First aid for coronary disease. Help with coronary heart disease

In a feverish state, the patient feels weakness, muscle pain, headaches, and rapid heartbeat; he throws himself either cold or hot with severe sweating.

Very high fever may be accompanied by loss of consciousness and seizures. When the body temperature is high, a so-called febrile state occurs. By increasing the temperature, the body reacts to various infectious diseases, inflammatory processes, acute diseases of various organs, allergic reactions, etc.

In febrile conditions, a distinction is made between low-grade temperature (not higher than 38°C), high temperature (38–39°C), and very high temperature (above 39°C) – fever.

Provide the patient with rest and bed rest;

In extreme heat, wipe the patient with a napkin soaked in lukewarm water or vodka;

Call the local physician of the clinic to the patient, who will determine further treatment;

In case of severe fever (with convulsions, loss of consciousness, etc.), call emergency medical assistance.

Cardiac ischemia

Coronary heart disease (CHD, coronary heart disease) is considered as ischemic damage to the myocardium due to oxygen deficiency due to inadequate perfusion.

a) sudden coronary death;

b) angina pectoris:

Angina pectoris;

Stable angina pectoris;

Progressive angina pectoris;

Spontaneous (special) angina;

c) myocardial infarction:

Large-focal (transmural, Q-infarction);

Small focal (not Q-infarction);

d) post-infarction cardiosclerosis;

e) heart rhythm disturbances;

e) heart failure.

In the 1980s The concept of “risk factors” for cardiovascular diseases associated with atherosclerosis has received the most recognition. Risk factors are not necessarily etiological. They may influence the development and course of atherosclerosis or may not have their effect.

Atherosclerosis – this is a polyetiological disease of arteries of the elastic and muscular-elastic type (large and medium caliber), manifested by the infiltration of atherogenic lipoproteins into the vessel wall

with the subsequent development of connective tissue, atheromatous plaques and organ circulatory disorders.

Risk factors for cardiovascular diseases can be divided into two groups: manageable and uncontrollable.

Uncontrollable risk factors:

Age (men > 45 years, women > 55 years);

Male gender;

Hereditary predisposition.

Controllable risk factors:

Smoking;

Arterial hypertension;

Obesity;

Physical inactivity;

Negative emotions, stress;

Hypscholistrinsmia (LDL cholesterol > 4.1 mmol/l, as well as reduced HDL cholesterol levels< 0,9).

Angina pectoris paroxysmal pain in the chest (compression, squeezing, unpleasant sensation). The basis for the occurrence of an attack of angina pectoris is hypoxia (ischemia) of the myocardium, which develops in conditions when the amount of blood flowing through the coronary arteries to the working muscle of the heart becomes insufficient, and the myocardium suddenly experiences oxygen starvation.

The main clinical symptom of the disease is pain localized in the center of the sternum (retrosternal pain), less often in the heart. The nature of the pain varies; many patients feel pressure, squeezing, burning, heaviness, and sometimes cutting or sharp pain. The pain is unusually intense and is often accompanied by a feeling of fear of death.

Irradiation of pain during angina pectoris is characteristic and very important for diagnosis: to the left shoulder, left arm, left half of the neck and head, lower jaw, interscapular space, and sometimes to the right side or upper abdomen.

Pain occurs under certain conditions: when walking, especially fast, and other physical activities (during physical stress, the heart muscle needs a greater supply of nutrients from the blood, which narrowed arteries cannot provide with atherosclerotic lesions).

The patient must stop, and then the pain stops. Particularly typical for angina is the appearance of pain after the patient leaves a warm room into the cold, which is more often observed in autumn and winter, especially when the atmospheric pressure changes.

When there is excitement, pain appears even without connection with physical stress. Attacks of pain can occur at night, the patient wakes up from sharp pains, sits up in bed with a feeling of not only sharp pain, but also with the fear of death.

Sometimes chest pain with angina is accompanied by headache, dizziness, and vomiting.

Angina pectoris – these are transient attacks of pain (compression, squeezing, discomfort) in the chest, at the height of physical or emotional stress due to increased metabolic needs of the myocardium (tachycardia, increased blood pressure). The duration of the attack is often 5–10 minutes.

New-onset angina appears as a separate form within 4 weeks, and in elderly patients - within 6 weeks. She is classified as an unstable condition.

Angina pectoris is stable. After a certain period of adaptation (1–2 months), a functional restructuring of the coronary circulation occurs, and angina becomes stable with a constant ischemic threshold. The level of stress that causes an angina attack is the most important criterion in determining the severity of coronary disease.

Progressive angina pectoris is a sudden change in the nature of the clinical manifestations of angina pectoris, the usual pattern of pain under the influence of physical or emotional stress. In this case, there is an increase in frequency and severity of attacks, a decrease in tolerance to stress, and a decrease in the effect of taking nitroglycerin. Progressive angina is considered one of the severe types of unstable angina (10–15% of cases end in myocardial infarction).

Among all the variants of unstable angina, the most dangerous is the one that progresses rapidly within hours and the first days from the onset of progression. Such cases are referred to as acute coronary syndrome, and patients are subject to emergency hospitalization.

Spontaneous (special) angina – attacks of pain in the chest (tightness, compression) that occur at rest, against the background of a constant myocardial need for oxygen (without an increase in heart rate and without an increase in blood pressure).

Criteria for diagnosing spontaneous angina:

a) angina attacks usually occur at rest at the same time (early morning hours);

b) elevation (total ischemia) or depression of the ST segment on the ECG recorded during an attack;

c) angiographic examination reveals unchanged or slightly changed coronary arteries;

d) administration of ergonovine (ergometrine) or acetylcholine reproduces changes on the ECG;

e) p-blockers increase spasm and have a pro-ischemic effect (worsen the clinical situation).

Treatment of angina and other forms of coronary heart disease is carried out in four main areas:

1) improving oxygen delivery to the myocardium;

2) decreased myocardial oxygen demand;

3) improvement of the rheological properties of blood;

4) improvement of metabolism in the heart muscle.

The first direction is more successfully implemented using surgical treatment methods. Subsequent directions are due to drug therapy.

Among the large number of drugs used to treat angina, the main group stands out - antianginal drugs: nitrates, beta blockers and calcium antagonists.

Nitrates increase ventricular stroke volume, reduce platelet aggregation and improve microcirculation in the heart muscle. Among them, the following drugs can be distinguished: nitroglycerin (nitromint), sustak, nitrong, nitromac, nitroglaurong, isosorbide dinitrate (cardiquet, cardiquet-retard, isomac, isomac-retard, nitrosorbide, etc.), isosorbide 5-mononitrate (efox, efox -long, monomac-depot, olicard-retard, etc.). In order to improve microcirculation in the heart muscle, molsidomine (Corvaton) is prescribed.

Beta blockers provide an antianginal effect, reducing the energy expenditure of the heart by reducing the heart rate, reducing blood pressure, negative inotron effect and inhibition of platelet aggregation. Thus, the myocardium's need for oxygen is reduced. Among this large group of drugs, the following have recently been used:

a) non-selective - propranolol (Anaprilin, Obzidan), sotalol (Sotakor), nadolol (Korgard), timolol (Blocarden), alprepalol (Antin), oxpreialol (Trazicor), pindolol (Wisken);

b) cardioselective - atenalol (Tenormin), metoprolol (Egilok), talinolol (Cordanum), acebutalol (Sectral), celiprolol;

c) β-blockers – labetalol (trandate), medroxalol, carvedilol, nebivolol (nebilet), celiprolol.

Calcium antagonists inhibit the influx of calcium ions into the body, reduce the inotropic function of the myocardium, promote cardiodilation, reduce blood pressure and heart rate, inhibit platelet aggregation, and have antioxidant and antiarrhythmic properties.

These include: verapamil (isoptin, finoptin), diltiazem (cardil, dilzem), nifedipine (kordaflex), nifedipine-retard (kordaflsks-retard), amlodipine (normodipine, cardilopia).

Primary prevention of cardiovascular disease focuses on reducing atherogenic lipid levels through lifestyle changes. This includes limiting the consumption of animal fats, reducing body weight, and exercising.

High serum cholesterol levels can be corrected with diet. It is recommended to limit the consumption of animal fats and include in the diet foods containing polyunsaturated fatty acids (vegetable oils, fish oil, nuts). The diet should also include vitamins (fruits, vegetables), mineral salts and trace elements. To normalize intestinal function, it is necessary to add dietary fiber to food (products made from wheat bran, oats, soy, etc.).

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Arrhythmias. A person usually does not feel his heart beating, and the appearance of arrhythmias is perceived as an interruption in his work.

Arrhythmia is a disturbance in the rhythm of cardiac activity caused by the pathology of the formation of excitation impulses and their conduction through the myocardium. Failure of the heart rhythm can be caused by psycho-emotional arousal, disorders in the endocrine and nervous systems. Once arrhythmias occur, they often recur, so timely treatment is extremely important.

Based on the nature of manifestation and development mechanisms, several types of arrhythmias are distinguished. Emergency care is primarily required for paroxysmal tachycardia, which is possible both in young and elderly people. The attack begins suddenly with a feeling of a strong push in the chest, pancreas, a “blow” in the heart, followed by severe palpitations, short-term dizziness, “darkening in the eyes” and a feeling of tightness in the chest.

