which reveals the body’s ability to absorb active substances;
A test is carried out on a bicycle ergometer - with angina pectoris, this organ is subjected to increased stress, as a result of which the attending physician makes a conclusion about what medications to take. If the effect is observed, then the drug is working.

An important role is played by how well the patient himself can describe the symptoms. To make the task easier for specialists, it is recommended to write down the frequency of attacks, how you feel and the names of the pills that were used to relieve an attack of angina.

Choice of medications

Let's start with the fact that any medicine from each group should be prescribed only by a cardiologist and only after an examination. As a rule, the following medications are used in the practice of cardiologists:

Antianginal

Nitroglycerine

The most famous medicine for suppressing the symptoms of angina attacks.

Available in the form of sublingual tablets, sprays, patches, drops, capsules with a prolonged effect, ointments, films .

There are a lot of brands with this active ingredient in pharmacies. Among them: Deponit, Gilustenone, Nitroglycerin, Nitradisk, Nitrangin, etc.

Directions for use:

The tablet is placed in the oral cavity under the tongue. The effect occurs within two to three minutes and lasts for half an hour.
The spray is also applied to the oral mucosa and begins to instantly relieve an attack, literally within a minute. Sprays are short-acting agents, like tablets.
Buccal forms of nitroglycerin ( plates, films ) are attached to the mucous membrane of the cheeks or gums. They have a longer effect - 3-4 hours.
Capsules are taken in advance of an attack and have a prolonged effect. Capsules are taken 1-2 times a day on an empty stomach.
The ointment is applied to the dosage paper in the amount prescribed by the attending physician. The paper with ointment is pressed tightly against the body in the hairless part.

Only a doctor can calculate the dosage of any form of nitroglycerin!

Prices for nitroglycerin depend on the manufacturer of the medicine and the form of its release. For example, the cost of domestic sublingual tablets rarely exceeds the price of 50 rubles.

Isosorbide dinitrate

The drug is available in tablet, capsule and aerosol forms. In pharmacies it is sold under the names: Isoket, Izolong, Cardiket, Nitrosobid . Taken orally in consultation with your doctor.

As a rule, it is prescribed 20 mg 2-3 times a day an hour before meals or 2 hours after meals . If the therapeutic effect is weak, the dose is gradually increased to 120 mg per day.

In order to avoid the body's tolerance to drugs, a month and a half after regular use, you need to take a break for a day , replacing one drug with another with a similar effect on the body.

Medicine prices also depend on the country of origin. For example, Nitrosorbide can be purchased in pharmacies for 25 rubles, and Isoket spray will cost about 400 rubles.

Isosorbide mononitrate

Trade names of the drug: Isomonit, Mononit, Pentacard, Plodin, Monocinque, etc. Medicines are produced in long-acting tablets and capsules with the addition of the prefix “retard” to the name. Tablets are taken 2 times a day, retard capsules - once a day . The dose is gradually increased.

It is important to know that the medicine affects the speed of reaction, therefore activities where speed of reactions is necessary should be excluded for the duration of treatment.

On average, the cost of tablets is 300-400 rubles for 30 pieces.

Calcium antagonists

, Nifedipine, Verapamil and Diltiazem are widely used in practice .

The drugs are taken 1-2 times a day.

Nifedipine can be used in combination with beta blockers, and medications containing Verapamil and Diltiazem are not allowed to be taken together with beta blockers .

Beta blockers

It is difficult to single out any specific effective drug from the group of beta blockers. The active ingredients of beta blockers are usually atenolol, metoprolol, timolol, bisoprolol, etc. Of all the tablets, Concor, Anaprilin, Coriol, Nebilet . Beta blockers are taken with food to reduce their side effects.

The name of the beta blocker and its dosage are selected only by the attending physician!

Be sure to monitor your heart rate while taking these medications. The pulse when taking the tablet should be 50-60 beats per minute.

Prices for domestic Anaprilin are not as high as, for example, for imported Concor or Nebilet. For comparison: 50 tablets of Anaprilin cost 27 rubles, and for 28 pills of the German drug Nebilet you will have to pay 980 rubles.

In any case, you should under no circumstances purchase and take medications without a cardiologist’s prescription, guided only by the principle of economy! This can lead to unpredictable consequences!

Antiaggregates against blood clots

The best known drug in tablet form is aspirin. Aspirin is taken in the evening after meals in a single dose of 75-150 mg .

For the treatment of cardiovascular diseases, aspirin is available in special forms - these are Aspirin Cardio, ThromboAss, CardiASK and Cardiomagnyl .

They differ from regular aspirin in having a more gentle effect on the stomach . The price of any aspirin is not very high - on average 250 rubles for 100 pieces.

For patients intolerant to aspirin or with severe angina, clopidogrel . Its effect is many times stronger than that of aspirin. But the cost is also significantly higher. For 28 Russian-made tablets you will have to pay more than 400 rubles.

Statins

Russian cardiologists prescribe statin drugs based on the active ingredients: rosuvastatin, simvastatin, fluvastatin and atorvastatin . Statins are taken primarily before going to bed.

Doses are prescribed by a doctor based on a blood cholesterol test. The drugs may cause nausea and muscle pain.

The cost of the tablets is quite high . For example, the English drug Crestor will cost 2,500 rubles in a pharmacy for 28 pieces, and the American Zocor will cost 750 rubles. for 28 pcs.

Treatment of cardiac angina in adults

How to treat angina? Treatment of angina pectoris is aimed at relieving pain, preventing the development of a heart attack, as well as stopping the development of atherosclerosis and cleansing blood vessels of atherosclerotic plaques.

All methods of angina therapy are aimed at achieving the following goals:

Prevention of myocardial infarction and sudden cardiac death;
Preventing progression of the disease;
Reducing the number, duration and intensity of attacks.

Drug therapy involves the use of the following medications:

ACE inhibitors. Keep blood pressure normal and reduce heart rate.
Omega-3 polyunsaturated acids, statins, fibrates. Stabilize and slow down the occurrence of sclerotic plaques.
Antiplatelet agents. Prevents the formation of blood clots in the coronary vessels.
Calcium antagonists. With vasospastic angina, the formation of coronary spasms is reduced. Nitrates (nitroglycerin and others). They stop attacks.
Prescribed for prevention before prolonged physical activity or before an outburst of emotions.

