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Early post-infarction angina
Early postinfarction angina occurring during the period from 48 hours to 2 weeks after acute myocardial infarction, in its prognostic value is also related to the NS. Resumption of anginal attacks in the early post-MI significantly affects both short-and long-term prognosis of MI: by the end of the first year, the frequency of relapses of MI is 50%, and mortality rate - 17%. Early postinfarction angina usually indicates incomplete thrombolysis in occluded spacecraft and formation of thrombus, including in other vascular areas, where there is a multivessel disease spacecraft.
Clinically anginal pain in these patients is not much different from ordinary angina, and there are cases like severe pain at rest and / or low loads, refractory to antianginal therapy, and cases of non-intensive anginal pain, provoked only excessive exercise. But in all these cases, early resumption of angina in patients with myocardial infarction is treated as NA.
Thus, a careful analysis of the main characteristics of the pain and other medical history is, in most cases, allows to distinguish among the patients of the disease with unstable coronary artery.
The term "unstable angina" (NA) proposed byFovler N. and C. Contyis used today to refer to the most difficult period of CHD, which is characterized by rapid progression of coronary artery disease and a high risk of myocardial infarction and sudden cardiac death (up to 15 20% at 1 year). Isolation of this form of ischemic heart disease, no doubt, is great practical importance, as the doctor directs to the possible early detection and aggressive treatment of patients with a high risk of fatal complications.
To unstable angina the following clinical forms are included.
1. First appeared angina of unstable flow (within 1 month after a first attack of angina pectoris).
2. Progressive exertional angina (sudden increase in frequency, severity, duration of angina attacks in response to the normal for the patient physical activity, reducing the effectiveness of nitroglycerin and other drugs have previously been successfully used by patients).
3. Heavy and prolonged chest pain of rest (15-20 min), including severe cases of spontaneous (variant) angina.
4. Early post-infarction and post-operative (after coronary artery bypass surgery, transluminal angioplasty, etc.) angina.
In some cases, the NA may include other forms of coronary heart disease, as described in the previous chapter, such as BIM and form microvascular angina, severe and prolonged attacks of vasospastic angina Prinzmetal.
The term "acute coronary syndrome" has been introduced to the clinical practice in the late 80's of the last century, when it became clear that the application of some of the active treatments (such as thrombolytic therapy or primary coronary angioplasty) should be addressed to establish a definitive diagnosis - availability or absence of MI (Russian recommendations of an expert committee GFCF, 2001). In other words, acute coronary syndrome - this is only a preliminary diagnosis, which helps to choose the best tactics for patients in the very start of acute illness, when accurately confirming or refuting the diagnosis of myocardial infarction is presented impossible.
Depending on the results of the initial clinical examination and registration of 12-lead ECG, patients with acute coronary syndromes can be classified into one of two categories of patients with acute ischemic heart disease:
1. Acute coronary syndrome with persistent elevation RS-T or "new", first mooted with left bundle branch block.
2. Acute coronary syndromes without persistent ST elevation RS-T.
It was found that more thantwo thirds of patients with acute coronary syndrome with persistent elevation RS-T or the "new" blockade,have got infarction, and in most cases - transmural MI with tooth Q (Savantto et al., 1999). Only a small percentage of cases, the outcome of this form of acute coronary syndrome is the NS. Therefore, the main goal of treatment in these patients, before the establishment of an accurate diagnosis of MI, is possible rapid and complete restoration of coronary blood flow with the help of thrombolysis or primary angioplasty (see below).
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