Paroxysmal tachycardia usually develops as a result of acute coronary insufficiency and myocardial infarction, and the attack is often accompanied by pain in the chest or in the heart area. There are several forms of paroxysmal tachycardia. A routine medical examination of patients does not always allow them to be differentiated; this can only be done by electrocardiological examination.

Symptoms At the time of the attack, the pulsation of the patient’s neck veins attracts attention. The skin and mucous membranes are pale, slightly bluish. With a prolonged attack, the cyanosis intensifies. The number of heart contractions increases to 140-200 times per minute, the filling of the pulse is weaker. Blood pressure can be low, normal or high.

First aid. Any form of paroxysmal tachycardia requires emergency medical care.

Before the doctor arrives, you should lay the patient down, and then use reflex techniques on the heart:

a) moderate (not painful) pressure with the ends of the thumbs on the eyeballs for 20 seconds;

b) pressing, also for 20 seconds, on the area of the carotid sinus (neck muscles above the collarbones);

c) voluntary holding of breath;

d) taking antiarrhythmic drugs that previously relieved attacks (procainamide, lidocaine, isoptin, obzidan).

Complete atrioventricular block- disruption of the conduction of impulses from the atrium to the ventricles, resulting in their uncoordinated contractions. The causes of the disease are myocardial infarction, atherosclerosis of the heart vessels.

Symptoms Dizziness, darkening of the eyes, severe pallor of the skin, sometimes fainting and convulsions. Rare pulse - up to 30-40 beats per minute. A further decrease in heart rate leads to death.

First aid. Providing the patient with complete rest. Oxygen therapy (oxygen cushion, oxygen inhaler, if they are not available, provide access to fresh air). An ambulance is urgently called. If the condition worsens, the first aid provider performs mouth-to-mouth artificial respiration and closed heart massage. Admission to the cardiac intensive care unit or intensive care unit of the cardiac department. Transportation on a stretcher in a lying position. Definitive treatment is carried out successfully in the cardiology departments of hospitals, where modern antiarrhythmic drugs, methods of electrical pulse therapy and cardiac pacing are used.

In the prevention of arrhythmias, timely treatment of heart disease, annual preventive examinations and clinical observation are important. Physical hardening, an optimal regime of work and rest, and balanced nutrition are necessary.

Hypertensive crises- acute increase in blood pressure, accompanied by a number of neurovascular and autonomic disorders. Develops as a complication of hypertension.

What are the blood pressure standards for adults?

The World Health Organization suggests being guided by the following indicators: for people aged 20-65 years, systolic pressure ranges from 100-139 mmHg. Art. and diastolic - no more than 89 mm Hg. Art.

Systolic pressure is from 140 to 159 mmHg and diastolic pressure is from 90 to 94 mmHg. Art. are considered transitional. If the systolic blood pressure is 160 mm Hg. Art. and higher, and diastolic - 95 mm Hg. Art. this indicates the presence of a disease.

The difficulty of fighting arterial hypertension is that about 40 percent of patients do not know about their disease. And only 10 percent of those who know and are treated in a clinic manage to reduce their blood pressure to normal levels. Meanwhile, a sudden weakening of cardiac activity can cause excitation of the central nervous system, which, in turn, sharply increases blood pressure. This is why people suffering from high blood pressure often experience hypertensive crises.

Symptoms With arterial hypertension, severe headaches, dizziness, tinnitus, flashing “spots” before the eyes, nausea, vomiting, palpitations, slight trembling, chills, and the face becomes covered with red spots occur. Blood pressure is high - up to 220 mm Hg. Art. The pulse is frequent - 100-110 beats per minute. The crisis can last up to 6-8 hours and, in the absence of emergency medical care, can be complicated by an acute disorder of cerebral or coronary circulation, in some cases by pulmonary edema.

First aid. Call a doctor urgently. Before his arrival, provide the patient with complete rest. The position of the victim is half-sitting. To lower blood pressure, previously prescribed antihypertensive (pressure-reducing) drugs are used: reserpine, dopegit, isobarine, tazepam, etc. Heating pads for the feet.

Prevention. The earliest possible detection and treatment of hypertension. Patients with high blood pressure are required to regularly take antihypertensive medications prescribed by their doctor. They should decisively give up smoking and drinking alcohol, and avoid psycho-emotional overload. It should also be taken into account that most patients are negatively affected by night shift work and its fast pace, forced body position, frequent bending and lifting, very high and very low temperatures, and food with limited fluid and salt.

Cardiac ischemia- one of the most common diseases today, which is based on poor circulation of the heart muscle. In a healthy person, there is complete harmony between the myocardial need for oxygen and the blood supply to the heart; the disease develops when this harmony is disturbed. Most often it occurs in people with so-called risk factors - smokers, leading a sedentary lifestyle, abusing alcohol, being overweight, suffering from hypertension. In older people, in addition, the disease is associated with sclerosis of the coronary vessels. Many experts pay attention to the prevalence of coronary disease also among people with certain character traits and lifestyles, for example, those who are characterized by dissatisfaction with what they have achieved, prolonged work overload, and chronic lack of time.

Clinically, coronary heart disease manifests itself most often in the form of myocardial infarction and angina.

Myocardial infarction- necrosis of a section of the heart muscle due to blockage of a coronary vessel by a thrombus. The main cause of the disease is atherosclerosis (chronic artery disease leading to narrowing of the lumen of the vessel). In addition, metabolic disorders, strong nervous excitement, alcohol abuse, and smoking play a large role in the occurrence of heart attacks.

Heart attacks claim thousands of lives every year; Even more people are deprived of the opportunity to work fully for a long time.

Symptoms The disease begins with acute chest pain, which becomes protracted and is not relieved by either validol or nitroglycerin. (Painless forms of myocardial infarction are often observed.)

The pain radiates to the shoulder, neck, and lower jaw. In severe cases, a feeling of fear arises. Cardiogenic shock develops (characterized by cold sweat, pale skin, adynamia, low blood pressure), shortness of breath. The heart rhythm is disturbed, the pulse is rapid or slow.

First aid. Call a doctor urgently. The patient is provided with complete physical and mental rest and measures are taken to relieve pain (nitroglycerin under the tongue, mustard plasters on the heart area, oxygen inhalation).

In the acute stage of myocardial infarction, clinical death may occur.

Since its main symptoms are cardiac and respiratory arrest, resuscitation measures should be aimed at maintaining respiratory and circulatory function using artificial lung ventilation and closed cardiac massage. Let us recall the technique for performing them.

Artificial ventilation. The patient is placed on his back. The mouth and nose are covered with a scarf. The person providing assistance kneels down, supports the patient with one hand, places the other on his forehead and tilts his head back as much as possible; takes a deep breath, tightly pinches the victim's nose, and then presses your lips to his lips and forcefully blows air into the lungs until the chest begins to rise. 16 such injections are performed per minute.

Closed heart massage. After one injection, 4-5 pressures are applied. To do this, feel the lower end of the sternum, place the left palm two fingers above it, and the right palm on it, and rhythmically squeeze the chest, making 60-70 pressures per minute.

Resuscitation measures are carried out until a pulse appears and spontaneous breathing or until an ambulance arrives.

Angina pectoris occurs as a result of spasm of the coronary arteries, the causes of which may be atherosclerosis of the heart vessels, excessive mental and physical stress.

Symptoms Severe attack of chest pain radiating to the shoulder blade, left shoulder, half of the neck. The patient's breathing is difficult, the pulse is rapid, the face is pale, and sticky cold sweat appears on the forehead. The duration of the attack is up to 10 - 15 minutes. Prolonged angina often develops into myocardial infarction.

First aid. Call a doctor urgently. The patient is provided with complete physical and mental rest. To relieve pain, they resort to nitroglycerin or validol (one tablet at an interval of 5 minutes). Give oxygen inhalation. On the heart area - mustard plasters.

Prevention of coronary heart disease. Knowledge of risk factors is the basis for its prevention. The nutritional regime plays an important role - limiting the caloric content of food, excluding alcoholic beverages. It is recommended to eat four meals a day, including vegetables, fruits, cottage cheese, lean meat, and fish. If you are overweight, a diet prescribed by your doctor is indicated. Physical exercise, walks, and hiking are required. You need to resolutely quit smoking. Rational organization of work, instilling tact and respect for each other are also important means of prevention. We should not forget about the timely treatment of chronic cardiovascular diseases (heart defects, rheumatism, myocarditis, hypertension) leading to coronary heart disease.

Tags: Heart disease, arrhythmia, complete atrioventricular block, blood pressure, myocardial infarction, coronary heart disease, angina pectoris, first aid, prevention

Possession of knowledge about life-threatening situations and ways to overcome them often becomes life-saving for a person who finds himself on the brink of life and death. Such situations undoubtedly include a heart attack called acute coronary heart disease. What is the danger of this situation, how to provide assistance to a person with an acute attack of IHD?

Cardiac (oxygen starvation) develops due to insufficient oxygen supply to the myocardium caused by impaired coronary circulation and other functional pathologies of the heart muscle.

