First aid for ischemic disease. Help with coronary heart disease

In a feverish state, the patient feels weakness, muscle and headaches, frequent heartbeat; he is thrown into the cold, then into the heat with severe sweating.

A very high temperature may be accompanied by loss of consciousness and convulsions. When the body temperature is high, the 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, subfebrile temperature is distinguished (not higher than 38 ° C), high (38-39 ° C), very high (above 39 ° C) - fever.

Provide the patient with rest and bed rest;

In case of strong heat, wipe the patient with a napkin dipped in slightly warm water, vodka;

Call the local therapist of the polyclinic to the patient, who will determine further treatment;

In case of a severe febrile condition (with convulsions, loss of consciousness, etc.), call an ambulance.

Cardiac ischemia

Ischemic heart disease (CHD, coronary heart disease) is considered as ischemic myocardial damage due to oxygen deficiency with inadequate perfusion.

a) sudden coronary death;

b) angina:

Angina pectoris;

Stable exertional angina;

Progressive angina pectoris;

Spontaneous (special) angina;

c) myocardial infarction:

Large focal (transmural, Q-infarction);

Small-focal (not Q-infarction);

d) postinfarction cardiosclerosis;

e) cardiac arrhythmias;

e) heart failure.

In the 1980s The concept of "risk factors" for cardiovascular disease associated with atherosclerosis has received the greatest recognition. Risk factors are not necessarily etiological. They may influence the development and course of atherosclerosis or may not exert their influence.

Atherosclerosis - This is a polyetiological disease of the arteries of the elastic and muscular-elastic type (large and medium caliber), manifested by 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 disease can be divided into two groups: manageable and unmanageable.

Unmanaged risk factors:

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

Male gender;

hereditary predisposition.

Controlled risk factors:

Smoking;

Arterial hypertension;

Obesity;

Hypodynamia;

Negative emotions, stress;

Gypsycholistriasis (LDL cholesterol> 4.1 mmol / l, as well as a reduced level of HDL cholesterol< 0,9).

angina pectoris paroxysmal pain in the chest (compression, squeezing, unpleasant sensation). The basis of the occurrence of an attack of angina is hypoxia (ischemia) of the myocardium, which develops in conditions when the amount of blood flowing through the coronary arteries to the working heart muscle 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 region of the heart. The nature of the pain is different; many patients feel pressure, constriction, burning, heaviness, and sometimes cutting or sharp pain. Pain is unusually intense and is often accompanied by a feeling of fear of death.

Characteristic and very important for diagnosis is the irradiation of pain in angina pectoris: 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.

There is pain under certain conditions: when walking, especially fast, and other physical exertion (with physical exertion, the heart muscle needs a greater supply of nutrients with the blood, which narrowed arteries cannot provide with atherosclerotic lesions).

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

With excitement, pains also appear out of 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 not only of sharp pain, but also with the fear of death.

Sometimes retrosternal pain in angina pectoris is accompanied by headache, dizziness, 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 an attack is usually 5-10 minutes.

For the first time, exertional angina is isolated in a separate form within 4 weeks, and in elderly patients - within 6 weeks. It is classified as unstable.

Stable angina pectoris. After a certain period of adaptation (1–2 months), a functional restructuring of the coronary circulation occurs, and angina pectoris acquires a stable course with a constant ischemia threshold. The level of stress that causes an attack of angina pectoris 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 stereotype of pain under the influence of physical or emotional stress. At the same time, there is an increase and aggravation of seizures, a decrease in exercise tolerance, a decrease in the effect of taking nitroglycerin. Progressive angina pectoris is considered as one of the severe types of unstable angina (10-15% of cases end in myocardial infarction).

Among all variants of unstable angina, the most dangerous is rapidly progressing 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 pectoris - attacks of pain in the chest (tightness, compression) that occur at rest, against the background of an unchanged myocardial oxygen demand (without an increase in heart rate and without an increase in blood pressure).

Criteria for the diagnosis of 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 determines unchanged or slightly changed coronary arteries;

d) the introduction of ergonovine (ergometrine) or acetylcholine reproduce changes in the ECG;

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

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

1) improvement of oxygen delivery to the myocardium;

2) reduced 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 with the help of surgical methods of treatment. Subsequent referrals are due to drug therapy.

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

Nitrates increase the stroke volume of the ventricles, reduce platelet aggregation and improve microcirculation in the heart muscle. Among them, the following drugs can be distinguished: nitroglycerin (nitromint), sustak, nitrong, nitromac, nitroglanurong, isosorbide dinitrate (kardiket, kardiket-retard, isomak, isomak-retard, nitrosorbide, etc.), isosorbide 5-mononitrate (efox, efox -long, monomak-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 costs of the heart by reducing the rate of heart contractions, lowering blood pressure, negative inotron effect and inhibition of platelet aggregation. Thus, myocardial oxygen demand decreases. Among this large group of drugs, the following have recently been used:

a) non-selective - propranolol (anaprilin, obzidan), sotalol (sotacor), nadolol (korgard), timolol (blockarden), alprepalol (antin), oxpreialol (trazikor), pindolol (visken);

b) cardioselective - atenalol (tenormin), metoprolol (egilok), talinolol (cordanum), acebutalol (sectral), celiprolol;

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

Calcium antagonists inhibit the intake of calcium ions inside, reduce the inotropic function of the myocardium, promote cardiodilatation, reduce blood pressure and heart rate, inhibit platelet aggregation, have antioxidant and antiarrhythmic properties.

These include: verapamil (isoptin, finoptin), diltiazem (cardil, dilzem), nifedipine (cordaflex), nifedipine retard (cordaflx retard), amlodipine (normodipine, cardilopia).

