Treatment of angina pectoris

Angina pectoris is a clinical syndrome (a set of symptoms) that manifests as a feeling of heaviness, discomfort, and pain in the heart area or behind the sternum. It often radiates to the left shoulder and arm. Angina attacks mainly occur during physical exertion or psycho-emotional stress. They may also appear at rest, but this is typical for complicated cases.

Attacks last about 10–15 minutes. Usually, the pain subsides when a person calms down and relaxes. Medications that dilate the coronary vessels are also used to relieve symptoms. They should be taken only as prescribed by a doctor.

Prolonged attacks increase the risk of myocardial infarction. If pain in the heart area occurs, it is necessary to consult a cardiologist and undergo an examination. Cardiac angina may be associated with atherosclerosis and coronary heart disease, which require serious treatment.

The pain may be aching or sharp. A feeling of pressure in the chest and burning may also occur.

Depending on the type of angina, symptoms may appear with increased physical and mental exertion, including significant overeating. They may also develop with hypothermia and even during rest.

In atypical cases, shortness of breath, bloating and abdominal pain, nausea, and vomiting may also occur.

In most cases, the pain subsides quickly when a person sits down and relaxes. An attack may last from a few minutes up to 15 minutes. This feature helps doctors distinguish the disease from other conditions with similar symptoms.

Angina is divided into several types. The main parameter is the time of onset of attacks. Depending on this, the following are distinguished:

• exertional angina — develops against the background of physical or emotional stress;

• rest angina — attacks develop without visible causes, including when the patient is resting and at night.

Depending on the severity of symptoms and the frequency of attacks, the following are distinguished:

• stable angina — there is a proportional relationship between the level of physical exertion, the increase in myocardial oxygen demand, and the intensity of attack symptoms;

• unstable angina — the frequency and intensity of symptoms vary, attacks may occur at rest.

Stable angina is also divided into 4 functional classes:

• Class I — no attacks during usual physical activity, but they appear with increased exertion;

• Class II — symptoms appear during walking up to 500 m and climbing more than one flight of stairs;

• Class III — attacks develop when walking 100–200 m and climbing a small flight of stairs;

• Class IV — symptoms develop when walking less than 100 meters and at rest.

Unstable angina is also divided into classes:

• Class I — attacks began within the last 2 months and occur only during exertion;

• Class II — subacute form, attacks frequently recur within a month and occur at rest;

• Class III — attacks often occur at rest and were present within the last 2 days before diagnosis.

To diagnose angina, a cardiologist performs a physical examination, reviews the patient’s complaints, and studies the medical history. After that, laboratory tests and instrumental examinations are prescribed.

The patient may be assigned:

• laboratory blood tests (complete blood count, biochemical analysis, blood glucose, cholesterol level, etc.);

• electrocardiogram (ECG) at rest and during physical activity;

• 24-hour Holter ECG monitoring;

• echocardiography (heart ultrasound);

• coronary angiography — an X-ray examination with contrast;

• scintigraphy — a method of functional imaging.

An important stage of diagnosis is conducting stress tests, that is, assessing heart function during physical exertion (exercise on a stationary bike or treadmill).

The doctor determines which examinations are necessary for the patient individually.

Angina often develops against the background of other diseases, in particular atherosclerosis and coronary heart disease. Therefore, comprehensive treatment is carried out, aimed not only at relieving symptoms but also at eliminating the cause of attacks.

Angina is treated with medical and surgical methods. First, the cardiologist recommends that the patient reduce physical exertion (but not exclude it completely), adjust the diet, quit smoking and alcohol consumption, and prescribes a set of medications. The doctor may recommend nitroglycerin to dilate the coronary vessels, acetylsalicylic acid to thin the blood, beta-blockers to reduce heart rate, or other medications.

In severe forms or in case of ineffectiveness of conservative therapy, surgical intervention may be required. In angina, coronary artery stenting, coronary artery bypass grafting, and plastic reconstruction of the coronary arteries are performed. All operations are aimed at restoring blood flow to the myocardium.