The disease can occur in acute and chronic forms, and the second can be asymptomatic for years. The same cannot be said about acute coronary heart disease. This condition is characterized by a sudden deterioration or even cessation of coronary circulation, which is why death is often the outcome of acute coronary heart disease.

The most characteristic signs of acute ischemia:

severe compressive pain along the left edge or in the center of the sternum, radiating (radiating) under the shoulder blade, into the arm, shoulder, neck or jaw;
lack of air, ;
rapid or increased pulse, feeling of irregular heartbeats;
excessive sweating, cold sweat;
dizziness, fainting or loss of consciousness;
change in complexion to an earthy tone;
general weakness, nausea, sometimes turning into vomiting, which does not bring relief.

The occurrence of pain is usually associated with increased physical activity or emotional stress.

However, this symptom, which most characteristically reflects the clinical picture, does not always appear. And all of the above symptoms rarely occur simultaneously, but appear singly or in groups, depending on the clinical condition. This often complicates diagnosis and prevents timely provision of first aid for ischemic heart disease. Meanwhile, acute ischemia requires immediate measures to save a person’s life.

Consequences of coronary heart disease

Why is an attack of cardiac ischemia dangerous?

What threatens a person with acute coronary heart disease? There are several ways to develop the acute form of IHD. Due to spontaneously occurring deterioration of blood supply to the myocardium, the following conditions are possible:

unstable angina;
myocardial infarction;
sudden coronary (cardiac) death (SCD).

This entire group of conditions is included in the definition of “acute coronary syndrome,” which combines different clinical forms of acute ischemia. Let's look at the most dangerous of them.

A heart attack occurs due to narrowing of the lumen (due to atherosclerotic plaques) in the coronary artery that supplies the myocardium with blood. Myocardial hemodynamics are disrupted to such an extent that the decrease in blood supply becomes uncompensated. Next, a violation of the metabolic process and the contractile function of the myocardium occurs.

With ischemia, these disorders can be reversible when the duration of the lesion stage is 4–7 hours. If the damage is irreversible, necrosis (death) of the affected area of the heart muscle occurs.

In the reversible form, necrotic areas are replaced by scar tissue 7–14 days after the attack.

There are also dangers associated with complications of a heart attack:

cardiogenic shock, serious cardiac arrhythmia, pulmonary edema due to acute heart failure - in the acute period;
thromboembolism, chronic heart failure - after scar formation.

Sudden coronary death

Primary cardiac arrest (or sudden cardiac death) is provoked by electrical instability of the myocardium. The absence or failure of resuscitation allows us to attribute cardiac arrest to SCD, which occurred instantly or within 6 hours from the onset of the attack. This is one of the frequent cases when the outcome of acute coronary heart disease is death.

Special hazards

The precursors of acute ischemic heart disease are frequent hypertensive crises, diabetes mellitus, pulmonary congestion, bad habits and other pathologies that affect the metabolism of the heart muscle. Often, a week before an attack of acute ischemia, a person complains of pain in the chest and fatigue.

Particular attention should be paid to the so-called atypical signs of myocardial infarction, which complicate its diagnosis, thereby preventing the provision of first aid for coronary heart disease.

You should pay attention to atypical forms of infarction:

asthmatic - when symptoms manifest themselves in the form of worsening shortness of breath and are similar to an attack of bronchial asthma;
painless - a form characteristic of patients with diabetes mellitus;
abdominal - when symptoms (bloating and abdominal pain, hiccups, nausea, vomiting) can be mistaken for manifestations of acute pancreatitis or (even worse) poisoning; in the second case, a patient who needs rest can be given a “proper” gastric lavage, which will certainly kill the person;
peripheral - when pain areas are localized in areas distant from the heart, such as the lower jaw, thoracic and cervical spine, the edge of the left little finger, the throat area, the left arm;
collaptoid - the attack occurs in the form of collapse, severe hypotension, darkness in the eyes, the appearance of “sticky” sweat, dizziness as a result of cardiogenic shock;
cerebral - signs resemble neurological symptoms with a disorder of consciousness and understanding of what is happening;
edematous - acute ischemia is manifested by the appearance of edema (up to ascites), weakness, shortness of breath, enlarged liver, which is characteristic of right ventricular failure.

Combined types of acute ischemic heart disease are also known, combining the features of different atypical forms.

First aid for myocardial infarction

First aid

Only a specialist can determine the presence of a heart attack. However, if a person exhibits any of the symptoms discussed above, especially those that occur after excessive physical exertion, hypertensive crisis or emotional stress, it is possible to suspect acute coronary heart disease and provide first aid. What is it?

The patient should be seated (preferably in a chair with a comfortable back or reclining with legs bent at the knees), freed from tight or constricting clothing - a tie, bra, etc.
If a person has taken medications previously prescribed by a doctor (such as Nitroglycerin), they should be given to the patient.
If taking the medicine and sitting quietly for 3 minutes does not bring relief, you should immediately call an ambulance, despite the patient’s heroic statements that everything will go away on its own.
If there are no allergic reactions to Aspirin, give the patient 300 mg of this medicine, and Aspirin tablets should be chewed (or crushed into powder) to speed up the effect.
If necessary (if the ambulance is not able to arrive on time), you should take the patient to the hospital yourself, monitoring his condition.

According to the 2010 European Resuscitation Council guidelines, lack of consciousness and breathing (or agonal convulsions) are indications for cardiopulmonary resuscitation (CPR).

Medical emergency care usually includes a group of measures:

CPR to maintain airway patency;
oxygen therapy - forced supply of oxygen into the respiratory tract to saturate the blood with it;
indirect cardiac massage to maintain blood circulation when the organ stops;
electrical defibrillation, stimulating myocardial muscle fibers;
drug therapy in the form of intramuscular and intravenous administration of vasodilators, anti-ischemic drugs - beta-blockers, calcium antagonists, antiplatelet agents, nitrates and other drugs.

Is it possible to save a person?

What are the prognosis for an attack of acute coronary heart disease? Is it possible to save a person? The outcome of an attack of acute ischemic heart disease depends on many factors:

clinical form of the disease;
concomitant diseases of the patient (for example, diabetes, hypertension, bronchial asthma);
timely and qualified first aid.

The most difficult to resuscitate are patients with a clinical form of coronary artery disease called SCD (sudden cardiac or coronary death). As a rule, in this situation, death occurs within 5 minutes after the onset of the attack. Although it is theoretically believed that if resuscitation measures are carried out within these 5 minutes, the person will be able to survive. But such cases are almost unknown in medical practice.

With the development of another form of acute ischemia - myocardial infarction - the procedures described in the previous section may be useful. The main thing is to provide the person with peace, call an ambulance and try to relieve the pain with cardiac medications at hand (Nitroglycerin, Validol). If possible, provide the patient with an influx of oxygen. These simple measures will help him wait for the doctors to arrive.

According to cardiologists, it is possible to avoid the worst-case scenario only if you pay close attention to your own health - leading a healthy lifestyle with feasible physical activity, giving up harmful addictions and habits, including regular preventive examinations to detect pathologies in the early stages.

Useful video

How to provide first aid for myocardial infarction - see the following video:

Conclusion

Acute ischemic heart disease is an extremely dangerous type of cardiac ischemia.
In some clinical forms, emergency measures for acute cardiac ischemia may be ineffective.
An attack of acute ischemic heart disease requires calling an ambulance and ensuring the patient rest and taking heart medications.

CARDIAC ISCHEMIA.

Cardiac ischemia (IHD) is a chronic heart disease caused by impaired blood supply to the heart muscle to one degree or another due to damage to the coronary vessels that supply the heart muscle with blood.
Therefore, coronary artery disease is also called coronary heart disease.

At the core Coronary heart disease lies the deposition of atherosclerotic plaques in the walls of the coronary arteries, which narrow the lumen of the vessel. Plaques gradually reduce the lumen of the arteries, which leads to insufficient nutrition of the heart muscle.
The process of formation of atherosclerotic plaques is called. The speed of its development is different and depends on many factors.
The coronary arteries play a crucial role in the functioning of the heart muscle. The blood flowing through them brings oxygen and nutrients to all the cells of the heart. If the arteries of the heart are affected by atherosclerosis, then in conditions when there is an increased need for oxygen in the heart muscle (physical or emotional stress), a state of myocardial ischemia may appear - insufficient blood supply to the heart muscle. As a result, coronary heart disease can lead to the development of angina pectoris and myocardial infarction.
Thus, Angina pectoris This is not an independent disease, it is a symptom Coronary heart disease. This condition is called "angina pectoris".

Thus, IHD is an acute or chronic myocardial disease caused by a decrease and cessation of blood flow to the myocardium as a result of damage to the coronary vessels.

IHD has several forms.

Angina pectoris
Myocardial infarction
Chronic heart failure.

Classification IHD according to WHO (70s).

SUDDEN STOP OF BLOOD CIRCULATION(primary), which occurred before the provision of medical care.
ANGINA
MYOCARDIAL INFARCTION (MI)
NON-SPECIFIC MANIFESTATIONS – this is (CH) and
Development Heart Failure speaks of the emergence of a new disease --- the so-called. those. growth of connective tissue in the heart muscle.