Primary prevention of cardiovascular disease focuses on reducing atherogenic lipid levels through lifestyle changes. This is the restriction of the use of animal fats, weight loss, physical activity.

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

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

Arrhythmia is a violation of 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 may be due to psycho-emotional arousal, disorders in the endocrine and nervous systems. Having arisen once, arrhythmias often recur, so their timely treatment is extremely important.

According to the nature of the manifestation and mechanisms of development, several types of arrhythmias are distinguished. The provision of emergency care primarily requires paroxysmal tachycardia, which is possible both in young and in old age. The attack begins suddenly with a feeling of a strong push in the chest, pancreas, "hit" in the heart, followed by a strong heartbeat, short-term dizziness, "blackout 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, while the attack is often accompanied by pain behind the sternum or in the region of the heart. There are several forms of paroxysmal tachycardia. The usual medical examination of patients does not always allow them to be differentiated; this can be done only by the method of electrocardiological examination.

Symptoms. At the time of the attack, the pulsation of the patient's cervical veins attracts attention. The skin and mucous membranes are pale, slightly cyanotic. With a prolonged attack, the cyanosis intensifies. The number of heartbeats increases up 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 attention.

Before the arrival of the doctor, the patient should be laid down, and then use the methods of reflex action on the heart:

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

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

c) arbitrary breath holding;

d) taking antiarrhythmic drugs that previously relieved seizures (novocainamide, lidocaine, isoptin, obzidan).

Complete atrioventricular block- violation of the impulse 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, a sharp 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 pillow, oxygen inhaler, in their absence, provide access to fresh air). Urgently call an ambulance. If the condition worsens, the first aid provider performs mouth-to-mouth artificial respiration, closed heart massage. Hospitalization in the cardiology department or intensive care unit of the cardiology department. Transportation on a stretcher in a prone position. The final treatment is not unsuccessfully carried out in the cardiology departments of hospitals, where modern antiarrhythmic drugs, methods of electrical impulse therapy and pacing are used.

In the prevention of arrhythmias, timely treatment of heart diseases, annual preventive examinations and dispensary observation are important. Physical hardening, optimal mode of work and rest, rational nutrition are necessary.

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

What are the norms for blood pressure in adults?

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

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

The complexity of the fight against arterial hypertension lies in the fact that about 40 percent of patients do not know about their disease. And only 10 percent of those who know and are treated in the clinic manage to reduce the pressure to normal numbers. Meanwhile, a sudden weakening of cardiac activity can cause excitation of the central nervous system, which, in turn, dramatically increases blood pressure. That is why people with high blood pressure often experience hypertensive crises.

Symptoms. With arterial hypertension, there is a severe headache, dizziness, tinnitus, flickering of “flies” before the eyes, nausea, vomiting, palpitations, small tremors, chills, the face becomes covered with red spots. High blood pressure - 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 assistance, be complicated by an acute violation of cerebral or coronary circulation, in some cases - pulmonary edema.

First aid. Urgently call a doctor. Before his arrival, provide the patient with complete rest. The position of the victim is semi-sitting. To lower blood pressure, previously prescribed antihypertensive (lowering pressure) agents are used: reserpine, dopegit, isobarine, tazepam, etc. Heating pads for the legs.

Prevention. Early detection and treatment of hypertension. Patients with high blood pressure are required to regularly take antihypertensive drugs prescribed by a doctor. They should strongly refrain from smoking and drinking alcohol, avoid psycho-emotional overload. It should also be borne in mind that the majority of 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, food with fluid and salt restriction.

Cardiac ischemia- one of the most common diseases today, which is based on a violation of the blood circulation of the heart muscle. In a healthy person, there is complete harmony between myocardial oxygen demand and 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, sedentary, alcohol abusers, 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 has been achieved, prolonged work overload, chronic lack of time.

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

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 disease of the arteries, leading to a narrowing of the lumen of the vessel). In addition, metabolic disorders, strong nervous excitement, alcohol abuse, and smoking play an important role in the occurrence of heart attacks.

Every year, a heart attack claims thousands of lives; even more people are permanently deprived of the opportunity to fully work.

Symptoms. The disease begins with acute retrosternal pain, which takes on a protracted character, is not relieved by either validol or nitroglycerin. (Painless forms of myocardial infarction are often observed.)

Pain is given to the shoulder, neck, lower jaw. In severe cases, there is a feeling of fear. Cardiogenic shock develops (it is characterized by cold sweat, pallor of the skin, weakness, low blood pressure), shortness of breath. The heart rhythm is disturbed, the pulse is quickened or slowed down.

First aid. Urgently call a doctor. The patient is provided with complete physical and mental rest and takes measures aimed at stopping the pain syndrome (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 signs are cardiac and respiratory arrest, then the revitalization measures should be aimed at maintaining the function of respiration and blood circulation by means of artificial ventilation of the lungs and closed heart massage. Recall the technique for their implementation.

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

Closed heart massage. After one injection, 4-5 pressures are produced. For this, the lower end of the sternum is felt, the left palm is placed two fingers above it, and the right palm is placed on it, and the chest is rhythmically squeezed, producing 60-70 pressures per minute.

Resuscitation measures are carried out until the appearance of a pulse and spontaneous breathing or until the arrival of an ambulance.

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. A severe attack of retrosternal pain radiating to the shoulder blade, left shoulder, half of the neck. The patient's breathing is difficult, the pulse is quickened, the face is pale, sticky cold sweat appears on the forehead. The duration of the attack is up to 10 - 15 minutes. Protracted angina often turns into myocardial infarction.

