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Unstable angina pectoris: precursor of heart attack

Angina pectoris is a form of coronary heart disease (CHD), which is characterized by paroxysmal pain behind the sternum when the stress on the cardiovascular system is increased against the background of emotional and physical stress. The cause of the disease is a violation of the blood supply to the heart muscle. Unstable angina is a dangerous condition that threatens the development of myocardial infarction and related complications.


Causes of unstable angina

Circulatory disorders of the heart muscle (myocardium) can be caused by various reasons. There are certain risk factors, which include:

  • age - the chances of developing the disease increase in patients older than 45 years;
  • heredity;
  • the presence of predisposing diseases such as diabetes, hypertension;
  • overweight;
  • Lifestyle - smoking, alcohol abuse, stress, physical inactivity.

In men, the disease is diagnosed more often. In women, before the onset of menopause, the risk of unstable angina is extremely low due to the production of sex hormones (estrogens), which preserve blood vessels. But after 50–55 years, the risk of developing the disease in women increases.

Atherosclerosis as a cause of coronary heart disease

Cardiovascular diseases, more than 2/3 of which are coronary heart disease, stroke and damage to peripheral arteries, are associated with atherosclerosis and remain the leading cause of death worldwide. Coronary artery disease and angina are most often caused by impaired blood supply to the myocardium due to atherosclerosis of the coronary (heart-feeding) vessels. Plaque deposition occurs on their inner surface. At the same time, the vessels lose their elasticity, their walls ulcerate, which leads to the formation of blood clots. Atherosclerotic plaque can grow, deforming and narrowing the lumen of the artery, which causes chronic blood supply to the organ. A local decrease in the vessel diameter by more than 50% can provoke an attack of unstable angina. The plaque can be destroyed due to inflammation, hemodynamic disorders, excess fat deposits, lack of collagen. Unstable form of angina occurs in the event of a rupture of the plaque with the formation of a thrombus, which prevents the normal blood supply to the heart muscle.

Atherosclerosis of heart vessels

The consequences of atherosclerotic disease

Along with atherosclerosis, there are other causes of unstable angina:

  • congenital malformations;
  • capillary rupture followed by hemorrhage into the plaque;
  • inflammatory process in the vessels;
  • increased gluing capacity of platelets;
  • spasm of heart vessels in infectious and rheumatoid diseases, a number of pathologies of the gastrointestinal tract;
  • the release of serotonin or other biologically active agent in the blood, in which there is a sharp narrowing of the lumen of the coronary vessels;
  • reduction of antithrombotic properties of the endothelium (cells of the inner surface of blood vessels).

Types of disease

The severity of pain depends on the degree of damage to the arteries, the number and location of damage. Depending on the characteristics of circulatory disorders in coronary vessels, angina can be:

  1. First appeared. The first attacks can occur with severe physical exertion and vary in intensity. Last from several minutes to half an hour. May increase or take place at rest. The prognosis is less favorable when the pain is increasing, prolonged from the first attacks and is associated with changes on the ECG (electrocardiogram).
  2. Progressive. Occurs with the existing diagnosis of stable angina. It differs from its usual manifestations by a much longer and more intense attack. Usually not enough usual dosages of nitroglycerin. In addition, progressive angina includes seizures with various types of arrhythmias alone.
  3. Postinfarction (recurrent). It starts 24 hours or up to 8 weeks after myocardial infarction. According to statistics, repeated attacks are associated with the activity of the patient or massive heart damage. At 20–40%, it can be fatal or recurrent myocardial infarction.
  4. Variant, or Prinzmetal stenocardia. The cause is a narrowing of the coronary vessels in the form of a spasm. It usually occurs at the same time and causes characteristic ECG changes that disappear after an attack.
  5. With the outcome in small focal myocardial infarction. It proceeds without visible rhythm disturbances and severe pain. It differs from other types of angina pectoris by pronounced changes on the ECG. The prognosis is often favorable.

Braunwald classification to determine the severity of an attack - table

A - secondary unstable angina.
Attacks are provoked by external causes (anemia, thyrotoxicosis, acute infection, etc.)
B - unstable primary angina.
Associated with heart disease
C - postinfarction angina.
Occurs within 2 weeks after myocardial infarction
I - first emerged, progressive angina, without rest angina IA IB Ic
II - rest angina during the month, but not in the next 48 hours IIA IIB Iic
III - resting angina in the next 48 hours Iiia IIIB IIIC

This technique allows us to assess the risk of myocardial infarction by the clinic and the causes of a painful attack.


First of all, the doctor takes into account the patient's complaints, conducts a general examination of the patient, listening to heart sounds and collects anamnesis (history of the disease). For diagnosis, instrumental diagnostics is also used, which primarily includes an ECG. When an angina attack occurs, you can notice a number of characteristic changes on the cardiogram.

In addition, a blood and urine test is prescribed. With unstable angina, biochemical parameters may be altered (glucose, cholesterol, triglyceride levels, creatine kinase, etc.).

A special diagnostic role has cardiac markers - troponins. They show the presence of damaged myocardial cells.

In the future, during inpatient treatment, a patient for in-depth diagnosis is performed an ultrasound of the heart - EchoCG, bicycle ergometry, coronarography, Holter monitoring. On ultrasound, you can detect a violation of cardiac contractility and congenital malformations.

Velgoergometry is a test in which the patient receives a load on the exercise bike to the maximum possible for him. At the same time changes are constantly recorded on the ECG.