Surgery

This type of surgical treatment of the disease involves creating a bypass for blood flow to the individual affected area of the heart. A so-called shunt is placed below the damage; this procedure is called coronary artery bypass grafting.

This intervention is indicated for patients who have a severe form of angina with reduced lumen of the heart vessels (70% or more).

Surgical intervention is often used in cases of previous myocardial infarction. The result of the operation is the restoration of impaired blood flow in the arteries that supply the heart muscle with oxygen.

Type of medicines

How to treat angina pectoris? This is the most common and pressing question asked by people with this condition. It is considered quite serious and affects many body functions.

Therefore, first of all, the doctor should try to reduce the manifestation of symptoms and the further development of pathology. This can be done with the help of certain medications. Basically, several varieties are used in order to affect more than one area at once. The following types of drugs are used against angina:

Nitrates.
Adrenergic receptor blockers.
Calcium channel antagonists.
Diuretics.

Nitrates

They are characterized by important pharmacological properties in the treatment of cardiac angina. The drugs help reduce pain syndromes and promote relaxation of the myocardium. Due to the expansion of peripheral blood vessels, it is possible to achieve rapid blood outflow. Among this group of drugs, the following nitrates are most common:

Nitroglycerine;
Nitrosorbide;
Transdermal stickers;
Isosorbide dinitrate.

When selecting medications for angina, modern doctors use a list compiled by the American College of Cardiology. Thus, experts advise the use of anticoagulants, lipid-lowering agents, angiotensin-converting enzyme inhibitors, and beta-blockers.

If necessary, therapy is supplemented with calcium antagonists, nitrates (for example, the well-known Nitroglycerin) and some other antianginal medications. Particular attention is paid to hypoglycemic drugs, especially if angina occurs against the background of diabetes mellitus.

Angina attack: symptoms and first aid

The main symptom of an angina attack is sudden pain in the chest, and people describe this condition in different ways. Some complain of a burning sensation and aching pain radiating to the left arm. Others feel bursting pain radiating under the shoulder blade or in the stomach, neck, and throat.

The attack most often lasts no more than 15 minutes and goes away on its own or after taking nitroglycerin. If this condition does not go away, it may mean that an acute heart attack has occurred.

There are many cases where the symptoms of an angina attack appear only in the form of discomfort in the stomach or headaches. In this case, diagnosing the disease causes certain difficulties.

It is also necessary to distinguish painful attacks of angina from symptoms of myocardial infarction. They are short-term and can be easily relieved by taking nitroglycerin or nidefilin. While pain during a heart attack is not relieved by this drug.

In addition, with angina pectoris there is no congestion in the lungs and shortness of breath, body temperature remains normal, and the patient does not experience agitation during an attack.

Providing emergency care for angina pectoris

Direct first aid provided for angina pectoris before the ambulance arrives consists of the following points:

the patient sits comfortably with his legs lowered; he should also be reassured, avoiding sudden movements and standing up;
Half a large aspirin tablet or 1 tablet is given under the tongue;
To alleviate the condition, nitroglycerin is also subsequently given - 1 tablet under the tongue;
instead of nitroglycerin, isoket aerosol (single dose, not inhaled) or nitrolingual can be used;
the use of nitroglycerin can be carried out at an interval of three minutes, while the use of aerosol medications is carried out at an interval of one minute;
reuse of drugs is possible only up to three times, otherwise it can provoke a sharp drop in blood pressure.

After providing the first necessary aid, the patient must see a doctor, who will clarify the diagnosis and select the optimal treatment. For this purpose, a diagnostic examination is carried out

Groups of drugs prescribed to patients

Drug treatment of angina pectoris is the most common method of therapy, which has shown its effectiveness over the years of use. Based on the type of impact, these funds are divided into several groups:

Antianginal drugs - they reduce the myocardial oxygen demand and increase its level in the blood, eliminating ischemia. These include nitrates for severe angina, beta blockers and calcium antagonists;
Blood thinners – these medications are used for angina pectoris to prevent the formation of blood clots. Very often the disease causes such a complication, fraught with blockage of blood vessels. This is especially dangerous with high blood pressure;
Medicines for the prevention of atherosclerosis - this disease is a common complication of coronary artery disease, so doctors prescribe preliminary preventive therapy, but only if there is a high risk of developing pathology. More often they are prescribed to elderly patients;
Cholesterol-lowering drugs - statins, long-term use gives a positive and pronounced therapeutic effect.

During therapy, it is recommended to use vitamins that are good for the heart. A complex of microelements with magnesium and potassium will be a good help in treatment. Heart patients can also take vitamins for preventive purposes.

The doctor determines what medications should be taken for angina pectoris after studying the symptoms, the general clinical picture, and examining the patient’s tolerance to medications. It is unacceptable to independently select analogues or self-medicate.

Treatment

IHD is a chronic progressive disease. Treatment of stable angina pectoris includes diet, smoking cessation, correction of other risk factors, rational physical activity, medication and surgery. In the treatment of angina, different groups of drugs are used, often in combination with each other, taking into account concomitant diseases of the heart and other organs.

Self-medication in this case can cause complications and side effects. Therefore, therapy should be prescribed by a cardiologist, and the diagnosis should be confirmed by additional diagnostic studies.

Often, patients are prescribed antianginal drugs without in-depth diagnostics, based only on complaints of pain in the heart area. This is incorrect, since the pain may be associated with another disease.

Taking unnecessary medications is not economically profitable and can harm the patient’s health.

The standard treatment for angina pectoris includes two large groups of drugs: those that improve the prognosis and those that prevent the onset of symptoms.

Drugs to improve prognosis and reduce the risk of complications:

antiplatelet;

statins;

in some cases - ACE inhibitors and beta blockers.

Medicines to relieve pain or prevent its occurrence:

beta blockers;

calcium antagonists;

nitrates;

Ir channel inhibitors.

We recommend reading about how to relieve an angina attack. You will learn about what stable angina is, rare forms of the disease, and stopping an attack at home. And here is more information about the rules for taking nitroglycerin for angina pectoris.

Antiplatelet agents

These drugs reduce the risk of blood clots forming on atherosclerotic plaques in blood vessels. Acetylsalicylic acid is used in a dose of 75 - 100 mg/day. To prevent stomach damage, it is better to use enteric-coated formulations (aspirin cardio) or combine aspirin with antacid medications (cardiomagnyl).

