ECG signs of stable angina

IHD is caused by stenosis of the coronary arteries. 

• Stable angina pectoris is manifested by characteristic symptoms, namely, compressive chest pain, during which specific objective changes, for example, on the ECG or in the level of biochemical markers in the blood serum ( creatine kinase activity , its CF fraction and troponin concentration ), are absent. 

• Resting ECG is often normal, sometimes mild ST segment depression or negative T wave may be recorded.

• The pathophysiological mechanism of stable angina pectoris is associated with moderate to severe coronary artery stenosis. As a result of stenosis during physical activity, myocardial ischemia develops, accompanied by insufficient oxygen delivery to the heart muscle. Stable angina is a chronic form of coronary artery disease and is usually caused by moderate to severe coronary artery stenosis. At rest, stable angina does not appear. A typical clinical manifestation of this form of ischemic heart disease is an attack of chest pain, which mainly appears during physical exertion. Here are 5 main features of such pain.

 

Five typical features of angina pain are:

• Localization. The pain is localized behind the sternum and usually radiates to the left arm. Patients often report feeling short of breath. Pains that are localized to the apex of the heart and often last for several hours were previously considered “true heart pains.” However, such pain is not typical for angina pectoris. 

• The nature of the pain. The pain is usually dull, aching or burning and often squeezing, “like a hoop squeezing the chest,” hence the Latin name ” angina pectoris “, which translates as “tightness in the chest.” The stabbing chest pain is almost always harmless and not associated with heart disease. 

• Provoking factors. An attack of pain with stable angina pectoris is provoked by physical or psychoemotional stress, stress, inhalation of cold air, as well as abundant food. If pain in the region of the heart appears in a state of complete rest and passes with physical exertion, angina pectoris can be excluded. 

• Factors that relieve pain. Nitroglycerin preparations have a good effect on angina pectoris. So, after taking one capsule of nitroglycerin, the pain usually goes away quickly. In healthy people, taking nitroglycerin causes headaches. 

• Duration. The pain usually does not last long, often only a few minutes; if it lasts more than a quarter of an hour, MI should be suspected. These 5 features should always be kept in mind. A targeted questioning of a patient who complains of chest pain and clarification of the described features allows in many cases to make an accurate diagnosis. Resting ECGs with stable angina are often normal. Sometimes there are nonspecific changes in the form of a slight decrease in the ST segment or a negative T wave. These changes in the ST interval are recorded mainly in leads V5 and V6, as well as I and aVL , especially during an attack. ECG of a patient with a history of angina. Currently, there are no attacks. A slight decrease in the ST segment and a negative T wave in leads V3-V5. However, trough-shaped ST-segment depression is sometimes observed, which is usually caused by digitalization or, less often, other forms of coronary artery disease. In coronary artery disease, primary changes in other ECG indicators, such as the P and R wave, QRS complex, or PQ interval, are not characteristic. Registration of a pathological Q wave indicates a previous MI, which confirms the diagnosis of ischemic heart disease. The symptoms of ischemic heart disease, as already mentioned, appear during exercise. Moreover, in 50% of patients with coronary artery disease, confirmed by coronary angiography , the ECG at rest may be absent. Therefore, at present, with appropriate clinical symptoms, in addition to an ECG at rest, an ECG test is performed with dosed physical activity on a bicycle ergometer. In addition, ECG and EchoCG monitoring is also performed , as well as the level of biochemical markers of myocardial necrosis in the blood serum is determined. Further, if necessary, myocardial scintigraphy , stress echocardiography and stress MRI are performed . Direct confirmation of coronary artery disease can be obtained by coronary angiography . The results of a blood test for serum markers, such as creatine kinase , its myocardial (MB) fraction, troponins I and T, with stable angina pectoris are negative. Tactics for stable exertional angina: • drug therapy (eg, nitrates, beta-adrenergic receptor blockers, calcium channel blockers, statins , aspirin); • after coronary angiography, if necessary, perform percutaneous coronary intervention (PCI) or coronary artery bypass grafting. Features of stable exertional angina: • No complaints at rest • The appearance of an attack of chest pain only with exertion • No changes in the ECG at rest • Normal level of creatine kinase activity and troponin concentrations Educational video ECG for angina pectoris and types of ST segment depression Download this video and watch from another video hosting is available on the page: Here. In the course of preparing this article for the users of MedUniver.com, the works of Belenkov Yu.N., Belyalov F.I., Bockeria L.A., Kovalev I.A., Oganov R.G., Alexander R., Branch W. were used. , Glyn T., Lyon You A. The – We also recommend “The symptoms of atypical angina on ECG angina Prinzmetal , silent myocardial ischemia” topics Index “Deciphering ECG (electrocardiogram)”: Common signs of cardiac hypertrophy in the ECG signs of ventricular hypertrophy, left ventricular hypertrophy on electrocardiogram signs right ventricle on ECG General signs of bundle branch block on ECG Signs of complete right bundle branch block (RHBB) on ECG Signs of incomplete right bundle branch block (RHBB) on ECG Signs of complete left bundle branch block (LBB) on ECG Signs of ischemic heart disease (IHD) on ECG Signs of stable angina on ECG Signs of atypical angina on ECG: Prinzmetal angina , mute myocardial ischemia Your questions and feedback:

