Ministry of health of republic of uzbekistan tashkent medical academy

Progressive angina
Progressive exertional angina (PS) is always regarded as the NS. It occurs usually in patients with more or less a long history of stable angina, evidencing the "intensification" of the disease. For the diagnosis of TS, should be aimed, first of all, to a qualitatively new nature of pain:
1. In patients, there is a significant increase in frequency and increase in duration and intensity of attacks of angina.
2. Pain attacks are provoked by physical and psycho-emotional stress, indicating a change in functional class of angina (III FC).
3. Chest pain of rest joins angina (if they weren`t exist before) (IV FC).
4. The effectiveness of nitroglycerin and other antianginal drugs previously used by patients to relieve or prevent angina is significantly reduced.
Angina of rest
Heavy and prolonged chest pain of rest (if not previously identified in this patient) is one of the most dangerous in the prognostic clinical variants of the NS. According to some reports, the incidence of MI within 1-2 months from the first occurrence of anginal episodes is 40-50%, and the mortality rate - 11-15%.
In fact, this form can be detected in patients with progressive angina (in those cases where the angina and chest pain of rest are attached), and in patients with AF and Prinzmetal angina. The sudden appearance of such pain attacks against a relatively stable course of the disease is also possible.
This form of NA is repeated clinically and severe chest pain of rest lasting for more than 15-20 minutes. Intense of chest pain is often accompanied by sharply attacking weakness, sweating, shortness of breath, transient arrhythmias and conduction and / or a sudden drop in blood pressure. The pain usually appears alone, without previous loads, and is becoming more refractory to nitroglycerin. To her relief often requires the use of narcotic analgesics. Here, exercise tolerance falls sharply.
Heavy and frequent bouts of spontaneous (variant) angina Prinzmetalis also related to very unfavorable form of the NS. According to some authors, in the next 2-3 months,1/4 - 1/2 patients with spontaneous variant angina are developing MI or sudden cardiac death.