Scheme of thrombus formation in a vessel

Aspirin can be combined with anti-inflammatory drugs taken for other diseases. It is recommended to use more modern drugs (meloxicam) and not prescribe ibuprofen. The use of diclofenac is acceptable.

If aspirin is contraindicated, clopidogrel is prescribed. In patients without a history of a heart attack, the use of both drugs at once is not recommended. In case of ulcer bleeding, it is better to use a combination of aspirin and esomeprazole than clopidogrel (Plavix).

Curantil and warfarin are not prescribed for stable angina in the absence of other indications.

Lipid-lowering drugs

The main drugs in this group are statins (Zocor, Mevacor, Liprimar, Crestor, Lescol, Lipostat).
They are prescribed to patients with angina pectoris at high risk of myocardial infarction, regardless of cholesterol levels, gradually increasing the dose. They are usually well tolerated and do not cause side effects. The target LDL cholesterol level is 2.5 mmol/l . The drugs are taken under the control of liver enzymes. An increase in their concentration by more than 3 times requires a revision of therapy.

For elevated triglyceride levels and diabetes, the use of fibrates (bezalip, gemfibrozil, lipanor, trikor) or delayed-release nicotinic acid is recommended.

Beta blockers

Drug treatment of angina pectoris includes selective beta blockers (bisoprolol, carvedilol, nebivolol), especially in patients after myocardial infarction. While taking these medications, your resting heart rate should be 55-60 per minute. Higher values indicate an insufficient dosage of the drug.

Selective beta blockers (Concor, Lokren, Nebilet, Dilatrend) can be prescribed with caution for diabetes and even asthma, but under the control of blood sugar or peak flow measurements.

ACE inhibitors

Drugs of this group (Tritace, Prestarium and others), and in case of intolerance - sartans (valsartan, candesartan), are prescribed if angina is combined with hypertension, heart failure, diabetes, previous heart attack or left ventricular dysfunction according to echocardiography.

Calcium antagonists

Verapamil and diltiazem may be used instead of beta blockers for severe pulmonary or peripheral arterial disease. Amlodipine (Norvasc) and other long-acting dihydropyridine calcium antagonists (Plendil, Lomir, Lacipil) are also used in cases of intolerance or contraindications to beta blockers.

Nitrates

In the treatment of angina pectoris, nitroglycerin preparations are of particular importance.
They dilate coronary vessels and quickly relieve pain. But with constant use of such drugs, their effect disappears. Therefore, it is necessary to provide a period during the day when nitrates do not act (usually at night).

Short-acting forms (nitroglycerin and nitrospray), as well as nitrosorbide, are applied under the tongue 10 minutes before exercise, which may cause pain. If pain occurs, you need to repeat taking nitroglycerin.

For severe angina, use long-acting forms - 5-mononitrate (monocinque retard, pectrol, efox long) in the morning. It is possible to combine them with beta blockers, which significantly increases the effectiveness of treatment.

Molsidomin

This nitrate-like agent can be used to prevent attacks.
It is prescribed 2-3 times a day. Sensitivity to it does not decrease, headache and other side effects of nitrates are not expressed. There is a form for once a day - Dilasidom retard.

Ir channel inhibitors

This is a new class of drugs whose effect is comparable to beta blockers. The main representative is coraxan. It is prescribed for contraindications or side effects of beta blockers.

Other means

Trimetazidine has sufficient evidence of effectiveness in angina pectoris. It can be prescribed in addition to the main treatment or instead of beta blockers, nitrates and calcium antagonists if they are intolerant.

The drug omega-3 fatty acids (omacor) has also been proven effective in the complex treatment of angina pectoris. It is prescribed at a dose of 1 gram per day.

The effectiveness of treatment is assessed by the reduction in the onset of symptoms. It is advisable to transfer angina to functional class 1 or eliminate it completely. If drug therapy, including 2 drugs, is ineffective, the issue of surgical intervention on the coronary vessels is decided. The operation is also performed when the patient does not want to constantly take medications, but prefers a more active treatment tactic.

For information on the diagnosis and treatment of angina pectoris, watch this video:

Applications of isosorbide dinitrate

Isosorbide dinitrate – has different dosage forms:

pills;
capsules;
aerosol.

The drug is used as prescribed by a doctor:

2-3 times a day, 20 mg 1 hour before meals;
if there is no therapeutic effect, the dose is increased to 120 mg per day.

In order not to provoke addiction to the medicine, during long-term use they take short breaks, replacing isosorbide dinitrate with drugs with similar pharmacological properties.

Classification of drugs prescribed for angina pectoris

Drug therapy for angina pectoris is part of the treatment regimen for coronary heart disease, and among the primary tasks facing drugs are the following:

an increase in the diameter of blood vessels, primarily coronary ones;
lowering blood pressure to reduce the load on the heart muscle;
reduction in heart rate (heart rate is based on phenomena that correlate with blood pressure, but these two functional states are not the same thing);
an increase in the rheological characteristics of blood (bringing the fluidity index back to normal).

Although there is a generally accepted treatment regimen for angina pectoris as a special case of coronary artery disease, in each specific case only the doctor decides which medications to take for angina, taking into account such diverse factors as the patient’s age, risk factors present in lifestyle, and the presence of a genetic predisposition to cardiovascular disease. diseases, test results and diagnostic procedures.

There are two approaches to prescribing medications for angina pectoris:

Based on consideration of the characteristics of clinical manifestations and course of the disease. This approach involves classifying angina into functional classes: patients with functional class II disease undergo therapy by taking one or two types of drugs. In severe cases of pathology, complex treatment would be appropriate.
Based on a qualitative assessment of the pharmacological action of specific drugs when passing special tests with a real (treadmill test) or a drug-simulated (“Dobutamine”) dosed load on the heart.

If a patient consults a cardiologist with signs of angina for the first time, he will be advised to keep a diary in which he will need to note the date and time of the onset of attacks, their duration, the amount and dosage of drugs taken to relieve the attack. These data will be useful in the future to make a more complete and reliable diagnosis.

Groups of drugs prescribed for the treatment of angina manifestations of coronary artery disease:

nitrates;
β-blockers;
antiplatelet agents;
calcium channel blockers;
statins.