ANGINA.

Angina pectoris (angina pectoris) --- a disease characterized by attacks of severe pain and a feeling of compression behind the sternum or in the heart area. The immediate cause of an angina attack is a decrease in the blood supply to the heart muscle.

Clinical symptoms of angina pectoris.

Angina is characterized by sensations of compression, heaviness, fullness, and burning behind the sternum that occur during physical activity. The pain can spread to the left arm, under the left shoulder blade, and into the neck. Less commonly, the pain radiates to the lower jaw, the right half of the chest, the right arm, and the upper abdomen.
The duration of an angina attack is usually several minutes. Since pain in the heart area often occurs when moving, a person is forced to stop; after several minutes of rest, the pain usually goes away.
A painful attack during angina pectoris lasts more than one, but less than 15 minutes. The onset of pain is sudden, immediately at the height of physical activity. Most often, such a load is walking, especially in cold winds, after a heavy meal, or when climbing stairs.
The end of pain, as a rule, occurs immediately after a decrease or complete cessation of physical activity or 2-3 minutes after taking Nitroglycerin under the tongue.

Symptoms associated with myocardial ischemia are a feeling of lack of air, difficulty breathing. Shortness of breath occurs under the same conditions as chest pain.
Angina pectoris in men usually manifests itself as typical attacks of chest pain.
Women, elderly people and patients with diabetes mellitus during myocardial ischemia may not experience any pain, but feel rapid heartbeat, weakness, dizziness, nausea, and increased sweating.
Some people with coronary artery disease experience no symptoms at all during myocardial ischemia (and even myocardial infarction). This phenomenon is called painless, “silent” ischemia.
Pain in the heart area not associated with coronary insufficiency-- This cardialgia.

Risk of developing angina.

Risk factors – these are features that contribute to the development, progression and manifestation of the disease.
Many risk factors play a role in the development of angina. Some of them can be influenced, others cannot, that is, factors can be removable or irremovable.

Unavoidable risk factors - these are age, gender, race and heredity.
Men are more susceptible to developing angina than women. This trend continues until approximately 50–55 years of age, that is, until the onset of menopause in women. After 55 years, the incidence of angina in men and women is approximately the same. Black Africans rarely suffer from atherosclerosis.
Eliminated reasons.
- Smoking – one of the most important factors in the development of angina pectoris. Smoking is highly likely to contribute to the development of coronary artery disease, especially if combined with an increase in total cholesterol levels. On average, smoking shortens life by 7 years. Smokers also have higher levels of carbon monoxide in their blood, which reduces the amount of oxygen that can reach the body's cells. In addition, the nicotine contained in tobacco smoke leads to spasm of the arteries, thereby leading to an increase in blood pressure.
- An important risk factor for angina isdiabetes. In the presence of diabetes, the risk of angina and coronary artery disease increases on average by more than 2 times.
- Emotional stress may play a role in the development of angina, myocardial infarction or lead to sudden death. With chronic stress, the heart begins to work with increased load, blood pressure rises, and the delivery of oxygen and nutrients to organs deteriorates.
- Physical inactivity or lack of physical activity. It represents another removable factor.
- is well known as a risk factor for angina pectoris and coronary artery disease. Hypertrophy (increase in size) of the left ventricle asa consequence of arterial hypertension is an independent strong predictor of mortality from coronary disease.
- Increased blood clotting , may lead to thrombosis.

VARIETIES OF ANGINA.

There are several types of angina:

Angina pectoris .

Stable angina, which includes 4 functional classes depending on the load to be tolerated.
Unstable angina, the stability or instability of angina is determined by the presence or absence of a connection between the load and the manifestation of angina
Progressive angina. The attacks become increasingly intense.

Angina at rest.

Variant angina, or Prinzmetal's angina. This type of angina is also called vasospastic. This is a vasospasm that occurs in a patient who does not have damage to the coronary arteries; there may be 1 affected artery.
Since the basis is a spasm, the attacks do not depend on physical activity and occur more often at night (n.vagus). Patients wake up and may have a series of attacks every 5-10-15 minutes. During the interictal period the patient feels normal.
The ECG outside the attack is normal. During an attack, the pattern of any of these attacks can lead to myocardial infarction.
X – form of Angina. It develops in people as a result of spasm of capillaries and small arterioles. Rarely leads to a heart attack, develops in neurotics (more in women).

Stable angina.

It is believed that for angina to occur, the arteries of the heart must be narrowed by 50 - 75% due to atherosclerosis. If treatment is not carried out, then atherosclerosis progresses, plaques on the walls of the arteries are damaged. Blood clots form on them, the lumen of the vessel narrows even more, blood flow slows down, and angina attacks become more frequent and occur with light physical activity and even at rest..

Stable angina (tension) is usually divided depending on severity to Functional Classes:

I functional class– attacks of chest pain occur quite rarely. Pain occurs with unusually large, rapidly performed loads YU
II functional class– attacks develop when quickly climbing stairs, walking quickly, especially in frosty weather, in a cold wind, sometimes after eating.
III functional class– pronounced limitation of physical activity, attacks appear during normal walking up to 100 meters, sometimes immediately when going outside in cold weather, when climbing to the first floor, they can be provoked by excitement.
VI functional class– there is a sharp restriction of physical activity, the patient becomes unable to perform any physical work without developing angina attacks; It is characteristic that attacks of angina pectoris at rest can develop without previous physical and emotional stress.

Identification of functional classes allows the attending physician to correctly select medications and the amount of physical activity in each specific case.

Unstable angina.

If habitual angina changes its behavior, it is called unstable or pre-infarction condition. Unstable angina refers to the following conditions:
New angina in life no more than one month old;

Progressive angina, when there is a sudden increase in the frequency, severity or duration of attacks, the appearance of nocturnal attacks;
Angina at rest- the appearance of angina attacks at rest;
Post-infarction angina- the appearance of angina at rest in the early post-infarction period (10-14 days after the onset of myocardial infarction).

In any case, unstable angina is an absolute indication for admission to the intensive care unit.

Variant angina.

Symptoms of variant angina occur as a result of sudden contraction (spasm) of the coronary arteries. Therefore, doctors call this type of angina vasospastic angina.
With this angina, the coronary arteries may be affected by atherosclerotic plaques, but sometimes there are none.
Variant angina occurs at rest, at night or in the early morning. Duration of symptoms is 2/5 minutes, helps well Nitroglycerin and calcium channel blockers,nifedipine.

Laboratory research.
The minimum list of biochemical parameters for suspected coronary heart disease and angina pectoris includes determination of the content in the blood:

total cholesterol;
high density lipoprotein cholesterol;
low-density lipoprotein cholesterol;
triglycerides;
hemoglobin
glucose;
AST and ALT.

The main instrumental methods for diagnosing stable angina include the following studies:

electrocardiography,
exercise test (bicycle ergometry, treadmill),
echocardiography,
coronary angiography.

If it is impossible to carry out a test with physical activity, as well as to identify the so-called non-painful ischemia and variant angina, it is recommended to carry out daily (Holter) ECG monitoring.

Differential diagnosis.
It should be remembered that chest pain can occur not only with angina, but also with many other diseases. In addition, there may be several causes of chest pain at the same time.
Angina pectoris may be disguised as:

Myocardial infarction;
Diseases of the gastrointestinal tract (peptic ulcer, diseases of the esophagus);
Diseases of the chest and spine (osteochondrosis of the thoracic spine, herpes zoster);
Lung diseases (pneumonia, pleurisy).

Typical angina:
Retrosternal ---- pain or discomfort characteristic quality and duration
Occurs during physical activity or emotional stress
It goes away with rest or after taking nitroglycerin.

Atypical angina:
Two of the above signs. Non-cardiac pain. One or none of the above symptoms.

Prevention of angina pectoris.
Methods for preventing angina pectoris are similar to preventing coronary heart disease,

EMERGENCY CARE FOR ANGINA!

An ambulance should be called if this is the first attack of angina pectoris in your life, as well as if: chest pain or its equivalent intensifies or lasts more than 5 minutes, especially if all this is accompanied by deterioration in breathing, weakness, vomiting; the chest pain did not stop or intensified within 5 minutes after dissolving 1 tablet of nitroglycerin.

Help with pain before the ambulance arrives for angina pectoris!

Make the patient sit comfortably with his legs down, reassure him and do not allow him to get up.
Let me chew it 1/2 or 1 large tablet aspirin(250-500 mg).
To relieve pain, give nitroglycerine 1 tablet under the tongue or nitrolingual, isoket in an aerosol package (one dose under the tongue, without inhalation). If there is no effect, use these drugs again. Nitroglycerin tablets can be reused at intervals of 3 minutes, aerosol preparations at intervals of 1 minute.You can reuse the drugs no more than three times due to the risk of a sharp decrease in blood pressure.
Often a sip of cognac helps relieve spasms, which you need to hold in your mouth for 1-2 minutes before swallowing.

TREATMENT IHD and STENOCARDIA.

Drug therapy.