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

Prevention of coronary heart disease. Knowledge of risk factors is the basis of its prevention. An important role is played by the nutritional regime - limiting the caloric content of food, the exclusion of alcoholic beverages. Recommended four meals a day, including vegetables, fruits, cottage cheese, lean meat, fish. In the presence of excess weight, a diet prescribed by a doctor is indicated. Mandatory exercise, walking, hiking. You need to strongly stop smoking. Rational organization of work, education of 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 saving for a person who finds himself on the verge of life and death. Such situations can undoubtedly include a heart attack called acute coronary heart disease. What is the danger of this situation, how to help a person with an acute attack of coronary artery disease?

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

The disease can occur in acute and chronic form, and the second can be asymptomatic for years. What can not be said about acute coronary heart disease. This condition is characterized by a sudden deterioration or even cessation of coronary circulation, due to which death often becomes the outcome of acute coronary heart disease.

The most characteristic signs of acute ischemia:

severe squeezing pains 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, a feeling of irregularity in heart beats;
excessive sweating, cold sweat;
dizziness, fainting or impaired consciousness;
change in complexion to an earthy shade;
general weakness, nausea, sometimes turning into vomiting, which does not bring relief.

The occurrence of pain is usually associated with an increase in physical activity or emotional stress.

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

Sequelae of coronary heart disease

How dangerous is an attack of ischemia of the heart?

What threatens a person with acute coronary heart disease? There are several ways to develop an acute form of IHD. Due to a spontaneously occurring deterioration in the 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. Consider the most dangerous of them.

A heart attack occurs due to a narrowing of the lumen (due to atherosclerotic plaques) in the coronary artery, which supplies the myocardium with blood. The hemodynamics of the myocardium is disturbed so much that the decrease in blood supply becomes uncompensated. Further, there is a violation of the metabolic process and the most contractile function of the myocardium.

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 risks associated with complications of a heart attack:

cardiogenic shock, serious failure of the heart rhythm, pulmonary edema against the background of acute heart failure - in the acute period;
thromboembolism, chronic heart failure - after scarring.

Sudden coronary death

Primary cardiac arrest (or sudden cardiac death) provokes electrical instability of the myocardium. The absence or failure of resuscitation actions 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 rare cases when the outcome of acute coronary heart disease is death.

Special hazards

Precursors of acute coronary artery disease are frequent hypertensive crises, diabetes mellitus, congestion in the lungs, 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, fatigue.

Particular attention should be paid to the so-called atypical signs of myocardial infarction, which make it difficult to diagnose, thereby preventing first aid for coronary heart disease.

You should focus on atypical infarct forms:

asthmatic - when the symptoms manifest themselves in the form of aggravated 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 arrange a “competent” gastric lavage, which will certainly kill a person;
peripheral - when pain foci are localized in areas remote from the heart, such as the lower jaw, thoracic and cervical spine, edge of the left little finger, throat area, left hand;
collaptoid - an attack occurs in the form of collapse, severe hypotension, darkness in the eyes, protrusion of "sticky" sweat, dizziness as a result of cardiogenic shock;
cerebral - signs resemble neurological symptoms with a disorder of consciousness, understanding of what is happening;
edematous - acute ischemia is manifested by the appearance of edema (up to ascites), weakness, shortness of breath, enlargement of the liver, which is characteristic of right ventricular failure.

Combined types of acute coronary artery disease are also known, combining signs of various atypical forms.

First aid for myocardial infarction

First aid

Only a specialist can establish the presence of a heart attack. However, if a person has any of the symptoms discussed above, especially those that have arisen after excessive physical exertion, a hypertensive crisis or emotional stress, it is possible, suspecting acute coronary heart disease, to 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), release him from tight or constricting clothing - a tie, bra, etc.
If a person has taken drugs previously prescribed by a doctor from (such as Nitroglycerin), they should be given to the patient.
If taking the drug 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.
In the absence of allergic reactions to Aspirin, give the patient 300 mg of this medicine, and the Aspirin tablets should be chewed (or crushed into powder) to accelerate 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, unconsciousness and breathing (or agonal convulsions) are indications for cardiopulmonary resuscitation (CPR).

Medical emergency care usually includes a group of activities:

CPR to maintain airway patency;
oxygen therapy - the forced supply of oxygen to the respiratory tract to saturate the blood with it;
indirect heart 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 agents - beta-blockers, calcium antagonists, antiplatelet agents, nitrates and other drugs.

Can a person be saved?

What are the prognosis in the event of an attack of acute coronary heart disease, is it possible to save a person? The outcome of an attack of acute coronary artery disease depends on many factors:

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

The most difficult thing to resuscitate patients with a clinical form of coronary heart 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 is carried out within these 5 minutes, a 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 a person with peace, call an ambulance and try to relieve pain with the heart remedies 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, the worst-case scenario can be avoided only if one is attentive to one's own health - maintaining a healthy lifestyle with feasible physical activity, giving up bad 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 coronary artery disease is an extremely dangerous type of cardiac ischemia.
In some clinical forms, urgent measures for acute ischemia of the heart may be ineffective.
An attack of acute coronary artery disease requires calling an ambulance and providing the patient with rest and taking heart medications.

CARDIAC ISCHEMIA.

Cardiac ischemia (CHD) - This is a chronic heart disease caused by a violation of the 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, ischemic disease is also called coronary heart disease.

At the core Ischemic heart disease lies the deposition in the walls of the coronary arteries of atherosclerotic plaques, 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 rate of its development is different and depends on many factors.
The coronary arteries play a crucial role in the life 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 artery disease can lead to the development of angina pectoris and myocardial infarction.
Thus, angina pectoris It's not a disease, it's a symptom Ischemic heart disease. This state is called "angina pectoris".