Bicycle ergometry

Functional test for unstable angina

Coronary angiography is perhaps the most informative method. It consists in the introduction of a contrast agent into the blood vessels of the heart, which makes it possible to determine the ischemic area using an x-ray.

Coronary angiography

Access routes for coronary angiography

Holter monitoring is performed more to diagnose rhythm disturbances at the time of an attack of angina pectoris. Results are recorded within 24 hours.

Symptoms and differential diagnosis - table

Sign of Unstable Angina Stable angina pectoris Intercostal neuralgia
Nature of pain A painful attack carries a burning character, sometimes unbearable. It has the typical burning character of chest pains. The aching, aggravated by palpation along the nerve, paroxysmal, sometimes may appear as a burning sensation or tingling.
Localization of pain It is localized behind the sternum and has an extensive distribution. Localized behind the sternum. Localized in the intercostal spaces.
Irradiation (distribution) of pain The pain radiates to the right or left arm, shoulders, under the scapula, to the abdomen, neck, lower jaw. The pain is usually localized only behind the sternum, rarely can give in the left hand. The pain radiates to the lower back, back, under the scapula, localized in the intercostal spaces.
Duration of painful attack More than 30 minutes. Up to 30 minutes at the termination of any physical activity. The appearance of pain in any movement, at rest completely absent.
Start of an attack During physical exertion, at rest, in sleep, under stress. During physical exertion, at rest, in sleep, under stress. When turning the body, inhaling deeply, after sharp turns or bending, when coughing or sneezing.
The cause of the attack
  • Atherosclerosis;
  • systemic diseases;
  • myocardial infarction;
  • angina pectoris;
  • smoking;
  • taking alcohol;
  • obesity;
  • high pressure;
  • stress;
  • intense exercise.
Intense exercise, stress, atherosclerosis, systemic diseases. Physical overstrain the day before, staying in a draft.
Pain relief Not stopped by previous dosages of nitroglycerin. It is stopped by three tablets of nitroglycerin. The pain is not relieved by nitroglycerin, but is quickly removed by systemic anesthetics (Analgin, Ketorolac, Diclofenac, Diklober, etc.).
Other symptoms
  • Nausea;
  • vomiting;
  • pallor of the skin;
  • sweating;
  • headache;
  • epigastric pain;
  • increase or decrease in pressure;
  • excited state;
  • fever.
May be accompanied by a rise in blood pressure. Possible increase in blood pressure.

Treatment of unstable angina

When treating unstable angina, several tasks need to be achieved:

  • to restore the patency of blood vessels;
  • remove pain;
  • prevent myocardial infarction;
  • eliminate concomitant complications.

Drugs that the patient can take before going to the doctor

Treatment can be divided into pre-medical and medical care. Independently during an attack, the patient can take an aspirin pill and up to 3 nitroglycerin tablets with a reception difference of 5 minutes. If the seizure has not stopped, you should consult a doctor or call an ambulance.

It should be remembered that nitroglycerin should be taken in a horizontal or sitting position under the control of blood pressure. If you are allergic to aspirin, then its reception should be limited.

Therapeutic measures that reduce the incidence of complications

At the prehospital medical stage, intravenously injected drugs that relieve an angiosis attack (nitroglycerin, Isomyc, Isosorbide dinitrite, etc.) that help prevent thrombosis (Heparin, Streptokinase, Metallis, Alteplaza). In case of severe pain syndrome, narcotic analgesics may be injected (Morphine, Fentanyl).

At the outpatient stage or in the hospital, different groups of drugs are added to the above-mentioned treatment, regardless of the type of unstable angina pectoris:

  • prolonged nitrates (used as nitroglycerin, but longer in action) - Molsidomin, Monocaps;
  • Beta-blockers (drugs to reduce the pulse) Bisoprolol, Metoprolol, Bikard, Propanolol;
  • alpha-blockers (necessary for normalization of blood pressure) - Lisinopril, Ramipril, Captopril;
  • diuretics (used in the presence of edema and heart failure) - Torasemide, Veroshpiron, Indap, Furosemide, Spironolactone;
  • statins (used to lower cholesterol in the blood) - Zokor, Atorvastatin, Rosuvastatin.

You can not take these drugs without a prescription!

Applied drugs in the photo

Recommendations for the prevention of disease

Dieting plays an important role. The patient must limit the amount of fatty foods, you can not eat salty, spicy, fried, smoked. It is necessary to give up smoking and alcohol. Physical exercise, exposure to fresh air, limiting stressful situations have a positive effect on the state of the body.

In addition, you can not skip the medication prescribed by a doctor, you must comply with the prescribed dosage.

But do not forget that medications are only part of the prevention of unstable angina, as well as maintaining a healthy lifestyle.

Treatment prognosis

Unstable angina is an intermediate stage between a stable course of IHD and a complication. In the absence of adequate assistance, the percentage of myocardial infarction is high. However, with timely hospitalization and initiated qualified treatment, the prognosis can be favorable.

How to protect your heart - video

Compliance with the recommendations of the doctor, timely diagnosis and reception of prolonged nitrates can delay repeated attacks, and in most cases, prevent a heart attack. The role of prevention of this disease is also increasing: the fight against risk factors for atherosclerosis, good nutrition, sports at any age.

Eleonora Verkhovskaya
2017-10-02 05:56:56
Useful article, few people think about their health.

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