Peculiarities of the Clinical Picture of Microvascular Angina, Angina Pectoris in Pathologically Entangled Vessels and Prinzmetal Angina

Despite the success achieved in recent decades in the prevention and treatment of coronary heart disease, it still represents one of the pressing issues. Stable stress angina remains a classic option, but the percentage of stable angina pectoris with angiographically intact vessels (coronary syndrome X, microvascular angina pectoris) and angina pectoris (angiospastic, spontaneous, variant), as well as in pathologically entangled vessels, gradually increases leading to a search optimal methods for diagnosing and treating such patients. The classic program for treating patients in such cases is not always sufficiently effective. The purpose of the study is to research specific features of the clinical picture of microvascular angina, angina pectoris with pathologically entangled vessels and Prinzmetal angina. Materials and metods. The research was conducted on the basis of the Poltava clinical cardiology hospital. We studied 60 patients of different sex aged from 54 to 67 years old. Taking into account the above said we formed four groups: the first one had patients with stable angina pectoris, the second – with microvascular angina, the third – with Prinzmetal angina, the fourth group included patients with angina pectoris in pathologically entangled vessels (the clearance is not narrowed along the entire length, but the angles between the existing bends relative to the axis of the vessel were less than 90°, the length of the vessels exceeded the projection from the exit point to the end). All patients were asked to complete a questionnaire including the following items: duration and course of the disease, duration and nature of angina attacks, provocative factors, methods and means of relief, concomitant diseases, heredity, and bad habits. We also performed the following examinations: biochemical blood test with the definition of the lipid spectrum (cholesterol, high and low density lipids, HDL, LDL), triglycerides), coagulogram, echocardioscopy, Holter monitoring of the electrocardiogram, veloergometric test, coronary angiography. Results and discussion. The results were as follows: with stable angina of stress for all patients, it was common that physical activity was a provoking factor, in the biochemical analysis of blood hypercholesterolemia due to cholesterol and low density lipoprotein, the bicycle ergometric test was positive and during coronary angiography there were stenoses of arteries more than 50 %. At microvascular angina – the attacks occur at any time regardless of physical activity or psycho-emotional strain, during conduction of coronary angiography, no pathological changes in the arteries were detected. In the angina pectoris, the characteristic circadian syndrome of angina attacks is more common in the morning, even during sleep and the presence of appropriate changes in the electrocardiogram during the attack itself: the RS-T segment is higher than the isoelectric line, the appearance of the pathological Q-tooth, the increase of the R wave, the expansion of the QRS- the complex. For pathologically entangled vessels, it was confirmed angiographically. All the representatives of the group had arterial hypertension, which is an etiological factor in their formation.