Overview
Worsening exertional angina refers to a sudden increase in the number of episodes of angina pectoris in a short period of time in patients with stable exertional angina pectoris, prolonged duration and aggravation of the degree of angina pectoris, caused by lighter and lighter activities, and even at rest, which is not easy to be relieved by the use of nitroglycerin. Since the patient is at risk of acute myocardial infarction at any time, timely treatment should be provided in hospital, including bed rest, continuous ECG monitoring, and close observation of changes in the patient’s condition.
Etiology
Angina pectoris is induced by increased myocardial oxygen demand due to factors such as physical labor or emotional excitement. The main cause is organic coronary artery stenosis so that the blood flow can not meet the needs, there is insufficient blood supply and chest pain occurs.
Symptoms
The pain may be located in the lower sternum, left precordial region or upper abdomen, radiating to the neck, jaw, left scapula or right anterior chest, and the pain may disappear quickly or there may be only left anterior chest discomfort and a feeling of tightness.
Examination
1. Electrocardiogram.
2. X-ray examination of the heart.
3. Radionuclide examination
4. Coronary angiography
5. Intravascular ultrasonography.
6. Angioscopy.
Diagnosis
In patients with stable angina, the frequency and duration of attacks have recently increased and the pain has become more severe. Angina may occur even with light activity and is not relieved by rest. The diagnosis is made by combining the results of coronary angiography and electrocardiography.
Treatment
Initially, intravenous nitroglycerin is continuously dripped for 1 to 2 days, and oral medications are mainly beta-blockers, together with nitrates and calcium antagonists. To prevent platelet aggregation and thrombosis, antiplatelet drugs such as enteric-coated aspirin or subcutaneous heparin are usually administered orally for 7 to 10 days in the absence of bleeding complications.
Routine thrombolytic therapy is not advocated for patients with worsening angina. Coronary angiography should be performed as soon as possible after the disease is stabilized, and according to the results, interventional therapy or coronary artery bypass grafting should be carried out at an opportune time, and if there is a lesion of the left main coronary artery, surgical treatment should be adopted as soon as possible.
Prognosis
Since the patient is at risk of acute myocardial infarction at any time, timely treatment should be provided in the hospital, including bed rest, continuous electrocardiogram monitoring, and close observation of changes in condition.
Prevention
1. Strictly control the diet, pay attention to the regulation of blood lipids and blood pressure, and do not smoke, do not drink, and control the weight.
2. Reduce sedentary and other bad habits, and maintain appropriate and moderate exercise.
3. Regular checkups.