Nitrates, or antianginal drugs, have a relaxing effect on the walls of the coronary vessels, promoting their greater elasticity (during an attack of ischemia, such drugs facilitate vasodilation as a response to oxygen starvation of myocardial cells). Taking nitrates allows you to increase blood flow both in the main coronary arteries (left, right, circumflex) and in collaterals - small vessels that deliver blood directly to the heart muscle cells.

The principle of action of beta-blockers is to normalize myocardial contractility (based on measuring the level of ejection fraction) and heart rate. Particularly effective for attacks of chest pain that appear as a result of physical activity. For angina at rest, they have a very minor effect.

The purpose of antiplatelet drugs is to reduce the concentration of platelets in the blood, which during angina attacks reduces the likelihood of acute thrombosis, the main cause of myocardial infarction.

Calcium antagonists are drugs that block the delivery of potassium ions into cells, which are responsible for increasing metabolism, which is extremely undesirable during myocardial ischemia, since it increases the tissue demand for oxygen.

The role of statins in the treatment of angina pectoris is to reduce cholesterol levels in the blood, which prevents the formation of atherosclerotic plaques and narrowing of the lumen of the coronary vessels - the main cause of attacks of angina pectoris.

We do not present here the names of tablets for angina pectoris, since this will be discussed in sufficient detail in the next section. It only remains to note that a cardiologist may recommend, to clarify the diagnosis, to perform diagnostic procedures that allow one to assess the internal state of the coronary vessels. In the presence of extensive stenoses, surgery (bypass surgery or angioplasty) may be required to restore normal blood flow. After surgery, your angina attacks will usually stop completely, although you will likely need medication for the rest of your life.

What drugs are prescribed

Antiaggregates

Doctors usually prescribe several drugs at the same time to patients with angina. Some of them relieve attacks, others improve long-term prognosis. You have to take a lot of pills, but they are all needed. Do not stop taking your medications without permission.

Nitrates	Relaxes blood vessels and expands their lumen. Nitroglycerin tablets under the tongue relieve attacks of chest pain. Nitroglycerin can also be taken for prophylaxis before physical activity or stressful situations.
Aspirin	Inhibits the formation of blood clots - blood clots. This reduces the risk of myocardial infarction. Your doctor may tell you to take aspirin daily to prevent a heart attack. It rarely causes stomach bleeding. But for people with angina, the benefits of aspirin are greater than the risks.

Read about medications containing aspirin:

Cardiomagnyl
Thrombo ACC
Aspirin Cardio
Acecardole

Plavix or Brilinta	Medicines to prevent blood clots include clopidrogel (Plavix), ticagrelor (Brilinta), and some other drugs. They may be prescribed in addition to or instead of aspirin. Possible side effects are bleeding, bruising. However, the benefits may be greater than the risks.
Beta blockers	The hormone epinephrine (adrenaline) makes the heart beat faster and stronger, and beta blockers partially inhibit its action. As a result, the pulse and the load on the heart decreases. Blood pressure, the frequency of chest pain attacks and the risk of heart attack are reduced.

Detailed articles on beta blockers:

Bisoprolol (Concor)
Nebivolol (Nebilet)
Metoprolol succinate
Carvedilol

Statins

Statins lower blood cholesterol and otherwise reduce the risk of heart attack. They can cause muscle pain, fatigue, memory impairment, but they delay a heart attack and prolong life by several years. Patients with angina pectoris must take them. These drugs should only be discontinued if side effects become intolerable.

What you need to know about statins:

Blood cholesterol level
Statins: list of drugs
Side effects of statins
Statins: FAQ. Answers on questions

Calcium antagonists

Otherwise called calcium channel blockers. These drugs relax and dilate blood vessels, facilitating blood flow to the heart. Frequent side effects are swelling, skin rash. Dr. Sinatra believes that magnesium tablets with vitamin B6 do the same thing as calcium antagonists, but without the harmful side effects.

Take your medications every day in the dosages you were prescribed. Keep an adequate supply of all tablets at home, in the garden and in the car. Find out why you were prescribed medications and what the effect of each drug is. This is easy to do and will greatly increase the benefits of taking the pills.

How long does the course of treatment last?

The course of treatment for angina pectoris should be long-term, usually lifelong. You cannot arbitrarily take breaks from taking medications or reduce their dosage. This can lead to stable angina becoming unstable, or even a heart attack.

If you want to stop taking any medications or reduce their dosage, discuss with your doctor. But before consulting with a doctor, do not change anything yourself. Modern medications for cardiovascular diseases cause almost no side effects. The unpleasant symptoms experienced by patients are usually caused by psychological reasons, as well as the consequences of atherosclerosis, which has affected the vessels that supply their heart, brain and legs.

All of the drugs described above have an affordable price and can be purchased in pharmacies without a prescription, with the exception of nitroglycerin patches and foreign analogues.

Reducing the total level of cholesterol in the blood plasma prevents further formation of atherosclerotic plaques and is the best prevention of myocardial infarction, progression of angina pectoris and coronary heart disease. Despite the severity of the clinical symptoms of the disease, lipid-lowering drugs should be prescribed when the level of low-density lipoprotein cholesterol is 100 – 129 mg/dl.

In addition, drugs in this group also have a so-called pleiotropic effect. Their use reduces the level of C-reactive protein and stops inflammatory processes in the vascular wall. Moreover, these effects develop much earlier than a decrease in low-density lipoprotein levels.

The medications are intended for long-term use, and the dosage is selected individually for each patient. At the first stage of treatment, Atorvastatin and its analogues under other trade names are taken 10 mg per day, then this amount is gradually (every 2-4 weeks) increased to 80 mg.

The medicine specifically affects the physiological factors in the development of angina pectoris. For adults, the medication is prescribed 1 tablet of 500 mg twice a day, if necessary, the dosage is increased to 2 g per day. Side effects when taking Ranexa occur extremely rarely, so it is recommended to take it if there is an increased risk of complications of a stable form of pathology.

The use of folk remedies for angina pectoris does not lose its popularity. So, with high blood pressure and the risk of an attack, it is recommended to drink an infusion of crushed cumin seeds at night (1 teaspoon per glass of boiling water), a decoction of clover flowers, prepared in the proportion of 30 g per 200 ml of hot water, take 50 ml four times a day. day on an empty stomach.

