5 treatments for vasospastic angina and the prognosis of the disease

Prinzmetal's angina (PV) is a variant angina with severe prolonged attacks that occurs at rest after a spasm of the coronary arteries. Pain during SP occurs at night or in the morning, is characterized by high intensity, tachycardia is present, the heart rhythm is disturbed, sweat appears, hypotension, fainting.

SP is considered a rare case of coronary heart disease, diagnosed in only two to five percent of all patients. Despite its rarity, SP is distinguished into an independent type due to the clinical course, methods of diagnosis and treatment plan. This disease is more common in people between the ages of thirty and fifty.

Causes of SP

Prinzmetal's angina appears after a sharp, severe spasm of the coronary artery. This spasm leads to the development of a critical blockage or complete obstruction weakened by spasm. Blood flow to the myocardium decreases and angina appears.

1. Fixed narrowing of the proximal coronary artery due to the appearance of an atherosclerotic plaque, which significantly narrows the lumen of the artery.
2. Absence of visible stenosis of large arteries: spasm occurs in small intramural vessels, and it is extremely difficult to detect any changes in them.
3. The developing spasm, in addition to the proximal section, can also diffusely affect other branches of the artery, where morphological changes are not visible.
4. The main prerequisite for SP is still atherosclerosis, which provokes angina pectoris even at the first stages of the development of the disease.

• tobacco or cocaine use;
• hypomagnesemia;
• insulin resistance;
• hypertension;
• cholecystitis;
• lack of vitamin E;
• ulcer;
• disruption of the ANS (vegetative nervous system);
• psychological stress;
• hypothermia;
• hyperventilation with low carbon dioxide.

Prinzmetal's angina is difficult to determine the first time, therefore it is worth excluding the causes of SP as much as possible, at least this applies to the rejection of any narcotic substances (including nicotine) and enriching the body with essential vitamins.

SP symptoms

The main difference between SP and other types of coronary heart disease is that angio attacks are much more severe and prolonged. These painful attacks are accompanied by serious deviations in the activity of the autonomic nervous system, as well as significant disruptions in the rhythm and conduction of the heart.

The main manifestation of Prinzmetal's angina is the appearance of long and severe pain in the left side of the chest, the so-called cardialgia, at rest. In addition to the morning and night hours, seizures sometimes occur at other times of the day, at the same hours after doing moderate physical activity that is habitual for the body.

The cardialgia described above occurs, as a rule, suddenly. Angio pain symptoms have a pressing, cutting or burning character, the duration of such attacks is from five to fifteen minutes, less often up to half an hour. Similar symptoms in SP are quite difficult to stop with drugs containing nitroglycerin. In some cases, the pain comes back in series and repeats every few minutes. In addition to such episodes with angio attacks, which may occur singly only once a day, or a week, or a month, the patient may not feel any other discomfort at all and not consider himself ill.

• profuse sweating;
• blanching of the skin;
• increased heart rate;
• headache attacks;
• nausea;
• decrease, less often increase in blood pressure;
• fainting spells.

It is worth noting that sometimes, against the background of an attack of joint venture, a patient may experience cardiac arrhythmia. It manifests itself as ventricular extrasystole (untimely depolarization and contraction of the heart or its individual chambers), paroxysmal ventricular tachycardia (a sharp increase in the frequency of contractions of the ventricles), blocking of the legs of the His bundle, or as a violation of the conduction of an electrical impulse from the atria to the ventricles (atrioventricular conduction).

Even with an accurate diagnosis of vasospastic angina (SP), patients may experience a spontaneous remission, and for quite a long time, it happens for years, but over time, typical attacks of SP reappear.

Diagnosis of Prinzmetal's angina pectoris

The main method for diagnosing Prinzmetal's angina remains the electrocardiogram recorded at the time of the attack. At this moment, the ST-segment elevation is visible, which is usually fixed during transmural ischemia of the heart. Such rises in the segment in SP appear for a short time (no more than a few minutes, only until an attack of angio pain occurs), in contrast to a heart attack, in which this rise can be displayed for a whole month.

• an increase in the amplitude of the main ECG wave (R);
• sharpening or inversion of a non-permanent ECG wave (U);
• inconsistency in heart rate and conduction.

Following standard electrocardiography, 24-hour monitoring of the heart, otherwise Holter ECG, can be used. This method will help to detect spontaneous ischemic attacks without strong changes in heart rate, which in turn will confirm the presence of vasospastic angina.

1. Provocative tests to detect the disease: hyperventilation, administration of ergometrine or acetylcholine, ischemic (atrial electrical stimulation through the esophagus) or cold test.
2. Tests using loads: bicycle ergometry, treadmill test (on a specialized treadmill).
3. Coronary angiography: in the presence of SP, the procedure will detect the absence of a significant proportion (more than 50%) of coronary artery stenosis.

Treatment

The main methods of treating SP are:

1. Relief of pain and stopping spasm with nitrate-containing agents.
2. The use of vasodilator drugs to stop coronary artery spasm and improve blood flow. Widely used drugs such as Verapamil or Diltiazem, antispasmodics or selective beta-blockers.
3. The use of anticoagulants and antiplatelet agents to avoid gluing blood elements (in this case, Heparin or Clopidogrel is most often used).
4. Exclusion of animal fats and fortification of the diet to prevent the appearance of atherosclerotic plaques.
5. The use of acetylsalicylic acid as a prophylactic against myocardial infarction.

• do not use tobacco and alcohol;
• provide the body with eight hours of sleep and an adequate work regime;
• avoid psychological stress as much as possible;
• engage in regular, not very debilitating physical activity (charging, walking, and so on);
• reduce, and it is better to completely abandon the use of salt in food;
• reduction of animal fats, fried foods and spices;
• increase in protein foods, fruits and vegetables;
• additional use of multivitamin preparations.

Disease prognosis and preventive measures

Potential complications in SP directly depend on the severity of the process of obstruction in the coronary arteries, the duration of attacks and the frequency of occurrence. If the process of obstruction does not affect the arteries, then the risk of sudden death is greatly reduced and amounts to only half a percent of the total number of annual cases of SP. However, if spasmodic attacks become prolonged and frequent, then the unfavorable prognosis grows, according to statistics, a lethal outcome in this case occurs in ¼ of all recorded cases of pathology.

Since Prinzmetal's angina is defined as one of the variants of progressive heart failure, patients should certainly be observed as part of a dispensary record by a specialist cardiologist.

If we talk about the long-term prognosis of the disease, then it is more positive than negative. The patient often states spontaneous remissions lasting for years. Of the negative complications, it is worth noting, of course, myocardial infarction - in patients suffering from Prinzmetal's angina pectoris for a long time, heart attacks develop many times more often.

Speaking about the prevention of SP, we note that the technique in this case is quite simple in terms of the necessary actions, although it will require a certain willpower from the patient.

1. And get rid of tobacco and smoke. Do you smoke? Drop it. Do not smoke? Avoid places with tobacco smoke.
2. B - move more. But remember, you can not expose the body to exhaustion.
3. C - lose weight, which often only aggravates the state of the cardiovascular system.

In addition, it is strongly recommended to normalize the tone of the autonomic nervous system, eliminate hyperlipidemia if present (increased levels of lipids and lipoproteins in the blood) and take aspirin to reduce the risk of a heart attack.

The main recommendation: if you have begun to notice the symptoms of Prinzmetal's angina in yourself or your loved ones, do not self-medicate at home! Be sure to consult with a cardiologist. Specialists in most cases can even out the current situation and reduce the impact of angina pectoris on your life both now and in the future.