Angina - a kind of coronary heart disease, for which pain is the main symptom.Angina is widespread among people of mature and elderly.Both male and female alike are at risk of angina. So, those aged 40-- 55 years of age suffer from the disease three to five people out of one hundred study, and at the age of sixty - one in five.The importance of this disease is extremely high, as in developed European countries recorded an annual average of thirty thousand initially identified cases of angina.
Another 80-ies of the last century, experts from the World Health Organization identified several types of the disease: angina (it is angina, emerged for the first time, a stable and progressive), variant angina (another name - angina at rest), which includes a separate species Prinzmetal angina.There is a second version of the classification, which emit stable, unstable angina, first diagnosed (Air Force), progressive (SP), early angina after a heart attack or surgery, vasospastic.
Angina medical history
When the patient angina person is admitted to hospital, it soon give birth to a special document, which has not only a great medical value, but also legal.This document is called a "case history".Even at the front desk in the patient record all of his passport details, the address at which he resides, and position that he occupies there, family composition and living conditions.
then examines the patient's angina doctor on duty.All complaints which the patient presents with the questioning immediately recorded in history.After this, the doctor must carry out a complete inspection, auscultation stethoscope, palpation, and percussion.Already in receiving this document should enter a preliminary diagnosis (if the doctor doubts without these studies, at the end put a question mark).If a patient has severe pain, or he is in a serious condition, it must be immediately delivered to the cardiology intensive care unit, or without conducting a preliminary examination at the reception.In these offices specialized doctors perform the necessary examinations and events, details of which are required to be recorded in history.
The survey angina patients need to find out all the anxious moments of the underlying disease, as well as a concomitant, if they are available.The survey data are entered in the relevant paragraphs of history.
On the first day, when the patient is admitted for treatment, it turns out history of the disease.In other words, data is collected on when the disease is manifest that preceded it (other conditions, occupational hazards, difficult life circumstances), how often the disease makes itself known, however unpleasant symptoms.It is also necessary to know whether the sick someone from relatives angina, and in general, any hereditary diseases present in the family of the patient.
a history of the disease need to specify what sick people for life (acute respiratory disease, chickenpox, measles, etc.) Whether there are allergic to any foods or medicines.It is also necessary to find out and write this paragraph, whether the patient is sick especially dangerous infectious and sexually transmitted illnesses (tuberculosis, syphilis, AIDS, and others.) Does it surgery or blood transfusion.The patient should know whether he is taking at the moment any medications, and accepting them in the near future.At the end of history was necessary to specify the information about the epidemic environment angina patients.
next item to fill in history - the history of the patient's life.This step is necessary to pay attention, since a detailed analysis of life can find the factors that gave rise to the development of the disease.History lives begin to collect from the data about when and where he was born patient, how the child on the account, as the leaked pregnancy and childbirth the mother as the patient developed (lagged or not the physical development of their peers), how many years went to the first class,how to assimilate school material, which received higher education.
then you should find out what the patient works (worked) and for how long, what are the conditions for employment (hazard production, emotional stress, work related to the risk of their lives).In the history of life is also necessary to make data on the composition of the family, illness of spouse (wife) and children, housing conditions (satisfactory or not, house or apartment, how much space is necessary on the human and other.).This item in addition to all of these data should include information on the bad habits of the patient with a detailed description (if you smoke, how many years and the number of cigarettes smoked per day, if you drink alcohol, what, how often and in what quantities).If bad habits have close relatives and family members, it is also necessary to specify.
After a medical history and life of harvested, transferred to posistemnomu objective study.Begin primarily to assess the general state of the person with angina (satisfactory, moderate, or severe severity).Assess the patient's consciousness (the clear, blurred or non-existent), its position on the bed (active and passive) and behavior (adequate or inadequate, peaceful or not).Next, make an assessment of parameters and make history data on weight, height and body type.Next, assess the skin and mucous membranes visible with an indication of the relevant paragraph in the document color, humidity (normal, increased or dry skin), elasticity and turgor measured fat fold on the belly.Then spend a feeling (palpation) lymph nodes chin, underarm, neck, chest and groin groups indicate their size and strength, pain (if any), texture, signs of fusion with the surrounding tissues (welded or not).After evaluate the joints: the symmetry, the amount of motor activity (movement stored or held down), pain in the study.