But with a severe exacerbation of the disease, especially with unstable angina, using traditional methods of relieving severe pain is simply dangerous. In such a situation, urgent hospitalization is required. There they will conduct the necessary studies of the functioning of the heart muscle and prescribe intensive therapy to stabilize the patient’s condition. After this, in the extract, cardiologists will indicate recommendations for further treatment at home.

To solve the first problem, three groups of drugs are used.

The first is acetylsalicylic acid. Just like that, for prevention, a healthy person or even a hypertensive person does not need to take aspirin. But if we have established a diagnosis of “coronary heart disease,” then constant use of acetylsalicylic acid is mandatory.

Some patients refuse to take acetylsalicylic acid because it affects the stomach. Yes, it works - but, of course, it does not directly corrode the stomach. Acetylsalicylic acid is absorbed into the blood and blocks the production of substances that form a protective layer of stomach mucus.

Well, if you have had an ulcer in the past and are afraid to take acetylsalicylic acid, your doctor will recommend gastric acid blockers such as omeprazole.

The second group of drugs are statins. These drugs have the ability to stabilize cholesterol plaque, reduce cholesterol deposits on the walls of blood vessels and prevent this plaque from rupturing.

According to global practice, statins for coronary heart disease must be prescribed to all patients, regardless of the initial cholesterol level. Reducing cholesterol once a diagnosis of coronary artery disease has been established using diet alone, as is often attempted, is a very serious mistake.

Patients with coronary heart disease should have very low cholesterol levels. When adjusting the dose of the drug, it is better to focus on the so-called “bad cholesterol” or LDL cholesterol, the level of which should be {amp}lt;1.8 mmol/l.

Let us briefly recall the main myths and legends associated with statins. Myth 1. Statins are addictive and should not be stopped. Truth: you should not stop taking statins not because they cause addiction, but because if you stop taking them, the plaque will grow further, the symptoms of angina will progress, and the likelihood of myocardial infarction will increase. Myth 2.

We treat one thing, we cripple the other. Statins cause changes in the liver and kidneys. Is it true. Significant changes in the liver while taking statins occur in one to two patients out of a thousand. During this time, it is possible to prevent 4–5 heart attacks. As for the kidneys, on the contrary, statins protect the kidneys even in renal failure.

The third group of drugs that increase life expectancy in patients with coronary heart disease are ACE inhibitors. These drugs are successfully used to lower blood pressure. However, back in the last century, their ability to prevent the development of heart failure in patients at high risk of complications was discovered.

How to treat angina pectoris?

Treatment of angina pectoris is divided into the following main approaches:

lifestyle modification;
drug treatment using basic drugs;
surgical treatment if indicated.

Lifestyle modifications include:

refusal to drink alcohol (according to the protocols, the maximum permissible dose of alcohol is 30 grams, which will increase to pure alcohol for men and 20 grams for women);
quitting smoking (nicotine is a strong vasoconstrictor that can provoke angina attacks);
fight against excess weight;
minimal physical exercise;
treatment of concomitant chronic diseases;
correction of metabolic disorders with diet;
organization of work, rest and sleep;
avoidance of stressful situations.

According to unified protocols, treatment of angina pectoris should not begin with the use of drugs.

Like any disease associated with a disruption in the functioning of the cardiovascular system, angina pectoris is treated with several types of drugs at once

If after life modification the patient’s condition does not improve, the doctor may prescribe a combination of the following groups of drugs:

nitrates;
beta blockers;
calcium channel antagonists;
diuretics;
ACE inhibitors.

Treatment can be carried out either with one drug (mototherapy) or in a combination of two or more drugs.

Nitrates

The most common representative of nitrates is “Nitroglycerin” - sublingual application (under the tongue).

Nitroglycerin is considered an emergency aid for angina and myocardial ischemia. The mechanism of action of the drug is associated with the expansion of peripheral vessels, in particular venules. As a result of the expansion of the periphery, the blood load on the heart is reduced and the pain attack is relieved.

Nitroglycerin should be taken at intervals of 10-15 minutes, but no more than three tablets per day (there are data that describe taking up to six tablets per day, without harm to health).

If you are intolerant to Nitroglycerin, the drug can be replaced with Nitrosorbide.

Nitroglycerin is the most effective drug that quickly relieves a painful attack of angina.

Nitrosorbide has a very similar mechanism of action, but the pharmacological effect occurs a little later. It is recommended to use Nitrosorbide to prevent angina attacks 30 minutes before meals, 3-4 tablets. The maximum daily dose should not exceed 120 mg.

Transdermal patches: Nitroglycerin patches are used for convenience and are sometimes called transdermal or transdermal patches. The daily dose should be 25-50 mg of the active substance.

For use, the patch is applied to the heart area or left forearm. There is much debate about its effectiveness, but for people with angina in the early stages of the disease, the patch is quite suitable.

Adrenergic blockers

This group of drugs helps lower blood pressure by blocking beta receptors in the arteries. In addition, beta blockers affect the myocardium, reducing the heart rate (they reduce the heart's need for oxygen).

Drugs are divided into two groups:

selective: “Bisoprolol” “Metoprolol”;
non-selective: "Anaprilin".

Selective drugs are much better because they only affect the myocardium. When taking non-selective beta blockers, side effects such as bronchospasm are observed.

"Anaprilin" is used relatively rarely, the drug is outdated and is rarely used in the treatment of angina pectoris.

This drug is prescribed according to the following scheme: the first few days, the dose is minimal: 20 mg 3 times a day

Betaxolol is a selective beta blocker with a pronounced dromotropic and bathmotropic effect. Well suited for the treatment and prevention of attacks of the disease. It is used 0.02 g once a day. The effect of this drug lasts about 24 hours.

Contraindications to taking Betaxolol are low blood pressure, bradycardia below 55 beats per minute and blockade of the Hiss bundle branches.

"Atenolol" is also a selective beta blocker, the pharmacological action time is 12 hours.

It is used in a dose of 50–100 mg once a day.

All beta blockers begin to be used with minimal doses, gradually increasing the amount of the drug. This method of administration allows you to avoid negative effects and side effects.

Calcium channel antagonists

Calcium channel antagonists are very good at dilating coronary and peripheral vessels, due to this effect more blood flows to the heart through the coronary vessels.

The most effective drug in this group for an attack of angina is “Nifidipine” - it acts quickly and is eliminated from the body.

The initial dose is 10 mg, the maximum daily dose is 100 mg.