Thus, IBS - this is an acute or chronic disease of the myocardium, due to a decrease and cessation of blood flow to the myocardium as a result of damage to the coronary vessels.

IBS has several forms.

angina pectoris
myocardial infarction
Chronic heart failure.

Classification ischemic heart disease according to WHO (70s).

SUDDEN CIRCULATION STOP(primary) that occurred before the provision of medical care.
ANGINA
MYOCARDIAL INFARCTION (MI)
NON-SPECIFIC MANIFESTATIONS is (SN) and
Development heart failure speaks of the emergence of a new disease --- the so-called. those. proliferation of connective tissue in the heart muscle.

ANGINA.

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

Clinical symptoms of angina pectoris.

Angina pectoris is characterized by sensations of pressure, heaviness, fullness, burning behind the sternum that occur during physical exertion. The pain can spread to the left arm, under the left shoulder blade, to the neck. Less commonly, 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 a few minutes. Since pain in the region of the heart often occurs when moving, a person is forced to stop, after a few minutes of rest, the pain usually disappears.
A painful attack with angina pectoris lasts more than one, but less than 15 minutes. The onset of pain is sudden, directly at the height of physical activity. Most often, such a load is walking, especially in cold winds, after a heavy meal, when climbing stairs.
The end of the 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 in breathing. Shortness of breath occurs in the same conditions as chest pain.
Angina in men is usually manifested by typical bouts of chest pain.
Women, the elderly and patients with diabetes during myocardial ischemia may not experience any pain, but feel a rapid heartbeat, weakness, dizziness, nausea, and increased sweating.
Some people with coronary heart disease experience no symptoms at all during myocardial ischemia (and even myocardial infarction). This phenomenon is called painless, "silent" ischemia.
Pain in the region of the heart, not associated with coronary insufficiency-- This cardialgia.

risk of developing angina pectoris.

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 pectoris. Some of them can be influenced, others cannot, that is, the factors can be removable or irremovable.

Fatal Risk Factors are age, gender, race and heredity.
Men are more susceptible to developing angina than women. This trend continues until about 50-55 years, that is, until the onset of menopause in women. After 55 years, the incidence of angina pectoris in men and women is approximately the same. Black Africans rarely suffer from atherosclerosis.
Removable causes.
- 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. On average, smoking shortens life by 7 years. Smokers also have increased levels of carbon monoxide in the 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 pectoris isdiabetes. In the presence of diabetes, the risk of angina pectoris and coronary artery disease increases on average by more than 2 times.
- emotional stress may play a role in the development of angina pectoris, myocardial infarction or lead to sudden death. With chronic stress, the heart begins to work with an increased load, blood pressure rises, and the delivery of oxygen and nutrients to the organs worsens.
- Hypodynamia or insufficient physical activity. It is another removable factor.
- well known as a risk factor for angina 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 , can lead to thrombosis.

VARIETIES OF ANGINA.

There are several types of angina pectoris:

angina pectoris .

stable angina, which includes 4 functional classes depending on the transferred load.
unstable angina, stability or instability of angina pectoris is determined by the presence or absence of a relationship between exercise and the manifestation of angina pectoris
Progressive angina. Seizures are on the rise.

Resting angina.

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 spasm is the basis, the attacks do not depend on physical activity, they occur more often at night (n.vagus). Patients wake up, there may be a series of attacks every 5-10-15 minutes. In the interictal period, the patient feels normal.
ECG outside the seizure is normal. During an attack pattern Any of these attacks can lead to myocardial infarction.
X is a form of angina pectoris. It develops in humans as a result of spasm of capillaries, small arterioles. Rarely leads to a heart attack, develops in neurotics (more in women).

stable angina.

It is believed that for the occurrence of angina pectoris, the arteries of the heart must be narrowed due to atherosclerosis by 50 - 75%. 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 exertion and even at rest..

Stable angina (tension), depending on the severity, it is customary to divide into Functional Classes:

I functional class- attacks of retrosternal pain occur quite rarely. Pain occurs with an unusually large, rapidly performed load YU
II functional class- attacks develop when climbing stairs quickly, walking fast, especially in frosty weather, in a cold wind, sometimes after eating.
III functional class- a 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 unrest.
VI functional class- there is a sharp limitation of physical activity, the patient becomes unable to perform any physical work without the manifestation of angina attacks; it is characteristic that attacks of rest angina pectoris can develop - without previous physical and emotional stress.

The allocation of functional classes allows the attending physician to choose the right drugs and the amount of physical activity in each case.

Unstable angina.

If habitual angina changes its behavior, it is called unstable or pre-infarction state. Unstable angina refers to the following conditions:
For the first time in life, angina pectoris is not more than one month old;

progressive angina, when there is a sudden increase in the frequency, severity or duration of attacks, the appearance of night attacks;
rest angina- occurrence of angina attacks at rest;
Postinfarction angina- the appearance of angina pectoris 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 hospitalization in the intensive care unit.

Variant angina.

Symptoms of variant angina are caused by a sudden contraction (spasm) of the coronary arteries. Therefore, doctors call this type of angina pectoris vasospastic angina.
In this angina pectoris, the coronary arteries may be affected by atherosclerotic plaques, but sometimes they are absent.
Variant angina occurs at rest, at night or in the early morning. Duration of symptoms 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 the 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 pectoris include the following studies:

electrocardiography,
exercise test (veloergometry, treadmill),
echocardiography,
coronary angiography.

If it is impossible to conduct a test with physical activity, as well as to identify the so-called pain ischemia and variant angina, it is indicated to perform daily (Holter) ECG monitoring.

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

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 with physical exertion or emotional stress
Passes at rest or after taking nitroglycerin.

