Stable angina - Heart danger

Stable angina is also called chronic ischemic heart disease, first described by William Heberden in 1789 with the term ' angina '. This is the most common disease in developed countries and tends to increase rapidly in developing countries including Vietnam.

What is stable angina?

Blood is supplied to the heart muscle through the coronary artery system. The coronary arteries come from the aorta root. The coronary arteries include the left coronary artery and the right coronary artery. These arteries divide into smaller branches to feed each region of the heart muscle. Coronary artery disease occurs when one or more of these arteries are partially or completely blocked (usually due to atheroma). Usually angina can occur when the coronary artery is narrowed over 50% of the lumen of the lumen.

When physically active, the body needs more oxygen, so the heart muscle must work harder such as increased contractions, increased heart rate, increased blood pressure . so the heart's oxygen demand also increases. If a coronary artery is narrowed, the corresponding supply of blood to the heart muscle becomes inadequate. Heart muscle is anemic and oxygen deficiency causes angina. This angina usually occurs during exertion and decreases when the patient is rested, so it is called stable angina.

Pain is usually in the middle of the chest, behind the sternum or in the front of the heart. Pain can spread to the neck, jaw, to the arm, most commonly spread to the left. Sometimes pain in the epigastric region. Tight feeling, tightness, pressure, sometimes just a feeling of discomfort in the chest. In some cases, the pain spreads to the back and the spinal area to make the patient mistakenly suffer from degenerative lumbar spine.

Stable angina usually resolves 1-5 minutes after stopping exercise. Sometimes angina can be silent (no pain or atypical chest pain) called a silent myocardial anemia.

The cause of stable angina

Cardiovascular disease is often caused by many causes. Risk factors work together to produce plaque. There are four main types of fats that exist in the blood: LDL-Cholesterol (known as a bad cholesterol), HDL-Cholesterol (known to be a useful cholesterol), total cholesterol and triglycerides. When those indicators are at an abnormal level, they can cause atherosclerosis, including coronary atherosclerosis.

Atheroma is primarily caused by fatty substances deposited on blood vessel walls, composed of a lipid nucleus and a fibrous shell. Atheroma reduces the vascular lumen and gradually obstructs.

Risk factors for stable angina, there are 2 types:

- Unchangable risk factors: Age: older age is more at risk of coronary artery disease; Women: women are at higher risk of coronary artery disease after menopause; Family history: if your parents, grandparents or siblings suffer from cardiovascular complications when they are still relatively young (men

- Risk factors can be changed:

Smoking: Smoking increases the risk of disease, not only cardiovascular diseases but also other diseases such as lung cancer, throat cancer . Smoking increases the risk of coronary artery disease. 2 times. When stopping smoking, this risk will decrease.

Sedentary lifestyle: People who do not exercise regularly will have a lower life expectancy than those who practice regularly.

Diseases such as hypertension, diabetes, obesity, dyslipidemia are also causes of stable angina. In adults, if cholesterol levels rise above 10% of normal values, the risk of cardiovascular complications will increase by 30%. It is more important to analyze the different components of cholesterol in the blood: LDL-C, HDL-C .

Drinking too much alcohol and beer is also an important cause of local chronic anemia in the heart muscle, causing stable angina attacks.

Important measures to detect disease

To determine if the signs of chest pain are caused by coronary artery disease, the doctor may have to conduct some basic exploration.

Resting electrocardiogram: is a screening probe for coronary artery disease. About 60% of patients with stable chest pain have an electrocardiogram at normal rest. Some patients may have Q waves (indicating that there is an old myocardial infarction), a stubborn, erect, ST segment. In addition, electrocardiography also helps detect other lesions such as left ventricular hypertrophy, branch block, pre-stimulant syndrome . ECG in pain can see the change of wave T, ST segment (paragraph ST elevation, T negative). However, if the electrocardiogram during normal pain does not rule out the diagnosis.

Stress test : is a method in which an electrocardiogram is recorded while the patient is exerting force (with a running mat or a dynamometer bicycle). The level of exercise is increased gradually until the heart rate reaches the maximum theoretical heart rate (theoretical maximum heart rate = 220 - age of the patient) or until chest pain or Abnormal manifestations on the electrocardiogram. In addition to the diagnostic value, the stress test also helps to assess patients with high-risk coronary artery disease.