However, trough-shaped ST-segment depression is sometimes observed, which is usually caused by digitalization or, less often, other forms of coronary artery disease. In coronary artery disease, primary changes in other ECG indicators, such as the P and R wave, QRS complex, or PQ interval, are not characteristic. Registration of a pathological Q wave indicates a previous MI, which confirms the diagnosis of ischemic heart disease. The symptoms of ischemic heart disease, as already mentioned, appear during exercise. Moreover, in 50% of patients with coronary artery disease, confirmed by coronary angiography , the ECG at rest may be absent. Therefore, at present, with appropriate clinical symptoms, in addition to an ECG at rest, an ECG test is performed with dosed physical activity on a bicycle ergometer. In addition, ECG and EchoCG monitoring is also performed , as well as the level of biochemical markers of myocardial necrosis in the blood serum is determined. Further, if necessary, myocardial scintigraphy , stress echocardiography and stress MRI are performed . Direct confirmation of coronary artery disease can be obtained by coronary angiography . The results of a blood test for serum markers, such as creatine kinase , its myocardial (MB) fraction, troponins I and T, with stable angina pectoris are negative. Tactics for stable exertional angina: • drug therapy (eg, nitrates, beta-adrenergic receptor blockers, calcium channel blockers, statins , aspirin); • after coronary angiography, if necessary, perform percutaneous coronary intervention (PCI) or coronary artery bypass grafting. Features of stable exertional angina: • No complaints at rest • The appearance of an attack of chest pain only during exertion • No changes in the ECG at rest • Normal level of creatine kinase activity and troponin concentrations

Opioids , codeine, pegidine in dentistry – features of the appointment

Opioids are not administered to a patient with suspected head injury, as the drug may mask pupillary symptoms of increased intracranial pressure due to their effects on pupillary -suzhivayuschy center. In therapeutic dentistry, narcotic analgesics are used less frequently than in surgical dentistry or maxillofacial surgery. Basically, opiates have a depressive and stimulating effect on the central nervous system. Depressive effect on pain, respiratory, vasomotor and cough centers. Stimulates vomiting, salivation and pupillary constriction. On a note. The positive effect of the drug is achieved to a greater extent by changing the patient’s perception of pain, rather than reducing pain as such. Dependence on opioids . The patient may develop both psychological and physiological dependence on opiates. It manifests itself with a need for medication and mental disorders in response to their withdrawal. Opioid tolerance . It occurs when the dose is increased to a certain level of therapeutic effect. This effect is limited to a depressive effect on the central nervous system. Uniform muscle stimulation underlies constipation (this effect of opiates is less than that of codeine).