For permanent treatment, Amlodipine is used, the mechanism of action of which is similar to Nifidipine, but the effect of the drug is longer. Amlodipine is used once a day at a dose of 20 mg.

Verapamil and Gallopamil also perfectly dilate coronary vessels - these drugs have a good effect on the tone of cerebral vessels.

Diuretics

This type works well for angina pectoris, which is accompanied by edema and high blood pressure.

During an attack, Furasemide is the most effective; its analogue is the drug Lasix. This is a very powerful diuretic and should only be taken during acute highs. Chlorthalidone may be the drug of choice; it is also a substance that should not be taken for a long time.

Calcium channel antagonists

They have a positive effect on the myocardium, which occurs by blocking certain proteins involved in spasm of blood vessels and arteries. When using these medications for angina pectoris, blood flow improves, general blood circulation and the patient’s well-being are normalized.

Among these drugs are the following:

Diltiazem is a modern effective medicine for diseases of the cardiovascular system. It has a vasoconstrictor effect and is prescribed mainly for hypertension and angina pectoris. The dosage of the drug is prescribed individually by a doctor, the maximum is 360 mg, the minimum is 180 mg per day. This remedy also has contraindications and side effects. If undesirable symptoms occur, the drug should be discontinued, as collapse or pulmonary edema may develop. Prescribed by a medical specialist.
Gallopamil is a second-generation drug that is effective for various severity of angina pectoris. Widely used in the prevention of myocardial infarction. The drug normalizes blood flow in all peripheral vessels. The dosage is determined by the patient's condition, the stage of the disease and generally ranges from 50 to 100 mg 2 times a day. The maximum dose of the drug can be divided into 4 doses. Contraindications are considered to be hypertensive crisis, pregnancy, early childhood, kidney disease and some pathologies of the cardiovascular system.
Verapamil is an effective drug belonging to group 1 antagonists. It has an effect on the myocardium, dilates blood vessels and normalizes heart function. The drug is widely used not only for treatment, but also as a preventive measure. The total dosage is 320 mg, taken 4 times a day. For more severe angina, the dose increases to 500 mg, especially in the last stage. In addition to its positive properties, the drug has contraindications and causes side effects in the form of changes in blood pressure, impaired renal and liver function.

Other medicines used to treat angina

Treatment of angina pectoris involves taking medications such as antiplatelet agents, statins, beta blockers, calcium antagonists, inhibitors, nitrates, and cytoprotectors. Doses are prescribed by a doctor.

Antiaggregates help prevent the formation of blood clots (thrombi), reduce the aggregation (sticking together) of platelets - blood cells that are responsible for the formation of a blood clot. The list of antiplatelet agents includes: aspirin, cardiomagnyl, thienopyridines.

Antiaggregates

Aspirin (acetylsalicylic acid) is the main antiplatelet agent; it is prescribed to all patients suffering from angina pectoris (with the exception of those who cannot tolerate it, for example, allergy sufferers with the “aspirin triad”). The dose of aspirin is 75-150 mg daily. Taken once, every 20-30 minutes. after meal. Typically in the afternoon.

Pay attention to the low dose! A typical aspirin tablet contains 500 mg, a dose that has been taken as an analgesic and antipyretic for over 100 years! For angina pectoris, no more than 1/4 tablet is recommended. This dose effectively prevents thrombosis and is quite safe for the stomach.

Since patients with angina pectoris require constant use of aspirin as treatment, special, safer forms for long-term use have been developed.

Cardiomagnyl (aspirin magnesium hydroxide) 75 and 150 mg. Magnesium hydroxide, which is part of the tablet, stimulates the formation of special protective substances in the stomach wall of a patient with angina pectoris that prevent the formation of ulcers and erosions.

Enteric-coated aspirin (AspirinCardio 100 mg, ThromboAss 50 and 100 mg, CardiASK 50 mg, etc.). The special coating does not allow the tablet to dissolve in the stomach; absorption of aspirin occurs in the intestines. Important: these tablets must be taken whole, you cannot break them or chew them (otherwise you will damage the shell and the protective effect will disappear)!

Thienopyridines are also prescribed as a treatment for those patients who cannot take aspirin due to intolerance or contraindications.

Important: Tell your doctor if you have previously had a stomach ulcer, duodenal ulcer (DU) or erosive gastritis, as well as unstable blood pressure with frequent crises, rises above 160-170/100 mm Hg. Art. This information will help your doctor make your antiplatelet treatment safe.

It has been proven that regular use of antiplatelet drugs can reduce the incidence of myocardial infarction, strokes and death in patients with angina pectoris by up to 23% (in every 23 people out of 100)!

After coronary angioplasty and stenting operations, doctors recommend taking aspirin and clopidogrel together for a certain period of time (from a month to several years).

The following groups of drugs are prescribed to reduce the frequency of angina attacks.

Beta blockers slow your heart rate. This property of drugs is also used to treat angina pectoris, since by slowing down the heart rate, we reduce the load on the heart. Accordingly, the dose of beta blockers is selected under control of the pulse rate.

Calcium antagonists have a vasodilatory effect, which is associated with their ability to reduce cardiac ischemia.

Long acting nitrates. Unfortunately, many patients are familiar with them. Why "Unfortunately? Yes, because according to modern ideas, these drugs are prescribed only in the case when everything we talked about earlier (beta blockers, calcium antagonists) does not help and the patient actually continues to have angina attacks.

In fact, there is a very common mistake: a patient is diagnosed with angina without any reason (some kind of incomprehensible pain in the chest, and his age, and the cardiogram is somehow not the same) and is immediately prescribed nitrates without any additional examination. As a result, the situation not only does not improve, but even worsens - a severe headache appears. This is the main and very common side effect of nitro drugs.

Approximately 60–70% of patients are diagnosed with coronary artery disease absolutely without any reason. Either simply because of age, or for nonspecific (“age-related”) changes on the ECG, or for some other unknown reason. According to the experience of my consultation, in approximately 2/3 of patients the diagnosis of IHD is unreasonable.

Yes, of course, fast-acting nitroglycerin in the form of a spray (aerosol) still remains relevant in the case when an attack of angina does not go away on its own with rest.