1. Drugs that improve prognosis (recommended for all patients with angina pectoris in the absence of contraindications):

This Antiplatelet drugs (Acetylsalicylic acid, Clopidogrel). They prevent platelet aggregation, that is, they prevent thrombus formation at its earliest stage.
Long-term regular use of acetylsalicylic acid (aspirin) by patients with angina pectoris, especially those who have had myocardial infarction, reduces the risk of developing a second heart attack is on average 30%.
This Beta blockers By blocking the effects of stress hormones on the heart muscle, they reduce the myocardial oxygen demand, thereby balancing the imbalance between the myocardial oxygen demand and its delivery through the narrowed coronary arteries.
This Statins (Simvastatin, Atorvastatin and others). They reduce the level of total cholesterol and low-density lipoprotein cholesterol, reduce mortality from cardiovascular diseases and
This Angiotensin-converting enzyme inhibitors - ACE (Perindopril, Enalapril, Lisinopril and others). Taking these drugs significantly reduces the risk of death from cardiovascular disease, as well as the likelihood of developing heart failure. ACE inhibitors should not be prescribed for 1st type.

2. Antianginal (anti-ischemic) therapy , aimed at reducing the frequency and intensity of angina attacks:

This Beta blockers (Metaprolol, Atenolol, Bisaprolol and others). Taking these drugs reduces heart rate, systolic blood pressure, cardiovascular response to exercise, and emotional stress. This leads to a decrease in myocardial oxygen consumption.
This Calcium antagonists (Verapamil, Diltiazem). They reduce oxygen consumption by the myocardium. However, they cannot be prescribed for sick sinus syndrome and atrioventricular conduction disorders.
This Nitrates (Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, Cardiket, Oligard, etc.). They expand (dilate) the veins, thereby reducing the preload on the heart and, as a consequence, the myocardium’s need for oxygen. Nitrates eliminate spasm of the coronary arteries. Since nitrates can cause headaches, especially at the beginning of treatment, small doses of caffeine should be taken simultaneously (it dilates brain vessels, improves outflow, prevents stroke; 0.01-0.05 g simultaneously with nitrate).
This Cytoprotectors (Preductal).It normalizes myocardial metabolism and does not dilate coronary vessels. Drug of choice for X-form angina. Do not prescribe for more than 1 month.

Coronary artery bypass grafting.

Coronary artery bypass grafting is a surgical intervention performed to restore blood supply to the myocardium below the site of atherosclerotic narrowing of the vessel. This creates a different path for blood flow (shunt) to the area of the heart muscle whose blood supply has been disrupted.

Surgical intervention is performed in case of severe angina (III-IV functional class) and narrowing of the lumen of the coronary arteries > 70% (according to the results of coronary angiography). The main coronary arteries and their large branches are subject to bypass surgery. Previous myocardial infarction is not a contraindication to this operation. The extent of the operation is determined by the number of affected arteries supplying blood to the viable myocardium. As a result of the operation, blood flow should be restored in all areas of the myocardium where blood circulation is impaired. In 20-25% of patients who have undergone coronary artery bypass grafting, angina returns within 8-10 years. In these cases, the issue of reoperation is considered.

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Nursing process for ischemic heart diseaseand angina

Definition of the concept of "IHD". Clinical manifestations. Functional classes. Emergency care for an angina attack. Principles of diagnosis, treatment, prevention, rehabilitation. Using nursing models W. Henderson, D. Orem when caring for a patient.

The student must know:

· definition of the concept of “coronary heart disease” (CHD);

classification of ischemic heart disease;

· definition of the concept of “angina pectoris”;

· clinical manifestations of angina pectoris;

· possible patient problems;

· principles of providing first aid for angina pectoris;

· principles of diagnosis, treatment, prevention and rehabilitation.

Cardiac ischemia (IHD)-- acute or chronic damage to the heart, resulting from a decrease in blood supply to the myocardium as a result of atherosclerosis of the coronary arteries.

Clinical forms IHD:

Sh angina pectoris

Sh myocardial infarction,

Sh post-infarction cardiosclerosis,

Sh heart rhythm disturbances,

Sh heart failure,

Sh sudden coronary death.

The main cause of ischemic heart disease is atherosclerosis of the coronary arteries of the heart.

Risk factors

Smoking,

Arterial hypertension,

Hypercholesterolemia,

Sedentary lifestyle,

Obesity,

Diabetes,

Nervous stress, etc.

Myocardial ischemia develops when there is a discrepancy between the myocardial need for oxygen and its delivery (myocardial oxygen demand increases and coronary blood flow decreases).

Nursing process for angina pectoris

Angina pectoris -- clinical syndrome of coronary heart disease, characterized by paroxysmal pain of a compressive nature localized behind the sternum, radiating to the left arm, shoulder and accompanied by a feeling of fear and anxiety.

There is a disruption in the flow of blood through the coronary vessels that supply blood to the myocardium, which leads to pain in the heart area or behind the sternum.

Angina pectoris is a clinical reflection of acutely developing oxygen starvation (ischemia) of the myocardium.

Insufficient blood flow through the coronary arteries can be caused by:

Atherosclerotic plaques,

Spasm of the coronary arteries,

Myocardial overstrain under heavy physical and nervous stress.

Classification :

1. Angina pectoris

2. Angina at rest

An attack of angina is associated with physical or emotional stress, so with coronary heart disease we talk about angina pectoris in contrast to reflex angina.

Types of angina pectoris (according to modern international classification:

1) appeared for the first time;

2) stable (indicating the functional class - I, II, III, IV); 3) progressive;

4) spontaneous (special);

5) post-infarction early.

All types except stable, refer to unstable angina pectoris (with the risk of developing myocardial infarction) and require mandatory hospitalization.

Clinical picture : Complaints for paroxysmal pain of a compressive nature, localization of pain in the heart and behind the sternum, irradiation to the left half of the chest, left arm, lower jaw. Usually the pain begins in the upper part of the sternum or in the third, fourth, or fourth intercostal space. Patients feel squeezing, heaviness, and a burning sensation behind the sternum. During an attack, the patient feels a feeling of fear, freezes, afraid to move and pressing his fist to the heart area.

Attacks of pain most often occur during movement, physical or mental stress, due to increased smoking and cooling. Distinguish angina pectoris (pain occurs with movement, physical stress) and angina at rest (pain occurs at rest, during sleep).

Taking nitroglycerin usually stops the attack .

Body temperature remains normal.

Changes in the ECG are not observed or are not persistent, a downward shift of the S-T interval may be observed, and the T wave may become negative. With appropriate treatment, these indicators return to normal. The morphological composition of blood in patients with angina pectoris remains unchanged. Auscultation of the heart does not reveal any specific changes.

An attack of angina lasts 1-5 minutes . A longer attack should be considered as a possibility of myocardial infarction.

During an attack of angina, signs of transient ischemia may appear on the ECG, in the form of tall, pointed teeth T in many leads, or segment decrease ST (less often its rise). After stopping the angina attack, changes in the ECG disappear.

ischemic heart nursing angina

The course of the disease is wave-like - periods of remission alternate with periods of increased frequency of attacks.

Violation of the attack algorithm (an attack with a lower load is relieved with a larger dose of nitroglycerin) is typical for progressive angina pectoris. New-onset and progressive angina are collectively called -- unstable and dangerous, as they can be complicated by myocardial infarction. Patients with unstable angina should be hospitalized .

Treatment. During an attack of angina, pain must be relieved immediately. The patient is given drugs that dilate the coronary vessels of the heart: nitroglycerin under the tongue.

Care . The patient is provided with complete rest, an influx of fresh air, a heating pad is placed at the feet, mustard plasters are placed on the heart area, if there are no mustard plasters, sometimes lowering the left arm up to the elbow in hot water relieves the pain.

If after 3 minutes the pain has not stopped, repeat the use of nitroglycerin under the tongue. If the pain does not stop, call a doctor and administer an analgesic intravenously, and if the pain persists, it is necessary to administer a narcotic analgesic (Promedol), and the patient should have an ECG and decide on the issue of hospitalization with suspected myocardial infarction.

Drugs of three groups have a real effect in ischemic heart disease :

Nitrates (sustacmite, sustac-forte, nitrosorbide),

Calcium antagonists (nifedipine, verapamil, finoptin, etc.)

B-blockers (anaprilin, trazicor, cordanum, atenolol, etc.)

Antiplatelet agents are prescribed (acetylsalicylic acid, ticlid, chimes, etc.).

The patient takes all medications taking into account an individual approach, dose selection, and treatment effectiveness

For emotionally excitable persons, it is advisable to prescribe sedatives: Valocordin (Corvalol) 25-30 drops per dose, Seduxen 1 tablet 2 times a day. Antiatherosclerotic therapy is prescribed.

The general principles of treatment include measures to reduce blood pressure, rational diet therapy, and reducing the amount of fluid consumed. Physical therapy, systematic walks, and spa treatment play an important role in the treatment of angina pectoris.

Prevention . Primary prevention is to eliminate risk factors for coronary artery disease. Secondary-- in dispensary observation, prescribing, if necessary, anti-atherosclerotic, antiplatelet, coronary therapy.

In case of continuous, frequent (many times during the day and night), attacks caused by obliteration of the coronary arteries, surgical treatment is resorted to - coronary artery bypass grafting, etc.