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

Prevention of angina pectoris.
Methods of prevention of angina are similar to the prevention of coronary heart disease,

URGENT HELP FOR ANGINA!

An ambulance should be called if this is the first attack of angina pectoris in life, as well as if: pain behind the sternum or its equivalent increases or lasts more than 5 minutes, especially if all this is accompanied by worsening of breathing, weakness, vomiting; pain behind the sternum did not stop or worsened within 5 minutes after resorption of 1 tablet of nitroglycerin.

Help with pain before the arrival of the ambulance for angina pectoris!

Comfortably seat the patient with his legs down, calm him down and do not let him get up.
Let me chew 1/2 or 1 large tablet aspirin(250-500 mg).
For pain relief, give nitroglycerine 1 tablet under the tongue or nitrolingual, isoket in aerosol packaging (one dose under the tongue, not inhaling). 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 because of the danger of a sharp decrease in blood pressure.
It often helps to relieve spasm with a sip of cognac, which must be held in the mouth for 1-2 minutes before swallowing.

TREATMENT IHD and ANGINA.

Medical therapy.

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

This Antiplatelet drugs (Acetylsalicylic acid, Clopidogrel). They prevent platelet aggregation, that is, prevent thrombus formation at its earliest stage.
Long-term regular intake of acetylsalicylic acid (aspirin) by patients with angina pectoris, especially those who have had myocardial infarction, reduces the risk of developing a recurrent heart attack by an average of 30%.
This Beta blockers By blocking the effect of stress hormones on the heart muscle, they reduce myocardial oxygen demand, thereby leveling the imbalance between myocardial oxygen demand and its delivery through the narrowed coronary arteries.
This Statins (Simvastatin, Atorvastatin and others). They reduce total and low-density lipoprotein cholesterol levels, provide a reduction in 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 (antiischemic) therapy , aimed at reducing the frequency and intensity of angina attacks:

This Beta blockers (Metaprolol, Atenolol, Bisaprolol and others). These drugs reduce 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 myocardial oxygen consumption. However, they cannot be prescribed for sick sinus syndrome and impaired atrioventricular conduction.
This Nitrates (Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, Kardiket, Oligard, etc.). They expand (dilate) the veins, thereby reducing the preload on the heart and, as a result, myocardial oxygen demand. 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 cerebral vessels, improves outflow, prevents stroke; 0.01-0.05 g simultaneously with nitrate).
This Cytoprotectors (Preductal).It normalizes myocardial metabolism, does not dilate coronary vessels. The drug of choice for the X-form of angina pectoris. Do not prescribe for more than 1 month.

Aorto-coronary bypass.

Coronary artery bypass grafting- this is an operative intervention carried out to restore the blood supply to the myocardium below the site of atherosclerotic vasoconstriction. This creates a different path for blood flow (shunt) to the area of the heart muscle, the blood supply to which has been disrupted.

Surgical intervention is performed in 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 shunting. Previous myocardial infarction is not a contraindication to this operation. The volume 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 underwent coronary artery bypass grafting, angina recurs within 8-10 years. In these cases, reoperation is considered.

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Nursing process in IHDand angina

Definition of the concept of "CHD". Clinical manifestations. functional classes. Emergency care for an attack of angina pectoris. Principles of diagnosis, treatment, prevention, rehabilitation. The use of nursing models W. Henderson, D. Orem in patient care.

The student must know:

Definition of the concept of "ischemic heart disease" (CHD);

classification of IHD;

definition of the concept of "stenocardia";

clinical manifestations of angina pectoris;

Potential problems for the patient

principles of first aid for angina pectoris;

principles of diagnosis, treatment, prevention and rehabilitation.

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

Clinical forms IHD:

W angina,

W myocardial infarction,

W postinfarction cardiosclerosis,

W cardiac arrhythmias,

W heart failure,

W sudden coronary death.

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

risk factors

Smoking,

arterial hypertension,

hypercholesterolemia,

Sedentary lifestyle,

Obesity,

Diabetes,

Nervous tension, etc.

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

Nursing process in angina pectoris

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

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

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

Insufficiency of blood flow through the coronary arteries can be caused by:

atherosclerotic plaques,

Spasm of the coronary arteries,

Overstrain of the myocardium with great physical and nervous stress.

Classification :

1. Angina pectoris

2. Angina at rest

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

Types of angina pectoris (in accordance with the modern international classification:

1) first appeared;

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

4) spontaneous (special);

5) postinfarction early.

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

Clinical picture : Complaints on paroxysmal pains of a compressive nature, localization of pain in the region of the heart and behind the sternum, irradiation - in 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 or fourth intercostal space. Patients feel squeezing, heaviness, burning behind the sternum. During an attack, the patient feels a sense of fear, freezes, afraid to move and presses his fist to the region of the heart.

Attacks of pain occur most often during movement, physical or mental stress, in connection with increased smoking, cooling. Distinguish exertional angina (pain occurs during movement, physical exertion) and rest angina (pain occurs at rest, during sleep).

Taking nitroglycerin usually stops an attack .

Body temperature remains normal.

Changes on the ECG are not noted or are not stable, there may be a downward shift in the S-T interval, the T wave may become negative. With appropriate treatment, these indicators return to normal. The morphological composition of the blood in patients with angina pectoris remains unchanged. Auscultation of the heart reveals no specific changes.

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

During an angina attack, the ECG may show signs of transient ischemia, in the form of high pointed teeth T in many leads, or a decrease in the segment ST (less often his rise). After stopping an attack of angina pectoris, changes in the ECG disappear.

ischemic heart nursing angina pectoris

The course of the disease is undulating - periods of remission alternate with a period of increased frequency of seizures.