Codeine in dentistry Usually not used alone, it is often used in combination with non-narcotic analgesics such as aspirin or paracetamol. It is an effective antitussive agent with no specific pain relieving properties. Dihydrocodeine tartrate in dentistry Has a similar effect to codeine. Recommended in cases of severe toothache, in which it works better than NPP; also used after oral surgery. Side effects: nausea, vomiting, constipation and drowsiness. Higher doses can cause hypotension and respiratory depression. Serious interactions can be with antidepressants, especially monoamine oxidase inhibitors , and some other drugs (see DPF / BNF). It is advisable to avoid its appointment or to use it with caution in old age, in children with bronchial asthma, in combination with antihypertensive therapy, in pregnant and lactating women, as well as in patients with liver and kidney disease. Doses: 30 mg per os after 4-6 hours. Can be administered intramuscularly at 50 mg every 4-6 hours. Pegidine in dentistry More suitable for outpatient use than morphine. Its side effects are less pronounced than morphine, but it is necessarily addictive and unacceptable for long-term use. Dose: adult – 50-100 mg per os 4 times a day.

Gastritis as a dental pathology.

The main reasons that cause erosion in the stomach are different. The first place is taken by drugs: aspirin, salicylates (non-ionized weak acids), phenylbutazone indomethacin glucocorticoids immunosuppressants , antibiotics, sulfanilamides , antipyretics, reserpine, etc .; alcohol, urea, butyric and bile acids also damage the stomach lining. The herpes virus can also cause erosion; the virus remains in a latent state for a long time, until it is activated by radiation therapy and chemotherapy, malignant diseases and others. Of no small importance in the development of gastritis is the pathology of the oral cavity. As a rule, it is pulpitis. The reasons for the development of gastritis with pulpitis have been known for a long time. First, it is eating disorder. Secondly, constant pain syndrome stimulates the secretion of hydrochloric acid in the stomach. It is not uncommon for gastritis to develop during dental treatment without anesthesia. Severe pain syndrome causes the release of glucocorticosteroids , which increase the pathological process in the gastric mucosa. Therefore, it is especially important to carry out dental treatment under general anesthesia. Duodenogastric reflux with erosive gastritis, – very often bile acids and pancreatic enzymes have a damaging effect on the mucous membrane of the pylorus. There are three hypotheses for the occurrence of acute erosive changes in the gastric mucosa: 1) local vascular disorders; 2) the release of glucocorticoids under stress, which reduce the secretion of mucus and change its composition, inhibit the mitosis of epithelial cells; 3) reverse diffusion of hydrogen ions from the lumen to the stomach and its mucous membrane. As a rule, pathological microorganisms contained in the oral cavity, in particular on the teeth, have a certain role in the development of gastritis. Pathological microorganisms on the teeth are removed only by regular bleaching at home or in a dental office.

There is nothing specific about the gastritis clinic. After taking the medicine (after 1 – 3 days) or dental treatment without anesthesia, vomiting, sour belching with heartburn, abdominal pain that occurs after eating, sometimes colic, appears; the presence of traces of microscopic hemorrhages is noted in the stool. When erosions are localized in the body of the stomach and subcardially , vomiting occurs with a clear admixture of blood, and later melena. If hemorrhages occur in the antrum or duodenum, hematemesis and melena are noted . More severe symptoms (massive hemorrhages, perforation) are manifested in combined pathology (peptic ulcer). With herpetic erosive gastritis, temperature is observed, sometimes trembling, vomiting, dysphagia. Often the esophagus is also involved. Usually there are no aphthae in the oral cavity, and the need for teeth whitening draws on itself. Gastritis may appear at the same time as a skin rash or precede it. Teeth whitening is the prevention of herpetic erosive gastritis, the price of this service, today, is at an acceptable level. When teeth whitening, a nutrient medium for microorganisms is removed, which, by lowering local immunity, contribute to the development of herpetic gastritis. When diagnosing gastritis, you should pay attention to the following points. There is a history of medication. The presence of herpetic erythema-vesicular rashes on the skin. Endoscopically , erosions are found mainly subcardially and in the body of the stomach, single or multiple, up to 2-3 mm in size, oval, sometimes hyperemic around. X-ray examination does not show the presence of erosion due to their superficial location. Treatment consists in the abolition of drugs and the use of symptomatic remedies, tooth extraction, especially with signs of a chronic infection, also contributes to a quick recovery. In case of hemorrhage – blood transfusion, hemostatics , calcium supplements, a gentle diet, etc. The prognosis of gastritis is favorable, especially when a chronic infection in the oral cavity is rehabilitated. Erosions disappear after a few days, very rarely within a few weeks after stopping the medication.

local_offerevent_note November 16, 2020

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