Rehabilitation of patients with IHD . Rehabilitation for coronary artery disease is aimed at restoring the state of the cardiovascular system, strengthening the general condition of the body and preparing the body for previous physical activity.

Rehabilitation of coronary heart disease involves sanatorium-resort treatment. However, you should avoid traveling to resorts with a contrasting climate or during the cold season (sharp weather fluctuations are possible), because Patients with coronary heart disease have increased meteosensitivity.

The approved standard for the rehabilitation of coronary heart disease is the prescription of diet therapy, various baths (contrast, dry-air, radon, mineral), therapeutic showers, manual therapy, and massage. Exposure to sinusoidal modulated currents (SMC), diademic currents, and low-intensity laser radiation is also used. Electrosleep and reflexology are used.

The beneficial effects of climate help improve the functioning of the body's cardiovascular system. Mountain resorts are most suitable for the rehabilitation of coronary heart disease, because... Staying in conditions of natural hypoxia (low oxygen content in the air) trains the body, promotes the mobilization of protective factors, which increases the body’s overall resistance to oxygen deficiency.

But sunbathing and swimming in sea water should be strictly dosed, because... contribute to thrombus formation, increased blood pressure and stress on the heart.

Cardiac training can be carried out not only on specialized simulators, but also during walking along special routes (trails). The paths are designed in such a way that the effect is a combination of the length of the route, ascents, and number of stops. In addition, the surrounding nature has a beneficial effect on the body, which helps to relax and relieve psycho-emotional stress.

The use of various types of baths, exposure to currents (SMT, DDT), low-intensity laser radiation helps to excite nerve and muscle fibers, improve microcirculation in ischemic areas of the myocardium, and increase the pain threshold. In addition, treatments such as shock wave therapy and gravity therapy may be prescribed.

Rehabilitation of coronary heart disease using these methods is achieved through the growth of microvessels into the ischemic area, the development of a wide network of collateral vessels, which helps improve myocardial trophism and increase its stability in conditions of insufficient oxygen supply to the body (during physical and psycho-emotional stress).

An individual rehabilitation program for coronary heart disease is developed taking into account all the individual characteristics of the patient.

The basis of cardiac rehabilitation is :

· physical training program,

· educational programs,

· psychological correction,

· rational employment of patients.

Nursing process for coronary heart disease

Istage.Nursing examination . The nurse kindly, with great concern and tact, finds out the patient’s living conditions, his problems, complaints about violations of vital needs. Information about pain in the heart is collected in great detail: its nature, localization, irradiation, conditions of occurrence and relief. As a rule, heart pain is accompanied by other symptoms: headache, dizziness, shortness of breath, fever, weakness, etc.

These symptoms clarify the circumstances or consequences of heart disease, heart pain. An objective examination can reveal increased or decreased blood pressure, weakness or tension of the pulse, cyanosis, shortness of breath, skin moisture (cold sticky sweat), oliguria.

A detailed clarification of the patient’s life circumstances and problems will allow the nurse to make the right decisions to save life, according to the specifics of patient care.

IIstage.Identifying patient problems (nursing diagnoses) . Acute chest pain due to impaired coronary blood flow.

1. Fear of death from heart pain or suffocation.

2. Severe weakness accompanied by pallor, sweating of the skin, thread-like pulse and low blood pressure.

3. Fainting in complete rest due to complete transverse heart block.

4. Feeling of discomfort due to limitation of physical activity (strict bed rest during myocardial infarction).

IIIstage.Planning nursing interventions

Goals of nursing interventions	Nursing intervention plan
After 30 minutes the patient will not experience heart pain	1. Place the patient comfortably. 2. Give 1 tablet of nitroglycerin (if blood pressure is more than 100 mm Hg) under the tongue, repeat after 5 minutes. 3. Place your left hand in a local bath (45°C) for 10 minutes. 4. Call a doctor if the pain persists. 5. Apply mustard plasters to the heart area 6. Prepare for injection: 10% solution (1 ml) of Tramal, 1 ml of 1% solution of promedol, 1 ml of 0.005% fentanyl, 10 ml of 0.25% solution of droperidol. 7. Chew 1/2 tablet of acetylsalicylic acid
The patient will not feel fear after 20	1. Talk with the patient about the essence of his disease, about its favorable outcomes. 2. Ensure the patient’s contact with those recovering. 3. Give 30-40 drops of valerian tincture to drink. 4. Prepare for injection as directed by your doctor. 2 ml of 0.5 diazepam solution (Relanium, Seduxen, Sibazon). 5. Talk with relatives about the nature of communication with the patient
After 1 hour the patient will not feel weak or lightheaded	1. Place the patient comfortably in a dry, warm bed with the chest raised. 2. Warm the patient: heating pads to the extremities, a warm blanket, hot tea. 3. Change your underwear in a timely manner. 4. Provide the room with fresh air and the patient with oxygen from an oxygen bag. 5. Measure blood pressure, assess pulse, call a doctor. 6. Prepare for injections as prescribed by the doctor: 2 ml of cardamine, 1 ml of 1% diphenhydramine, 1 ml of 0.025 strophanthin, a dropper for internal drip administration of the polarizing mixture, ampoules with prednisolone (30 mg each), 2 ml of 1% lidocaine.
After a few minutes the patient's consciousness will be restored.	1. Assess the pulse (possibly less than 40 per minute). 2. Lay the patient horizontally. 3. Call a doctor. 4. Prepare for injection: 1 ml 0.1% atropine solution, 10 ml 2.4% aminophylline solution
After 1-2 days the patient will not experience discomfort due to lack of movement	1. Conduct awareness-raising work about the need for strict bed rest. 2. If the patient is very uncomfortable lying on his back, place the patient in strict bed rest on the right side. 3. Convince the patient that in a day the feeling of discomfort will disappear. 4. Talk with relatives about the need to distract the patient from thoughts of inconvenience through conversation and reading.

IVstage.Implementation of the nursing intervention plan . The nurse consistently implements the nursing intervention plan.

Vstage.Assessing the effectiveness of nursing interventions . Having assessed the positive result of nursing interventions, making sure that the goal has been achieved, the nurse continues to monitor the patient’s condition, blood pressure, pulse, physiological functions, and body temperature.

New problems may arise:

lack of appetite;

dryness of the oral mucosa and tongue;

oliguria;

The nurse sets goals for solving new problems, draws up a plan for nursing interventions, and implements it.

The nurse records all data on the implementation and evaluation of the effectiveness of nursing interventions in the nursing history of recording the patient’s health status.

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The essence (pathophysiology) of angina pectoris

Angina pectoris is also often called “angina pectoris”, since its essence is pain of a different nature, localized behind the sternum, in the central part of the chest in the area where the heart is located. Typically, angina is described as a feeling of pain, heaviness, squeezing, pressure, discomfort, burning, squeezing, or pain in the chest. Unpleasant sensations in the chest can spread to the shoulders, arms, neck, throat, lower jaw, shoulder blade and back.

Angina pain occurs due to insufficient blood supply to the heart muscle due to coronary heart disease. The moments at which there is a severe lack of blood supply to the heart muscle are called ischemia. With any ischemia, oxygen deficiency occurs because insufficient blood is brought to the heart muscle to fully satisfy its needs. It is the lack of oxygen during ischemia that causes pain in the heart, which is called angina.

Ischemia of the heart muscle is usually caused by atherosclerosis of the coronary (heart) vessels, in which there are plaques of various sizes on the walls of the blood arteries, closing and narrowing their lumen. As a result, much less blood flows through the coronary arteries to the heart muscle than necessary, and the organ begins to “starve.” At moments of particularly severe fasting, an attack develops, which from a physiological point of view is called ischemia, and from the point of view of clinical manifestations - angina pectoris. That is, angina pectoris is the main clinical manifestation of chronic coronary heart disease, in which the myocardium experiences severe oxygen starvation, since a sufficient amount of blood does not flow to it through vessels with a narrow lumen.

The situation of coronary heart disease, the main manifestation of which is angina pectoris, can be roughly compared to old, rusty pipes, the lumen of which is clogged with various deposits and dirt, as a result of which water flows from the tap in a very thin stream. Likewise, too little blood flows through the coronary arteries to meet the needs of the heart.

Since IHD is a chronic disease that lasts a long time, its main manifestation - angina pectoris - also occurs in a person for years. Angina pectoris usually has the character of an attack that occurs in response to a sharp increase in the heart's need for oxygen, for example, during physical exertion, strong emotional experience or stress. At rest, angina pain is almost always absent. Attacks of angina, depending on living conditions, the presence of provoking factors and treatment, can be repeated with varying frequencies - from several times a day to several episodes a month. You should know that as soon as a person has an attack of angina, this indicates oxygen starvation of the heart muscle.

Angina pectoris - symptoms (signs) of an attack

The symptoms of angina pectoris are few, but very characteristic, and therefore they are easy to distinguish from the manifestations of other diseases. So, angina pectoris is manifested by intense pressing or squeezing pain or a feeling of heaviness, burning and discomfort in the chest right behind the sternum. Pain, heaviness or burning may radiate to the left arm, left shoulder blade, neck, lower jaw or throat. Relatively rarely, pain may spread to the right side of the chest, right arm, or upper abdomen.