After a general inspection of moving to the evaluation systems.Begin with breathing.Assess the nasal breathing (free or not), type of breathing, respiratory rate, the shape of the thorax, synchronicity participation of both halves in the act of breathing, and proper expression of the subclavian pits (normal, drawn, smoothed).Then proceed to palpation: pain evaluate elasticity of the chest angina patients.Then spend percussion (comparative - on symmetrical sections, topographic - to assess the height of the tops of the lung fields Kreniga) and listening.
After respiratory system begin to explore the cardiovascular.In patients with angina, the system should be studied carefully.Begin by finding the apical impulse and determine its basic parameters (localization on the intercostal space, resistance and height).After moving to the pulse.It measures the both limbs at the same time determining the synchronicity wave, resistance, rhythm, intensity and degree of filling.Then proceed to auscultation.Angina patients need to listen several times - first at rest and then after a brief load (if the patient's condition).It is important to assess the rhythm tones as they clear and sonorous, determine if there are any changes in the relationship of tones that can occur when a disease like angina, heart.After listening to a patient with angina is necessary to measure blood pressure.
following system, which must be studied and described in the patient - a digestive.At this point, check the patient's main symptoms: Shchetkina-Blumberg, Ortner, frenikus-symptom and Murphy.It is necessary to carry out palpation of the liver and determine its size.
In a study of the urogenital system in patients with angina need to find out if there are complaints about the increase in or decrease in urine output, urine output which prevails (day or night), hurt if he had ever kidney or bladder.
neuropsychiatric status includes checking the main tendon reflexes, the condition of the pupils and pupillary reflexes and gait assessment.
After evaluation of all systems of patients with angina put the preliminary diagnosis and determined a plan under which it will be tested.The examination of the patient with angina must include laboratory tests (blood and urine), blood biochemistry, instrumental methods: electrocardiography, X-rays of the chest, ultrasound of the heart.
According to the results of all inspections and investigations patient put a final (final) diagnosis and therapy.Daily doctor, are sure that the patients with angina should take a detour and enter all the data on the change in well-being and performance of the patient in a special item in the history of the disease - a diary.It is filled daily and without fail.
When the patient is ready for discharge from the hospital in the medical case history is filled.It concisely describe all the time of hospital stay, carried out manipulation, research and treatment.In epicrisis also give a general outlook and recommendations on the necessary preparations, the daily routine and diet.
One of the main causes of this variety of CHD - atherosclerotic lesions of large vessels, which is characterized by narrowing of the arteries due to the occlusion of its lipid plaques.In the initial stages of atherosclerosis, angina patient will not be bothered.The first pain attacks occur when the lumen of the vessel is closed cholesteric conglomerates by more than half.
clinical manifestations of angina intensified with the growth of vascular stenosis.The severity of angina associated with how large plot underwent occlusion, and how many arteries were involved in this process.Sometimes the development of angina can contribute simultaneously by three factors: atherosclerosis, chronic spasm of blood vessels and the presence of blood clots nonlipid origin near the walls.
In some cases, angina, heart begins solely because of the absence of vasoconstriction of atherosclerotic vascular damage.Angina may also bear the reflex character.Reflex version of this disease develops if a person has some kind of pathology of the gastrointestinal tract (cholecystitis, cholelithiasis, hernia of the diaphragm).In addition to gastrointestinal diseases can lead to angina allergies, diseases of an infectious nature, syphilis and rheumatism, which cause damage to the blood vessels (aortitis, vasculitis, and others.).