But what about the drugs for “improving nutrition”, our favorite “vitamins for the heart” or, as they are scientifically called, “metabolic drugs”? Trimetazidine, mildronate, mexidol, coenzyme Q-10, L-carnitine, riboxin, ATP and cocarboxylase. Most of these drugs have not been properly studied, and those that have been studied do not affect the prognosis at all, which the manufacturers prefer to keep silent about. So, if you see these drugs in your prescriptions, you need to seriously think about it.

The frequency of prescribing drugs “to improve cardiac nutrition” is inversely proportional to the qualifications of the cardiologist.

Thank God, in cardiovascular medicine of the 21st century there are seriously studied drugs with proven effectiveness and safety that can really help.

Treating angina involves adopting a healthy lifestyle, taking medications and supplements. In severe cases, it is advisable to undergo surgery to restore blood flow through vessels affected by atherosclerosis. Treatment goals are divided into short-term and long-term.

Urgent Care

Emergency care for angina pectoris is to relieve pain as quickly as possible. It is better to prevent an attack of chest pain than to treat it. But if you have to treat, then you need to do it as quickly as possible. You already know that rest and nitroglycerin under the tongue help with chest pain.

Some patients endure the pain, trying not to take nitroglycerin again. However, this is wrong. An attack of angina pectoris is harmful - it destroys the heart. Therefore, you need to quickly take nitroglycerin - tablet, drops or spray. Try to avoid situations in which you often experience chest pain.

How to treat angina pectoris at home?

Surgical treatment of angina pectoris involves tens of millions of operations that are performed around the world every year. Patients are sent to a surgeon if the effect of drug treatment is insufficient. Typically, patients need to continue taking medications after surgery, even if the surgery was successful and blood flow to the heart has improved.

Angioplasty and stenting	A procedure in which an elastic balloon is inserted into an artery in an area narrowed due to atherosclerosis. It inflates and the lumen in the artery expands under pressure. The balloon is then deflated and removed, and a stent, a spring-like device, is installed in its place. A stent is needed to prevent the artery from narrowing again in the same area.
Coronary artery bypass surgery	An operation in which the surgeon takes a vein, usually from the patient's leg, and uses it to create a bypass for blood to flow to the heart. Thus, blood flows freely bypassing vessels affected by atherosclerosis.

Angioplasty and stenting are called percutaneous coronary intervention. In Western countries, it is not considered a major surgical procedure at all. Coronary artery bypass grafting is a more complex procedure than angioplasty and stenting. After it, patients recover longer.

Patients are interested in two main questions:

What to choose - stenting or bypass surgery?
Is surgical treatment necessary at all or can I limit myself to taking medications?

For many patients with angina, there is no point in undergoing surgery, and they can limit themselves to taking medications. You will feel better if you use more supplements:

magnesium-B6

coenzyme Q10

And

L-carnitine

. Find out below in which cases surgical treatment is appropriate and in which it is not. Doctors are interested in doing more operations because they make money from it.

Back in 1984, the results of the Coronary Artery Surgery Study (CASS) were published - a study of the effectiveness of surgical treatment of coronary heart disease. Patients who refused surgery showed unexpectedly good results. This even applied to patients in whom all coronary arteries were seriously affected by atherosclerosis.

The mortality rate among patients treated with medications without surgery was about 1% per year. Among those who had stenting or bypass surgery, it was about the same. However, they still had a significant risk of dying during the operation.

Causes

Risk factors include heredity, age and gender. Men aged 50-55 years are more susceptible to developing the disease than women. If we talk about percentages, then at the age of 45 to 54 years, angina attacks affect 2-5% of people, while among 65-74 year olds, it increases to 10-20%.

The leading cause of angina, as well as coronary heart disease, is the narrowing of the coronary vessels caused by atherosclerosis. Symptoms develop when the lumen of the coronary arteries narrows by 50-70%. The more pronounced the atherosclerotic stenosis, the more severe the angina.

Factors that contribute to the occurrence of angina attacks are:

Increased physical activity;
Strong emotional experience, stress;
Tachycardia;
Exit from a warm room into cold, cold and windy weather.

Those most prone to angina are:

Males;
Overweight, obese people;
Hypertensive patients;
Addicted to smoking, alcohol, drugs;
Fast food lovers;
People with a sedentary lifestyle;
People often exposed to stress;
Persons with diseases such as diabetes mellitus, arterial hypertension (hypertension).

Adrenergic blockers

Medicines help reduce heart contractions, which reduces the need for oxygen. Such drugs do not affect the body, which is at rest. Their effect occurs only during physical activity. This group includes:

Anaprilin is a common medicine against angina pectoris, it helps to significantly improve the general condition of the patient, reduce vascular spasms and the frequency of attacks. But when treating angina pectoris with the drug, the dose and method of administration should be strictly observed, because there are side effects. They are expressed by allergic reactions with intolerance to any component; headaches, vomiting, nausea, as well as poor sleep and dizziness are possible. The drug should be taken with caution if you have liver diseases; in this case, you must carefully calculate the dose. Therefore, at first the doctor prescribes a minimum dosage of 20 mg 3 times a day, then, after a certain number of days, the dose is increased, gradually reaching 240 mg per day. If you experience any discomfort after using anaprilin, it is better to replace it with a similar drug in consultation with a medical specialist.

Betaxolol is an effective drug that is used no more than once a day. Characterized by rapid blocking of attacks, the initial dose is 10 ml. After 2 weeks of use, if the treatment result is not achieved, the dosage can be doubled. The drug is characterized by the presence of side effects; it is not recommended for people with diabetes, liver and blood diseases. In case of overdose, convulsions, dizziness and bronchospasm are possible.
Atenolol - the drug is prescribed after meals in the morning, 1 time per day. The minimum dosage is 50 mg, then, after a certain time, it is doubled. If there is no therapeutic effect at the maximum dose, the drug is not taken.

Contraindications must also be taken into account: hypertensive crisis, pregnancy, bradycardia and heart failure.

Antianginal agents

Drug treatment of angina often begins with antianginal drugs. They are aimed at combating myocardial ischemia, reducing the need for oxygen in the heart muscle, and increasing the level of this element in the blood. This group of drugs includes nitrates, which relieve and prevent angina attacks by dilating the walls of blood vessels and increasing oxygen access to the heart muscle.

Nitrates do not have a pronounced therapeutic effect; they only relieve or prevent the development of attacks. With the constant use of such drugs, the body can get used to their action, so a break is taken during the day to remove the residues from the body. For better effects, nitrates are taken directly during an attack or for prophylaxis before physical activity.

