Unstable angina is one of the forms of IHD

The concept of ischemic heart disease combines a group of diseases, the development of which is associated with a violation of the blood supply to the heart muscle. According to the classification, they are all divided into acute and chronic. Acute coronary diseases include sudden coronary death, myocardial infarction and unstable angina.

The classification of this disease distinguishes stenokardia de novo, subacute and acute stenocardia of rest and progressive angina.

With stenokardia de novo, angina attacks are observed not so long ago and on the background of complete health.

Unstable angina pectoris such as subacute angina pectoris is manifested by the fact that attacks of pain stopped 48 hours ago.

In acute angina pectoris, chest pain continues for the last 48 hours and is observed at the time of examination of the patient.

The most important clinical symptom of unstable angina is the inconsistent pain syndrome. This is manifested by the development of progressive angina pectoris or rest stenocardia, the rapid addition of new symptoms. General weakness, cold sweat, shortness of breath, cough, bubbling breath, arrhythmia at the height of physical or psychoemotional load - complaints that accompany any type of acute coronary disease, including unstable angina. The medical history reflects these typical manifestations of the disease.

Characteristic of progressive unstable angina is the contracting pain behind the sternum, which then stops, then appears with renewed vigor. The pain does not lend itself to or is difficult to treat with nitrates, often accompanied by fear of death, shortness of breath, arrhythmia. Episodes of attacks of angina become more frequent, and interictal periods - short. Each subsequent attack becomes heavier than the previous one. Nitrates, which previously removed pain behind the breastbone, become ineffective, although the patient takes them in large doses. Unstable angina is accompanied by pain, which can occur not only in connection with physical or psychoemotional stress, but also at rest. Sometimes it is eliminated only narcotic analgesics. Sometimes there is an attack of cardiac asthma with suffocation and dry cough.

Diagnostics

Unstable angina is diagnosed taking into account anamnestic data, patient complaints, as well as data from laboratory and instrumental studies.

The main ECG symptom that exhibits unstable angina is the reduction or depression of the ST segment in combination with the acute and high T wave. It is possible to transfer the T wave from positive to negative. Such changes on the ECG can be determined within a day or longer.

When echocardiograms are found areas of low mobility of the walls of the heart, passing in a few days.

Serological heart mark with damage to cardiomyocytes is low-molecular protein myoglobin. However, this test is very non-specific, since the appearance in the blood of myoglobin is possible with damage to skeletal muscles. In the first hours after the onset of unstable angina in the blood, the level of the enzyme, total creatine phosphokinase, increases. As a marker of instability of the coronary circulation, C-reactive protein and fibrinogen are also used.

Treatment

Patients with unstable angina should be hospitalized. In those cases when there are no severe and prolonged attacks of resting angina for two weeks, and an ECG without pathological changes and stable hemodynamics, patients can be treated out-patient.

Modern treatment of this disease includes therapeutic and surgical methods. The main goal of the treatment is early restoration of coronary patency.

Unstable angina is treated with antithrombotic drugs (anticoagulants, antiaggregants, antithrombin), antianginal drugs (nitrates, beta-adrenoblockers, calcium antagonists), ACE inhibitors and statins.

The patients are discharged when they achieve stabilization of the course of IHD.