Violation of the attack algorithm (an attack at a lower load is removed with a higher dose of nitroglycerin) is typical for progressive angina. For the first time, emerging and progressive angina pectoris are united by the name - unstable and dangerous, as they can be complicated by myocardial infarction. Patients with unstable angina should be hospitalized .

Treatment. During an attack of angina pectoris, it is necessary to immediately eliminate the pain. The patient is given funds that expand 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 the pain is relieved by lowering the left arm to the elbow in hot water.

If after 3 minutes the pain has not stopped, repeat the application of nitroglycerin under the tongue. If the pain does not stop, a doctor is called and an analgesic is administered 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 hospitalization with suspected myocardial infarction.

Three groups of drugs have a real effect in IHD :

Nitrates (sustakmite, sustak-forte, nitrosorbide),

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

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

Assign antiaggregants (acetylsalicylic acid, tiklid, curantil, etc.).

The patient takes all drugs taking into account the individual approach, the choice of dose, the effectiveness of treatment

It is advisable for emotionally excitable persons to prescribe sedatives: valocordin (Corvalol) 25-30 drops per appointment, seduxen 1 tablet 2 times a day. Anti-atherosclerotic therapy is prescribed.

The general principles of treatment include measures to reduce blood pressure, rational diet therapy, and reducing the amount of fluid consumed. An important role in the treatment of angina pectoris is played by physiotherapy exercises, systematic walks, spa treatment.

Prevention . Primary prevention is to eliminate risk factors for coronary artery disease. Secondary- in dispensary observation, appointment, if necessary, antiatherosclerotic therapy, antiplatelet, coronary lytic.

With incessant, frequent (many times during the day and night), attacks caused by obliteration of the coronary arteries, they resort to surgical treatment - coronary artery bypass grafting, etc.

Rehabilitation of patients with ischemic heart disease . Rehabilitation for IHD aims to restore the state of the cardiovascular system, strengthen the general condition of the body and prepare the body for the previous physical activity.

Rehabilitation of coronary heart disease involves spa treatment. However, trips to resorts with a contrasting climate or during the cold season (sharp weather fluctuations are possible) should be avoided. in patients with coronary heart disease, increased meteosensitivity is noted.

The approved standard for the rehabilitation of coronary heart disease is the appointment of diet therapy, various baths (contrast, dry air, radon, mineral), therapeutic showers, manual therapy, massage. Also applied are exposure to sinusoidal modulated currents (SMT), diademic currents, and low-intensity laser radiation. Electrosleep and reflexotherapy are used.

The beneficial effects of climate contribute to the improvement of the cardiovascular system of the body. For the rehabilitation of coronary heart disease, mountain resorts are most suitable, because. stay in conditions of natural hypoxia (reduced oxygen content in the air) trains the body, promotes the mobilization of protective factors, which increases the overall resistance of the body to oxygen deficiency.

But sunbathing and swimming in sea water should be strictly metered, because. contribute to the processes of thrombosis, increased blood pressure and stress on the heart.

Cardiology training can be carried out not only on specialized simulators, but also during hiking along special routes (terrenkurs). Terrenkur are composed in such a way that the effect is made up of the length of the route, the ascents, the 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 contributes to the excitation of nerve and muscle fibers, improves microcirculation in ischemic areas of the myocardium, and increases 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 by the germination of microvessels in the area of ischemia, the development of a wide network of collateral vessels, which helps to improve myocardial trophism, increase its stability in conditions of insufficient oxygen supply to the body (during physical and psycho-emotional stress).

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

The basis of cardiorehabilitation is :

physical training program

· educational programs,

psychological correction,

Rational employment of patients.

Nursing process in coronary heart disease

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

These symptoms clarify the circumstances or consequences of heart disease, pain in the heart. 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 circumstances of life, the patient's problems will allow the nurse to make the right decisions to save lives, according to the specifics of patient care.

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

1. Fear of death from heartache or suffocation.

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

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

4. Feeling uncomfortable due to limited physical activity (strict bed rest for myocardial infarction).

IIIstage.Planning for nursing interventions

Goals of nursing interventions	Nursing Intervention Plan
After 30 minutes, the patient will not experience pain in the heart	1. Comfortably lay the patient down. 2. Give 1 tablet of nitroglycerin (if blood pressure is more than 100 mm Hg) under the tongue, repeat after 5 minutes. 3. Place the left hand in a local bath (45°C) for 10 minutes. 4. Call a doctor if the pain persists. 5. Put mustard plasters on 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 his favorable outcomes. 2. Ensure patient contact with convalescents. 3. Give 30-40 drops of valerian tincture to drink. 4. Prepare for injection as prescribed by the physician. 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 weakness, lightheadedness	1. Conveniently, with a raised chest, lay the patient in a dry, warm bed. 2. Warm the patient: heating pads to the limbs, a warm blanket, hot tea. 3. Change linen in a timely manner. 4. Provide the ward with fresh air, and the patient with oxygen from an oxygen bag. 5. Measure blood pressure, evaluate the pulse, call a doctor. 6. Prepare for injection as prescribed by a doctor: 2 ml of cardiamine, 1 ml of 1% diphenhydramine, 1 ml of 0.025 strophanthin, a dropper for internal drip administration of a 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 1 min). 2. Lay the patient in a horizontal position. 3. Call a doctor. 4. Prepare for injection: 1 ml of 0.1% atropine solution, 10 ml of 2.4% aminophylline solution
The patient after 1-2 days will not experience discomfort due to lack of movement	1. Carry out explanatory work on the need for strict bed rest. 2. If the patient is very uncomfortable to lie on his back, lay the patient in accordance with 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 for conversation, reading to distract the patient from thoughts of inconvenience

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

Vstage.Evaluation of the effectiveness of nursing interventions . Having assessed the positive result of nursing interventions, making sure that the goal is 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, 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 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 of \u200b\u200bthe heart. Typically, angina is described as a feeling of pain, heaviness, squeezing, pressure, discomfort, burning, constriction, 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 in coronary heart disease. Moments in which there is a severe shortage of blood supply to the heart muscle are called ischemia. With any ischemia, oxygen deficiency occurs, since insufficient blood is brought to the heart muscle to fully meet its needs. It is oxygen deficiency during ischemia that causes pain in the region of the heart, which is called angina pectoris.