Nitroglycerine

The most famous drug for angina pectoris is Nitroglycerin. It is available in the form of a spray, patch, wafers, sublingual tablets, drops, ointments, long-acting capsules or ointments. The active ingredient of the drug also contains Deponit, Nitrangin, Gilustenone, Nitradisk. The drugs increase the oxygen saturation of tissues, expand the lumen of blood vessels, and relieve angina pectoris.

The tablets dissolve under the tongue and act in 2-3 minutes for half an hour. The spray is applied to the oral mucosa; it begins to work instantly, but its effect is short in time. Plates and films (buccal forms) are attached to the gum or buccal mucosa and last for 3-4 hours. Capsules must be taken in advance of an attack, 1-2 times a day on an empty stomach. The ointment is applied to dosage paper and pressed firmly onto an area of the body where there is no hair. 40 tablets cost 50 rubles, a spray of 200 doses costs 100 rubles, 10 ml drops cost 49 rubles.

Isosorbide dinitrate

Tablets, capsules and aerosol preparations for angina pectoris based on isosorbide dinitrate are found in pharmacies under the names Izolong, Izoket, Nitrosorbide and Cardiket. They are taken orally in the dosage prescribed by the doctor - 20 mg 2-3 times a day an hour before meals or 2 hours after meals. If the effect is not enough, the dose is gradually increased to 120 mg per day.

The body can get used to the effects of active components after 1-1.5 months of regular use, so after this period of time a daily break is taken, during which the product is replaced with another with a similar effect on the body. 60 tablets of Nitrosorbide cost 25 rubles, a 15 ml spray under the brand name Isoket will cost 375 rubles, 20 tablets of Cardiket Retard - 115 rubles.

All drugs for angina pectoris in this group are peripheral vasodilators that affect the veins. They have antianginal and hypotensive effects, reduce left ventricular filling and preload, reducing the need for oxygen in the spasmodic myocardium. This leads to an increase in capillary blood flow, opening of the lumen of the coronary vessels, and improved supply to the ischemic area.

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Isosorbide mononinrate

Peripheral vasodilators based on isosorbide mononitrate (Isomonit, Mononit, Pentacard, Plodin, Monocinque) affect the veins, exhibiting vasodilator and antianginal effects. They reduce preload and afterload, dilate the coronary arteries, improve blood flow, increase exercise tolerance, and cause a muscle relaxation response.

Vasospastic medications are available in tablet and capsule formats and are taken orally twice daily. If the formula is long-acting, then it is taken once a day with a gradual increase in dosage. During treatment with such drugs, activities that require sustained increased concentration of attention should be excluded. 30 tablets cost approximately 350 rubles.

Calcium antagonists

Tablets for angina pectoris from the group of calcium antagonists prevent the penetration of the element into the muscle and reduce myocardial contractility. Their action is aimed at reducing blood pressure, regulating the rhythm of the heartbeat, and relieving spasms of the coronary arteries. Due to this, blood flow improves, myocardial oxygen demand decreases, and the flow of nutrients to the heart muscle increases.

Popular drugs are Verapamil, Diltiazem, Nifedipine, which improve the penetration of calcium ions, saturate cardiomyocytes (heart cells) with oxygen, and lead to muscle relaxation. Medicines are taken 1-2 times a day, 10 mg, and can be combined with other tablets for angina pectoris. 30 tablets of Nifedipine cost 40 rubles, Diltiazem - 90 rubles.

Beta blockers

Drugs for the treatment of angina from the group of beta blockers reduce the patient's blood pressure and pulse rate, which leads to a decrease in the heart's need for oxygen. Medicines in this group (Concor, Nebilet, Coriol, Anaprilin) are not addictive, do not have a cumulative effect (do not accumulate), and therefore are easy to adjust the dose. It is impossible to use medications for a long time due to the large number of side effects. After the patient’s condition normalizes, the dosage is reduced to the minimum effective.

The composition of the drugs includes the active substances nebvolol, betaxolol, metoprolol, propranolol, timolol, bisoprolol. Medicines are taken with meals once a day, 2.5-5 mg; during arterial therapy, the balance of the pulse rate must be taken into account - when taken, it should be 50-60 beats per minute. For 50 Anaprilin tablets you will have to pay 30 rubles, 28 Nebilet tablets - 1000 rubles.

Angina pectoris (angina pectoris) - what is it?

Angina is a process during which ischemia (acute oxygen starvation of the myocardium) of the heart muscle occurs. An attack of angina is a manifestation of cardiac ischemia. Therefore, when they talk about angina, they mean ischemic heart disease, or coronary heart disease.

During the onset of an angina attack, there is still no necrosis of the heart muscle, that is, a heart attack does not develop. But in a severe attack, a heart attack can be its outcome, and sometimes its cause, since post-infarction angina is known.

With angina, the discrepancy between the delivery of oxygen to the myocardium and its demand is especially acute. Almost always its causes are associated with processes developing in the coronary or coronary arteries that supply nutrition to the heart. But in some rare cases, the cause may be, for example, an increase in physical activity (and, accordingly, the heart’s need for oxygen), against the background of severe anemia and a pronounced decrease in hemoglobin, for example, less than 65 g/l.

About risk factors

The entire “bouquet” of cardiovascular diseases revolves around the same set of risk factors. Of course, there are factors that cannot be “neither bypassed nor bypassed,” for example, being male and being over 50-60 years old.

But you can largely avoid heart attack (which is a possible outcome of an angina attack), ischemic stroke and sudden cardiac death if you understand the following conditions:

Hyperlipidemia, dyslipidemia, increased atherogenic fractions (“bad” cholesterol) in the blood;
Increased blood vascular pressure (arterial hypertension);
Diabetes mellitus or impaired glucose tolerance. If you have diabetes, it is very important to keep your blood sugar levels as close to normal as possible;
Obesity. To reduce the risk of cardiovascular pathology and angina pectoris, in addition to reducing body weight, it is necessary that in men the waist circumference does not exceed 102 cm, and in women - 88 cm;
Smoking and alcohol abuse;
Physical inactivity. It is known that the lack of regular load depletes the compensatory capabilities of the myocardium, which can lead to myocardial ischemia even with a slight load.