Angina is always an attack of described pain in the heart area. Outside of an attack, angina does not manifest itself in any way. Typically, an angina attack develops against the background of physical exertion, strong emotional stress, cold air temperature, and strong wind. The duration of the attack ranges from one to fifteen minutes. An attack of angina always begins acutely, sharply, suddenly, at the peak of physical activity. The most strenuous physical activity that often triggers angina is brisk walking, especially in hot or cold weather or strong winds, as well as walking after a large meal or climbing stairs.

The pain may go away on its own after cessation of physical activity or emotional stress, or under the influence of nitroglycerin 2 to 3 minutes after administration. Nitroglycerin has the ability to greatly expand the lumen of the coronary vessels, increasing blood flow to the heart muscle, which eliminates oxygen starvation of the organ, along with which an attack of angina occurs.

Since the pain goes away after stopping physical activity, a person suffering from angina pectoris is often forced to stop moving to wait for the condition to normalize and the attack to stop. Because of this intermittent movement, with frequent and numerous stops, angina is figuratively called “window shopping disease.”

The described symptoms of angina pectoris are classic, but along with them there are also atypical manifestations of myocardial ischemia. In men, as a rule, angina pectoris manifests itself as a classic pain syndrome in the heart area.

Symptoms of atypical angina

An atypical attack of angina may manifest as pain in the arm, shoulder blade, teeth, or shortness of breath. But women, older people, or those with diabetes may not experience any pain during an angina attack. In this category of people, angina pectoris is manifested by rapid heartbeat, weakness, nausea and severe sweating. In rare cases, angina is completely asymptomatic, in which case it is called “silent” ischemia.

In general, there are two main types of atypical manifestations of angina:
1. Shortness of breath that occurs on both inhalation and exhalation. The cause of shortness of breath is incomplete relaxation of the heart muscle;
2. Severe and sudden fatigue under any load, which occurs due to insufficient oxygen supply to the heart muscle and low contractile activity of the heart.

Atypical signs of the syndrome are currently called angina equivalents.

Angina pectoris - classification

Currently, based on the characteristics of the clinical course, three main types of angina are distinguished:
1. Stable angina, the course of which does not change over time. This variant of the course of angina pectoris is divided into four functional classes depending on the tolerance of physical and emotional stress.
2. Unstable angina is characterized by a very variable course, in which attacks of pain are completely unrelated to physical activity. Unstable angina is an attack that is different from normal, or occurs spontaneously against the background of complete rest or rest. Unstable angina is more severe than stable angina; the attack lasts much longer and is provoked by minimal stress. The appearance of unstable angina is considered as a harbinger of a heart attack or heart attack. Therefore, unstable angina requires mandatory hospitalization in a hospital and qualified therapy, which is radically different from that for stable angina.
3. Prinzmetal's angina (variant angina). Seizures develop during rest, during night sleep, or while in a cold room or outdoors. Prinzmetal's angina develops with a sharp spasm of the coronary vessels. This type of angina develops when the lumen of the coronary vessels is almost completely blocked.

Stable angina (angina pectoris)

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%. Currently, doctors and scientists have found that angina can only develop when the lumen of the coronary vessels is narrowed by at least 50%. If, after the appearance of the first attacks of angina pectoris, the necessary therapy is not started, then the narrowing of the vessels will progress, and not 50% of the lumen will be blocked, but 75 - 95%. In such a situation, as the lumen of the vessels narrows, the blood supply to the heart will deteriorate, and angina attacks will develop more often.

Stable angina, depending on the severity and nature of the attacks, is divided into the following functional classes:

I functional class characterized by the rare occurrence of short-term attacks. Angina pain develops with an unusual and very quickly performed type of physical activity. For example, if a person is not used to carrying heavy and uncomfortable objects, then quickly carrying several basins or buckets of water from one point to another may well provoke an angina attack;
II functional class characterized by the development of angina attacks when quickly climbing stairs, as well as when walking or running quickly. Additional provoking factors may be frosty weather, strong wind or dense food. This means that moving quickly in a cold wind will cause angina more quickly than simply walking at a high speed;
III functional class characterized by the development of angina attacks even when walking slowly over a distance of more than 100 meters or when climbing stairs to one floor. An attack can develop immediately after going outside in frosty or windy weather. Any excitement or nervous experience can provoke angina attacks. With functional class III angina, a person’s normal, everyday physical activity is very limited;
VI functional class characterized by the development of angina attacks during any physical activity. A person becomes unable to perform any simple and light physical activity (for example, sweeping the floor with a broom, walking 50 m, etc.) without angina attacks. In addition, functional class IV is characterized by the appearance of angina at rest, when attacks appear without previous physical or psychological stress.

Usually in the diagnosis or specialized medical literature the term “functional class” is indicated abbreviated as FC. Next to the letters FC, a Roman numeral indicates the class of angina pectoris diagnosed in a given person. For example, the diagnosis can be formulated as follows: “angina pectoris, FC II.” This means that the person suffers from angina pectoris of the second functional class.

Determining the functional class of angina is necessary, since it is on this that the selection of medications and recommendations on the possible and safe amount of physical activity that can be performed are based.

Unstable angina

A change in the nature and course of existing angina is regarded as the development of unstable angina. That is, unstable angina is a completely atypical manifestation of the syndrome, when an attack lasts longer or, conversely, is shorter than usual, is provoked by any completely unexpected factors or develops even against the background of complete rest, etc. Currently, unstable angina refers to the following conditions:

Primary angina, occurring for the first time in life and lasting no longer than a month;
Progressive angina characterized by a sudden increase in the frequency, number, severity and duration of angina attacks. The occurrence of angina attacks at night is typical;
Angina at rest characterized by the development of attacks against the background of rest, in a relaxed state, which was not preceded by any physical activity or emotional stress for several hours;
Post-infarction angina– is the appearance of attacks of pain in the heart area at rest within 10–14 days after myocardial infarction.

The presence of any of the above conditions in a person means that he suffers from unstable angina, manifested in this way.

The development of unstable angina is an indication for urgent medical attention or calling an ambulance. The fact is that unstable angina requires mandatory, immediate treatment in the intensive care unit. If the necessary therapy is not carried out, unstable angina can trigger a heart attack.

Methods for distinguishing between stable and unstable angina

To distinguish between stable and unstable angina, the following factors must be assessed:
1. What level of physical activity provokes an angina attack;
2. Duration of attack;
3. Efficacy of Nitroglycerin.

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

With stable angina, the duration of the attack is no longer than 5–10 minutes, and with unstable angina it can last up to 15 minutes. In principle, any prolongation of the duration of an attack compared to normal is a sign of unstable angina.

With stable angina, the attack is controlled by taking only one Nitroglycerin tablet. The pain goes away within 2 - 3 minutes after taking a Nitroglycerin tablet. For unstable angina, one tablet of Nitroglycerin is not enough to stop the attack. A person is forced to take more than one Nitroglycerin tablet to stop the pain. That is, if the effect of one Nitroglycerin tablet is sufficient to relieve pain in the heart area, then we are talking about stable angina. If one tablet is not enough to stop the attack, then we are talking about unstable angina.

Prinzmetal's angina

This type of angina is also called variant or vasospastic angina. An attack of Prinzmetal's angina occurs when there is a sudden and severe spasm (vasospasm) of the blood vessels that carry blood to the heart muscle. Prinzmetal's angina does not always develop against the background of coronary heart disease. This type of angina can develop in people who have heart valve defects (aortic stenosis), severe anemia, or an extremely enlarged (hypertrophied) heart muscle. In all of these cases, a person may develop a reflex spastic narrowing of blood vessels, which is the direct cause of Prinzmetal's angina.

Variant angina is characterized by the development of attacks at night or early in the morning against the background of complete rest and the absence of any previous physical activity for several hours. The attacks have a short duration - on average from 2 to 5 minutes. An angina attack can be easily controlled by taking one Nitroglycerin tablet under the tongue. Also, Prinzmetal's angina is quickly stopped by taking any drug from the group of calcium channel blockers, for example, Nifedipine, Amlodipine, Normodipine, Octodipine.

Vasospastic angina (Prinzmetal's angina): causes, symptoms, treatment - video

The relationship between heart attack and angina

Heart attack and angina are different clinical manifestations of coronary heart disease (CHD). The essence of IHD is that the heart muscle is constantly experiencing oxygen starvation due to insufficient blood supply. The reasons for insufficient blood supply of oxygen to the heart muscle can be various factors, such as:

Narrowing of the lumen of the heart vessels by atherosclerotic plaques (atherosclerosis of the coronary vessels);
Spasm (sharp narrowing) of the heart vessels due to severe anxiety, excessive physical activity, defects or inflammatory diseases of the heart, etc.;
Excessive increase in myocardial oxygen demand during physical activity or emotional experience.

The main reasons for the development of ischemia of the heart muscle are listed above, but their list is much longer. Any factor that can either narrow the lumen of the coronary vessels or increase the heart's need for oxygen can cause ischemia.

Coronary heart disease is characterized by the constant presence of myocardial ischemia of varying severity. If IHD is in remission, then the manifestations of ischemia are attacks of angina. If IHD goes into the acute stage, then its manifestation is myocardial infarction. Thus, angina pectoris and heart attack are manifestations of the chronic and acute course of the same disease - coronary artery disease.