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 that close and narrow their lumen. As a result, the coronary arteries supply the heart muscle with much less blood than necessary, and the organ begins to “starve”. At moments of particularly strong starvation, an attack develops, which from the point of view of physiology is called ischemia, and from the standpoint of clinical manifestations - angina pectoris. That is, angina pectoris is the main clinical manifestation of chronic coronary heart disease, in which the myocardium feels a pronounced oxygen starvation, since sufficient blood is not supplied 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 with old, rusty pipes, the lumen of which is clogged with various deposits and dirt, as a result of which water from the tap flows in a very thin stream. Similarly, too little blood flows through the coronary arteries to meet the needs of the heart.

Since coronary artery disease is a chronic disease that occurs for a long time, then 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 exercise, strong emotional experience or stress. At rest, angina pain is almost always absent. Attacks of angina pectoris, depending on living conditions, the presence of provoking factors and treatment, can be repeated at different frequencies - from several times a day to several episodes per month. You should know that as soon as a person has an attack of angina pectoris, this indicates oxygen starvation of the heart muscle.

Angina pectoris - symptoms (signs) of an attack

Symptoms of angina pectoris are few, but very characteristic, and therefore they are easy to distinguish from 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 just behind the sternum. Pain, heaviness, or burning may radiate to the left arm, left shoulder blade, neck, lower jaw, or throat. Relatively rarely, pain can spread to the right side of the chest, right arm, or upper abdomen.

Angina pectoris is always an attack of the described pains in the region of the heart. Outside of an attack, angina pectoris does not manifest itself in any way. Usually, an angina pectoris attack develops against the background of physical exertion, strong emotional impact, cold air temperature, and strong wind. The duration of the attack is from one to fifteen minutes. An attack of angina pectoris always begins sharply, abruptly, suddenly, at the peak of physical activity. The most severe physical activity that often provokes angina is brisk walking, especially in hot or cold weather or strong winds, as well as walking after a heavy meal or climbing stairs.

Pain can disappear on its own after the cessation of physical activity or emotional impact, or under the influence of nitroglycerin 2-3 minutes after ingestion. 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 angina attack also passes.

Since the pain disappears after the cessation of physical activity, a person suffering from angina pectoris is forced to stop frequently when moving in order to wait for the condition to normalize and the attack to stop. Because of this intermittent, with frequent and numerous stops of movement, angina pectoris is figuratively called "the disease of shop window observers."

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 is manifested by a classic pain syndrome in the region of the heart.

Symptoms of atypical angina

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

In general, there are two main variants of atypical manifestations of angina pectoris:
1. Shortness of breath on both inhalation and exhalation. The cause of shortness of breath is incomplete relaxation of the heart muscle;
2. Strong and severe fatigue with 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 now called angina equivalents.

Angina pectoris - classification

Currently, based on the characteristics of the clinical course, three main variants of angina pectoris are distinguished:
1. Stable angina, the course of which does not change with 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 variant course, in which attacks of pain are completely unrelated to physical activity. Unstable angina is an attack that differs from the usual, 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 and qualified therapy, which is fundamentally different from that for stable.
3. Prinzmetal's angina (variant angina). Attacks develop against the background of rest, during a night's sleep, or when you are in a cold room or on the street. Prinzmetal's angina develops with a sharp spasm of the coronary vessels. This type of angina pectoris develops with almost complete blockage of the lumen of the coronary vessels.

Stable angina (angina pectoris)

Stable angina is also called exertional angina, since the development of attacks is associated with excessively intense work of the heart muscle, which is forced to pump blood through the vessels, the lumen of which is narrowed by 50 - 75%. Currently, doctors and scientists have found that angina pectoris can develop only 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 vasoconstriction will progress, not 50% of the lumen, but 75 - 95% will be clogged. 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 of the course and the nature of the attacks, is divided into the following functional classes:

I functional class characterized by a rare occurrence of short-term seizures. 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 the rapid transfer of several basins or buckets of water from one point to another may well become a provocateur of an angina attack;
II functional class characterized by the development of angina attacks when climbing stairs quickly, as well as when walking or running fast. Additional provoking factors can be frosty weather, strong winds or dense food. This means that moving quickly in a cold wind will cause angina more quickly than just walking at 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 the III functional class of angina pectoris, a person has a very severely limited normal, everyday physical activity;
VI functional class characterized by the development of angina attacks with 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 rest angina pectoris, when attacks appear without previous physical or psychological stress.

Usually in the diagnosis or specialized medical literature, the term "functional class" is abbreviated as the abbreviation FK. Next to the letters FC, a Roman numeral indicates the class of angina diagnosed in this 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.

Determination of the functional class of angina pectoris is necessary, since this is the basis for the selection of drugs and recommendations for the possible and safe amount of physical activity that can be performed.

Unstable angina

A change in the nature and course of existing angina pectoris is regarded as the development of unstable angina pectoris. That is, unstable angina is a completely atypical manifestation of the syndrome, when an attack lasts longer or, conversely, 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, which arose for the first time in life and lasts no longer than a month;
Progressive angina characterized by a sudden increase in the frequency, number, severity and duration of angina attacks. Emergence of attacks of stenocardia at night is characteristic;
rest angina 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;
Postinfarction angina- this is the appearance of attacks of pain in the region of the heart 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 for 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, then unstable angina can provoke a heart attack.