On the occurrence of angina pectoris and its further development have an effect avoidable and unavoidable risks.Fatal include male gender, age (after forty), a genetic predisposition.The frequency of the incidence of angina in men over fifty to fifty-five years, at an older age, both sexes are equally affected.On the avoidable factors people with angina can if desired affect and significantly improve their lives.Such factors include fatty foods (reducing cholesterol will reduce the rate of atherosclerosis and protect against angina), overweight (people who do not have excess weight, suffer from angina, much less), pressure (blood pressure control and timely treatment reduces the risk of angina).
defining symptom of the clinical picture of the disease such as angina pain are of different nature and strength or behind the breastbone or on the left of it (in the projection of the heart).The pain can wear a compressed, stinging, burning, pressing, pulling, at least - piercing and cutting in nature.
strength of the pain in angina pectoris varies widely.The pain may be barely noticeable or very sharp and intense, forcing the person to moan and thrash.Pain can produce radiating to the left upper limb, the lower jaw in the epigastric area or in the chuck area.Cases and atypical variants of distribution - in the right half of the body.Typical irradiation due to its spread from the heart muscle to the last cervical and first and second thoracic segments of the spinal cord, from which impulses are transmitted along the nerves.
often pain overtake angina patients when climbing stairs, long walks, after a nervous shock or strong emotions (including positive), sometimes the pain wash to overtake and at night.In most cases, angina lasting more than a few minutes, sometimes up to twenty.At the moment of attack man thinks that he is suffocating, he tries to stop his hand and flatten the place where the pain is felt.He begins to fade begins numbness in hands and feet.In the first minutes pulse angina begins to grow, and then slow down the contrary, it is impossible to exclude the development of arrhythmia, tachyarrhythmia, or increased blood pressure.
Symptoms of angina pectoris is important to know to be able to differentiate this disease from other cardiac pathologies, including those that can carry a large threat to human life (for example, a minor heart attack, or myocardial infarction).
a sign that the patient is angina, is the duration of pain (no more than twenty minutes), the nature of feelings and factors Cropped this attack (after taking nitrate derivatives should go through the pain).The importance given to the definition of specific cardiac troponin (1 and 2).These are special markers that allow us to determine heart muscle damage.If they were found in the blood, it indicates the development of a minor heart attack or stroke.Troponins allow time to begin treatment and prevent the occurrence of post-MI patient strokes.On the ECG, if it was taken during an attack of pain, are also unique to the angina symptoms: decrease the interval between the teeth S and T, the appearance of the T wave with a negative index in the chest leads, pathology conduction or rhythm.
lot of useful data will ECG monitoring during the day.It will allow to fix any ischemia phenomenon, changes in heart rate, rhythm.Thus, if the number of heart beat increases immediately before the pain attack begins, it is a sign of angina.If the heart rate was normal, a sign of spontaneous angina.With angina patients for diagnostic purposes can be conducted scintigraphy.In this case, the body is introduced a special product - thallium.He is intensely absorbed by living cardiomyocytes, and if a person has angina pectoris, will significantly violation of perfusion of the heart cells.Echocardiography in patients with angina show characteristic localized pockets of ischemia, pathologies of myocardial contractility.
such diseases as angina, can be divided into four functional classes.
When FK1 standard daily load (walking, stairs) does not provoke attacks of pain.Pain in humans, in this case may appear only after an uncharacteristic, unaccustomed load.This latent stage flow angina is extremely difficult to diagnose because the pain is very rare.Angina at this stage reveal rarely also because patients do not pay attention to minor occasional discomfort and simply do not seek the help of a doctor.
When FK2 has revealed a decrease in the usual features.So, people with angina may feel pain when walking fast or moderate for a distance of no more than two hundred meters.Rise to the second floor also provoke another attack.A characteristic feature of a person with this functional class is a heightened sensitivity to changes in the weather.Attacks of pain may occur during time spent in the cold during a nervous breakdown or after a heavy meal.
If FK3 diagnosed marked limitation of physical activity.Angina makes itself felt in the quiet driving on a flat road at a distance of one hundred and two hundred meters, with the rise to the first floor.