Since both heart attack and angina are manifestations of coronary artery disease, they can precede each other. So, according to statistics, when angina appears, 10% of people develop a myocardial infarction within a year. And after a heart attack, a person’s angina attacks may become more frequent, that is, its functional class will become higher.

Angina pectoris is not a pre-infarction condition, but its presence indicates a high risk of developing myocardial infarction. And any previous heart attack can lead to the appearance or worsening of existing angina. However, there is no direct connection between these two manifestations of IHD.

Angina pectoris - causes

The causes of angina pectoris may be the following factors:

Obesity. Moreover, the more obesity, the higher the risk and the faster a person will develop angina. The immediate causes of obesity do not play a role in the development of angina;
Smoking. The more a person smokes, the more likely and faster he will develop angina;
High blood cholesterol levels;
Diabetes mellitus, the presence of which increases the risk of developing angina by 2 times. Currently, scientists and doctors believe that if diabetes mellitus lasts for at least 10 years, a person either already has angina or it will manifest itself in the near future;
Severe emotional stress or nervous overload;
Chronic stress;
Insufficient physical activity (physical inactivity);
Arterial hypertension (hypertension);
Increased blood clotting (high values of PTI, INR, APTT and TV), against the background of which numerous blood clots are formed, clogging the lumen of blood vessels. Thrombosis of the coronary arteries is the direct cause of the development of angina attacks or myocardial infarction;
Tendency to thrombosis, thrombophlebitis or phlebothrombosis;
Metabolic syndrome (obesity + hypertension + high blood cholesterol).

For the development of angina pectoris, it is not necessary for a person to have all the causative factors; sometimes only one is enough, but usually there are several of them. The development of angina pectoris can occur against the background of various combinations of several causative factors. If a person has any of the listed causes of angina, but does not have attacks themselves, this indicates a high risk of their development. This means they can appear at any time.

All of these factors are causes of angina, but the immediate triggers of an attack are physical exertion, emotional distress, or unfavorable weather conditions. This means that under the influence of causes, a person develops angina, but its attacks develop only under the influence of provoking factors.

Diagnosis of angina pectoris

To diagnose angina pectoris, it is necessary to evaluate clinical symptoms, as well as perform a number of laboratory, instrumental studies and functional diagnostic tests, which are necessary to determine the severity and functional class of the pathology.

In the process of diagnosing angina, the doctor first finds out whether a person has the following clinical symptoms:

Feeling of squeezing, bursting, burning and heaviness in the heart area.
Sensations of squeezing, bursting, burning and heaviness are localized behind the sternum, but can spread to the left arm, left shoulder, left shoulder blade and neck. Less commonly, sensations may spread to the lower jaw, the right half of the chest, the right arm and the upper abdomen.
Sensations of squeezing, bursting, heaviness or burning occur in attacks. Moreover, the duration of the attack is not less than one minute, but not more than 15 minutes.
Under what conditions does an attack develop - suddenly, at the peak of physical activity (walking, running, climbing stairs even one flight, eating a large meal, overcoming strong wind, etc.).
How an attack is stopped - pain reduction occurs very quickly, after stopping physical activity or after taking one nitroglycerin tablet.

When a person has all of the above clinical symptoms, he has typical angina. In principle, in this case, the diagnosis is obvious, but additional tests and instrumental examinations are still prescribed, since they are necessary to clarify the general condition of the body and the severity of the disease.

If a person has only one of the listed symptoms, then such pain is of non-cardiac origin, that is, caused not by angina, but by an atypical course of gastric or duodenal ulcer, pathology of the esophagus, osteochondrosis of the thoracic spine, herpes zoster, pneumonia or pleurisy. In such a situation, the cardiologist will refer the person to another specialist, who will prescribe the necessary examinations to identify gastric or duodenal ulcers, pathology of the esophagus, osteochondrosis of the thoracic spine, herpes zoster, pneumonia or pleurisy (for example, EFGDS (sign up), x-ray (sign up) etc.).

After a person has been diagnosed with angina based on clinical signs, the doctor performs a general examination, during which he evaluates the condition of the skin, cardiovascular system, respiratory system and body weight.

In the process of assessing the condition of the skin, the doctor pays attention to indirect signs of impaired fat metabolism and the presence of atherosclerosis, which is one of the causative factors of angina pectoris. Thus, the first and main sign of atherosclerosis are xanthelasmas and xanthomas - small yellow accumulations of fat protruding above the surface of the skin over the entire surface of the body. The second sign of atherosclerosis is the corneal arch, which is a light gray stripe along the edge of the cornea of the eye.

To assess the state of the cardiovascular system, the doctor measures blood pressure, feels the pulse and percusses the borders of the heart and Auscultation of heart sounds (sign up). Blood pressure during angina pectoris is usually higher than normal values. But counting the pulse is usually done simultaneously with listening to heart sounds, since with angina pectoris the heart rate may be higher than the pulse.

Percussion involves tapping the chest with your fingers and, depending on the change in sound tones, determining the boundaries of the heart. As a result of percussion during angina, a displacement of the borders of the heart to the left is often detected due to thickening of the heart muscle.

Auscultation involves listening to heart sounds using a stethoscope. With angina pectoris, the heart sounds are muffled, there are pathological murmurs in the heart, the heartbeat is too rare or frequent, and arrhythmia can be heard.

Body weight is recorded and body mass index (BMI) is calculated, which is necessary to determine the degree of obesity, since many patients with angina are overweight.

In the process of assessing the state of the respiratory system, the frequency and nature of breathing (shallow, strained, etc.), the participation of the chest in the act of inhalation and exhalation, and the presence of shortness of breath are studied. The lungs and bronchi are also auscultated using a stethoscope. Often, with severe angina, moist rales are heard, arising from pulmonary edema.

What tests can a doctor prescribe for angina pectoris?

After a general examination and identification of clinical symptoms of angina pectoris, the doctor must prescribe a general blood test and a biochemical blood test. A complete blood count is necessary mainly to monitor hemoglobin and platelet levels. As part of a biochemical blood test for angina pectoris, determination of the concentration of glucose, total cholesterol, low-density lipoproteins, high-density lipoproteins, atherogenic index, triglycerides, AST and ALT activity is prescribed.

In addition, if thyroid disease is suspected, additional treatment for angina pectoris is prescribed. blood test to determine the concentration of thyroid hormones (sign up)– T3 and T4.

If the doctor suspects a recent heart attack that a person experienced, which is called “on his feet,” then a blood test is prescribed to determine the activity of troponin, CPK-MB (creatine phosphokinase, a subunit of MB), myoglobin, LDH (lactate dehydrogenase), AST (aspartate aminotransferase). The activity of these enzymes makes it possible to detect even small heart attacks that were relatively mild, masquerading as an attack of angina.

In addition, coronary angioplasty is often combined with vascular stenting, laser burning of atherosclerotic plaques or their destruction with a drill. Stenting a vessel is the installation of an endoprosthesis on it, which is a metal frame that will maintain the lumen of the capillary constant.

Coronary angioplasty is performed for the following indications:

Angina pectoris III – IV functional class, poorly responding or not amenable to drug therapy;
Severe damage to one or more coronary arteries.

After angioplasty, angina attacks stop, however, unfortunately, the operation does not provide a 100% guarantee of recovery, since relapses of the disease develop in approximately 30–40% of cases. Therefore, despite the good condition after surgery and the absence of angina attacks, it is necessary to carry out supportive conservative treatment.

Coronary artery bypass grafting is a large-scale surgical intervention. As the name of the operation implies, its essence lies in the fact that a bypass shunt is applied from the artery below the place of its narrowing to other heart vessels, which allows blood to be delivered to them, despite the existing obstacle. That is, a bypass path is artificially created to transport blood to the heart muscle. During the operation, several shunts can be applied, which will provide blood supply to all areas of the myocardium suffering from ischemia.

Coronary artery bypass grafting is performed for the following indications:

Angina pectoris III – IV functional classes;
Narrowing of the lumen of the coronary arteries by 70% or more.

A previous myocardial infarction is not an indication for coronary artery bypass grafting.

The operation allows you to completely eliminate angina, but to prevent relapse you will have to carry out conservative treatment throughout your life. Recurrent angina develops in 20–25% of people within 8–10 years after coronary artery bypass surgery.

Angina: causes, symptoms, treatment - video

Prevention of angina

Currently, the method of preventing angina pectoris is very simple and consists of: I.B.S rules, Where
AND means to get rid of tobacco smoke. If a person smokes, he should quit. If you do not smoke, you should avoid places where there is a high risk of inhaling tobacco smoke;
B means – move more;
WITH means to lose excess weight.

This simple set of rules of I.B.S. effectively prevents the development of angina pectoris in any person, regardless of gender, age and concomitant diseases.

Angina pectoris - traditional treatment

Folk remedies can only be used to relieve an attack of angina, as well as to prevent its occurrence. However, to fully control the course of the disease, a person will still need treatment with traditional medications. Therefore, traditional methods can be a good addition to the main treatment of angina.