Cardiac scan : To confirm the diagnosis, the doctor must inject into a vein a radioactive isotope (Thalium 201 or Technectium 99m) capable of attaching itself to a healthy heart muscle at the end of the stress test. . The patient is then placed under a machine that measures radioactive activity and the image of the heart muscle is recorded, which is myocardial radiography. The second image was recorded several hours after rest. The oxygen-deprived heart muscle region due to narrowed or blocked coronary arteries will not be fitted with radioisotopes and create a 'defect' on the image of myocardial scintigraphy immediately after exertion. On photos taken during a break, the 'defect' image will be present if the patient has a heart attack.

Strenuous echocardiography: Includes analysis of the response of the left ventricle in conditions of greater work. To do that, a special drug is injected or given intravenously to increase the heart rate. If the coronary arteries are normal, the contraction of the ventricles becomes stronger and evenly. If the coronary artery is narrowed, the contraction of the corresponding cardiac muscle will be reduced. A region of the heart muscle is reduced or inactive, if it is possible to restore normal contractions with a certain dose of medicine, it will show the 'viability' of that heart muscle area.

24-hour electrocardiogram (electrocardiographic Holter): A small electrocardiograph is attached to the patient. Patients can walk and work normally. The device will automatically record all heart activity continuously for 24 hours. The doctor will analyze the ECG images recorded on the machine to see if the patient has an arrhythmia or coronary artery disease.

Coronary angiography (Multislices CT scanner): The tomography machine has a very fast speed that allows for coronary artery imaging. The machine will automatically rebuild the coronary artery system image in 3-dimensional space. The doctor will analyze images of coronary artery tomography to see if it is calcified, narrowed or blocked.

Selective coronary angiography: Helps to diagnose the disease, accurately assess the level of coronary artery damage, and help choose the most appropriate treatment method: medical treatment, coronary intervention transdermal or bypass surgery on the host-rim.

Treatment of stable angina

There are 3 main treatments:

Photos of coronary artery tomography (Photo: TTO)

Medical treatment : drug therapy, can use one or more drugs combined. This method reduces symptoms but does not resolve the cause of coronary artery stenosis.

Sino-coronary bypass surgery: anemia of the heart muscle is supplied with blood by another blood vessel that bypasses the narrowed or blocked coronary artery.

Percutaneous coronary intervention: this is a modern method that is being applied effectively in our country, without having to dissect but just reduce symptoms, and solve the cause of coronary artery stenosis.

The long-term treatment of stable angina can be summarized as follows:

A (aspirin and anti-anginals): take aspirin and anti-angina medications.

B (beta blocker and blood pressure): use sympathetic beta blockers and treat hypertension.

C (cholesterol and cigarettes): treatment of blood cholesterol and smoking cessation disorders.

D (diet and diabetes): diet and diabetes treatment.

E (education and exercise): exercise regularly.

Prevention

Whether the patient has been treated by surgical or cardiovascular intervention, the lifestyle changes, treatment of some related diseases and continued long-term use of some drugs are essential to treatment and prevention of angina.

Lifestyle changes: Smoking is the leading cause of disease, so no smoking is an important requirement. Build a peaceful, happy lifestyle, avoid excessive stress, especially stress.

Minimize fat intake, eat more green vegetables, fruits, eat less sugar, butter, cheese , should not eat salty, melon dishes, more limited coffee. In particular, should not be happy with animal visceral items, many people think that 'eating anything' should be heart disease and then eat animal heart, this is not only not heart-healthy but also increases the risk factors for the heart, which is an increase in harmful cholesterol. Do not drink much alcohol, beer and other stimulants.

Exercise regularly , especially on daily walks, preferably 30 minutes a day in the morning or evening.

For those who have had stable angina pectoris, all the above requirements need to be abstained and carried out thoroughly, and to detect and treat coronary artery disease-related diseases such as diabetes and confusion. dyslipidemia, hypertension, obesity, overweight.

According to TS.BS. Nguyen Quang Tuan (Cardiologist, Hanoi Medical University)