Methods for distinguishing between stable and unstable angina

To distinguish between stable and unstable angina, the following factors should be assessed:
1. What level of physical activity provokes an attack of angina pectoris;
2. The duration of the attack;
3. The effectiveness of nitroglycerin.

With stable angina, an attack is provoked by the same level of physical or emotional stress. With unstable angina, an 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 lengthening of the duration of an attack compared to normal is a sign of unstable angina.

With stable angina, an attack is stopped by taking only one tablet of Nitroglycerin. The pain disappears within 2 to 3 minutes after taking a Nitroglycerin tablet. With unstable angina, one tablet of Nitroglycerin is not enough to stop an attack. A person is forced to take more than one tablet of Nitroglycerin to stop pain. That is, if the effect of one tablet of Nitroglycerin to relieve pain in the region of the heart is sufficient, then we are talking about stable angina. If one pill 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 disease (aortic stenosis), severe anemia, or an oversized (hypertrophic) heart muscle. In all of these cases, a person can develop a reflex spastic constriction of blood vessels, which is the direct cause of Prinzmetal's angina.

Variant angina is characterized by the development of attacks at night or in the early morning against the background of complete rest and the absence of any previous physical activity for several hours. Seizures are of short duration, averaging 2 to 5 minutes. An angina pectoris attack is well stopped by taking one tablet of Nitroglycerin 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, Normodipin, Octodipine.

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

Relationship between heart attack and angina pectoris

Heart attack and angina pectoris 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 causes of insufficient blood supply to the heart muscle with oxygen can be various factors, such as:

Narrowing of the lumen of the vessels of the heart by atherosclerotic plaques (atherosclerosis of the coronary vessels);
Spasm (sharp narrowing) of the heart vessels against the background of strong excitement, 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 causes 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.

Ischemic heart disease is characterized by the constant presence of myocardial ischemia of varying severity. If IHD is in remission, then manifestations of ischemia are angina attacks. If the ischemic heart disease goes into an 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 myocardial infarction and angina pectoris are manifestations of coronary artery disease, they may precede each other. So, according to statistics, with the appearance of angina pectoris, 10% of people develop myocardial infarction within a year. And after a heart attack in a person, 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 transferred heart attack can lead to the appearance or aggravation of existing angina pectoris. However, there is no direct connection between these two manifestations of IHD.

Angina pectoris - causes

The causes of angina pectoris can be the following factors:

Obesity. Moreover, the stronger obesity, the higher the risk and the faster a person will develop angina pectoris. The immediate causes of obesity do not play a role in the development of angina pectoris;
smoking. The more a person smokes, the more likely and faster he will develop angina;
High blood cholesterol;
Diabetes mellitus, the presence of which increases the risk of developing angina pectoris by 2 times. Currently, scientists and doctors believe that with a duration of diabetes mellitus of at least 10 years, a person either already has angina pectoris, 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 which numerous blood clots are formed that clog the lumen of the 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. 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 pectoris, but there are no attacks themselves, then this indicates a high risk of their development. This means that they can appear at any moment.

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

Diagnosis of angina pectoris

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

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

Feeling of squeezing, bursting, burning and heaviness in the region of the heart.
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 often, 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 at least 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 for one march, eating a large meal, overcoming a strong wind, etc.).
What stops the attack - the decrease in pain occurs very quickly, after the cessation of physical activity or after taking one tablet of nitroglycerin.

When a person has all of the above clinical symptoms, then he has typical angina pectoris. 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 any of the symptoms listed, then such pains are of non-cardiac origin, that is, they are not caused by angina pectoris, but by an atypical course of peptic ulcer of the stomach or duodenum, 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 examinations necessary to detect gastric or duodenal ulcer, esophageal pathology, osteochondrosis of the thoracic spine, shingles, pneumonia or pleurisy examinations (for example, EFGDS (sign up), x-ray (book) etc.).

After angina pectoris is detected in a person based on clinical signs, the doctor performs a general examination, during which he assesses the condition of the skin, cardiovascular system, respiratory system and body weight.

In the process of assessing the condition of the skin, the doctor draws attention to the indirect signs of impaired fat metabolism and the presence of atherosclerosis, which is one of the causative factors of angina pectoris. So, the first and main sign of atherosclerosis are xanthelasmas and xanthomas - yellow small 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 strip along the edge of the cornea.

To assess the state of the cardiovascular system, the doctor measures blood pressure, feels the pulse and percussion of the borders of the heart and auscultation of heart sounds (sign up). Blood pressure in 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 can be higher than the pulse.

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

Auscultation is listening to heart sounds with a stethophonendoscope. With angina pectoris, heart sounds are muffled, there are pathological heart murmurs, the heartbeat is too rare or frequent, and arrhythmia can also 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, forced, 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 with a stethophonendoscope. Often, in severe angina pectoris, moist rales are heard due to 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 needed mainly to monitor the level of hemoglobin and platelets. As part of a biochemical blood test for angina pectoris, the 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, in addition to angina pectoris, blood test to determine the concentration of thyroid hormones (sign up)- T3 and T4.

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

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

Coronary angioplasty is performed according to the following indications:

Angina pectoris III - IV functional class, poorly amenable 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 give a 100% guarantee of recovery, since relapses of the disease develop in about 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 volume surgery. 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 obstruction. That is, a bypass 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 according to the following indications:

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

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

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

Angina pectoris: causes, symptoms, treatment - video

Prevention of angina pectoris

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

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

Angina pectoris - alternative treatment

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