DISEASE OF BODIES OF BLOOD CIRCULATION : Angina (stenocardia). Angina (angina pectoris) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Кровеносная система, сердце, сосуды, кровь
Pain is the main and sometimes the only symptom. Typical is a pain in the sternum. Less pain occurs slightly below the left collarbone, sometimes to the left or to the right of the sternum and even in the epigastric region (pseudoallergy). Pain arising in the area of the heart, vstrechaet infrequently, usually when cardialgias (see cardiac Neurosis). Pain bottom and from left nipple arises in connection with the tonic spasm phrenic obstacles in so-called frankardi. Sometimes the pain appears in the abdomen due to spasm of the mesenteric vessels. The pain is characterized by the suddenness (pristupoobraznaya) and communication with specific points:
The duration of pain oshusheniya several seconds to several minutes . Pain that lasts more than hours, suspicious of myocardial infarction (the initial stage) . Pain varieret in wide limits from easily portable to cause incredible suffering, leading to shock; sometimes they change and qualitatively clenching, pressure, wrenching, cutting, drill, searing pain. Pain irradiiruut in the left arm up to the elbow or lower side of the ulnar nerve (little finger), shoulder, neck, even in the jaw (teeth), usually the left side. Korticosteroidnyi crisis often not limited koronarospazm (and pain), but can give, and other manifestations of overstimulation of the vagus nerve (decrease heart rate, nausea, vomiting, pain in the stomach, re-chair, pot)and sympathetic (increased blood pressure, the delay urination, followed by a large discharge of pale urine urina spastica and others). Patient bound, avoids unnecessary movement at occurrence of pain in bed carefully changes position, sometimes forced to stand, as this pain sometimes weaken and even pass (orthostatic weakening of vagal tone and decrease the amount of circulating blood). The attack in the long duration may have the character following one after the other waves. If a seizure occurs only under strictly defined conditions (for example, at movement), it ends when you change these terms (the bus stop etc). After the termination of an attack of angina patient immediately experiences a feeling of complete health. After a long attack (15-30 minutes) usually there is a great sense of fatigue.
Angina of effort. The attack greater or lesser strength occurs during movement or any physical work. Usually the most difficult first steps (100-200) then the patient may go away, and the pain subside (acute training apparatus in charge of circulation and development in the process of muscles vasodilator agents). In severe cases, the patient is deprived of ability to move, especially the stairs and up the hill, the wind (cold weather) and after meals (even load and with poor). In the late condition, i.e. at home, the patient feels absolutely healthy. You have coronarosclerosis. With gradual increase of coronarosclerosis and the vessel stenosis severity of the clinical picture is also rising.
Angina at rest. Attacks usually occur at night and often acquire a formidable character. Vertical position may terminate or to facilitate the attack. In some cases, angina at rest occurs without the preliminary stage of angina of effort. On the contrary, sometimes moderate movement may be more feasible. Angina at rest, as if often ends with myocardial infarction. Emerged after one of the attacks of angina arrythmia usually indicates mikroinfarkt. Discovered (with careful and repeated research) a slight increase in body temperature, fleeting leukocytosis, and accelerated ROHE speak for myocardial infarction .
Psychogenic angina. Lability of the psyche (reactivity) and vegetative nervous system is the main etiological moment of this form angina. Mental turmoil, sometimes completely innocent excitement are the immediate cause of the occurrence of an attack. This option is especially vividly delineated korticosteroidnyi pathogenesis of angina and most of the conditioned reflex communications.
Tobacco angina. Attacks often parallel to grow and fall (even disappear) in connection with the number of cigarettes (pipes, cigars). Until he developed persistent changes in the coronary vessels, in the autonomic nervous system, stopping Smoking can lead to full recovery. Tobacco stenocardia, of course, is particularly easy occurs when you have a previous version.
is made on the basis chest pain occurring pristupoobrazna and has spread most often in the left arm or left shoulder. A more advanced age and the presence of atherosclerosis of the aorta and heart vessels, strengthen the diagnosis. The positive action of nitroglycerin further increases the reliability of the diagnosis. To differentsirovki angina have from the heart neurosis , procardia , mirabelou neuralgia and dry pericarditis . Cardialgias and procardia characteristic of different localization of the pain; intercostal neuralgia is not usually paroxysmal character, the pain lasts longer, is enhanced with a deep breath, and especially with the feeling of intercostal spaces, Pericarditis is set in the presence of friction noise pericardium. Long attack stenokardicheskie pain on the ground of coronarography may be accompanied by pericarditis (pericarditis epistenocardica). In this case, therefore, there is a and angina, and pericarditis.
in respect of recovery and even life seriously, especially in older people with atherosclerosis of the aorta and other vascular areas. When strokes efforts that have fallen further in the rest angina, increasing the frequency of seizures forecast overshadowed, as angina in such cases ends with myocardial infarction . Death from koronarospazm (without coronarography) is extremely rare. At a relatively young people, especially those suffering from psychogenic angina, and when worn a form angina prediction concerning life and even recovery is often quite good. The degree of coronary insufficiency, i.e. the frequency, duration and force attacks, of course, to some extent, proportional to the violation of disability. Angina of effort dramatically reduces the disabled persons mostly physical labor; psychogenic (emotional) angina is the most violates disabled persons mostly mental work. Light physical work (with the third disability group or without it), certain restructuring mental work (off especially exciting events) are the main prerequisites for employment.
When strokes physical effort patients themselves quickly to take the magnitude and the pace of physical stress, which corresponds to the degree of their coronary insufficiency (slow walk without load weights etc). Nevertheless each patient on ordinary matters of attack: overflow stomach, cold wind, tobacco Smoking, etc. During a severe attack (large seizure) you should always start with sedation of the patient and others (are looking for peace and patients themselves; sometimes they rush about and go).
In psychogenic form is particularly important calming the patient's authoritative word, often relieving the conditioned reflex layers, fear of the usual reason for the attack, and the use of sedative drugs (bromides, Valeriana, luminal, omnopon). Dieticheskie instructions are not so much to the quality rather than the quantity once entered the food, especially the liquid (not to burden the stomach, to get up from the table slightly starving, not to drink at lunch, tea, coffee, juice, mineral water or other drinks). Fatty foods and eggs are removed (prevention of atherosclerosis). Persons suffering from angina efforts should be advised to leave the house on an empty stomach and Breakfast already at work (if possible).
Psychotherapy in any form, in particular, masked drugs and treatments, especially shown in psychogenic form angina. Physiotherapy, especially lukewarm (indifferent) water procedures (pine baths, circular shower, wrapping). Cold treatments are usually transferred wrong. Bathing in the river is valid at temperatures not lower than 22-21 degrees in calm weather (also in the calm sea). Useful General massage with light, soothing techniques (stroking). Galvanization cervical sympathetic nodes (diferently anode) often gives a positive effect. Therapeutic physical culture valid in cases where the attacks are very rare and weak (erased form), and when it is desirable to increase metabolism (ozarelix) or create a degree of fitness to muscle strains (in patients with angina of effort). When conducting procedures is the possibility of elimination of conditioned reflexes (fear movements and others). Spa treatment is usually contraindicated in severe and frequently recurring strokes. In such cases the method of choice is a sanatorium treatment with the use of all of the above remedial measures. In the light forms strokes, especially in the high-psychoneural excitability, stay in the spring and summer months, on the lake, a river in the middle zone of Russia or on the Riga coast with its flat terrain can have a favor.