Variant angina. Variant angina (Prinzmetal type angina)
angina pectoris, which is characterized by pain at rest with a transient rise in the ST segment (according to ECG), called variant. This type of angina pectoris is caused by a transient spasm of the coronary arteries, so it usually occurs without regard to physical activity. Variant angina was described by Prinzmetal in 1959.
The prevalence is unknown, but the disease appears to be rare.
Pathogenesis
The tone of the coronary vessels depends on the balance of vasodilating and vasoconstrictive factors. An increase in the activity of vasoconstrictor agents contributes to the development of spasm of the coronary arteries. Severe spasm causes ischemia, which is characterized by the rise of the ST segment on the ECG.
Clinical picture of variant angina pectoris.
Variant angina is characterized by the appearance of typical pain behind the sternum, more often at night or in the early morning hours, the duration of the attack can be more than 15 minutes. At the height of pain, ventricular arrhythmias or AV blockade may occur. Reception of nitroglycerin in most cases stops attacks of variant angina pectoris. Variant angina may occur with stable exertional angina in 50% of patients. Often note its appearance in patients in the acute period of myocardial infarction.
A characteristic feature of variant angina is migraine, which occurs in 25% of patients. In 25% of patients, variant angina is combined with Raynaud's phenomenon. Syncope due to ventricular arrhythmias or AV block may be diagnostic of variant angina. The disease can proceed in waves - after several attacks, a long break is possible, and then the resumption of attacks of variant angina pectoris.
Diagnostics.
If it is possible to record an ECG during a pain attack, then an increase in the ST segment (usually in several leads) is recorded, returning to the isoline after relief of the pain syndrome. 24-hour ECG monitoring can also detect ST-segment elevation episodes. ECG during the exercise test provokes angina pectoris with ST segment elevation in 30% of patients in the active phase of the disease.
For the diagnosis of variant angina, a cold test is sometimes used (place the hand to the middle of the forearm in water with a temperature of 4 degrees Celsius for 3-5 minutes; the test is considered positive if ischemic changes appear on the ECG during the dive or within the next 10 minutes).
In some cases, MRI is performed in the vascular mode during exercise tests, the data reveal anomalies in the rate of coronary blood flow in the anterior interventricular branch of the left coronary artery. Today, MRI is done in many clinics that are equipped with modern diagnostic devices.
Treatment of variant angina pectoris.
Nitroglycerin is used to relieve an attack of variant angina pectoris. With an exacerbation of the disease (more frequent attacks), it is possible to use prolonged-acting nitrates. Calcium channel blockers may also be recommended. A positive effect of the use of alpha-blockers, amiodarone, guanethidine, clonidine in variant angina was noted. Beta-blockers can prolong the attack of variant angina, so they are not indicated in this category of patients. Patients with variant angina pectoris, as in other forms of coronary heart disease, are shown to use acetylsalicylic acid for the prevention of myocardial infarction.
If a pronounced atheroscrotic narrowing of the arteries is detected using coronary angiography, coronary bypass grafting or balloon dilatation is recommended. However, there is evidence that rates of operative mortality and postoperative myocardial infarction in patients with variant angina are higher than in patients without variant angina.
Forecast.
Quite often, spontaneous disappearance of seizures occurs, which sometimes lasts for years. A number of patients develop myocardial infarction within 3 months. To a large extent, the severity of atherosclerosis of the coronary arteries affects the prognosis of patients with variant angina pectoris.
From the options provided, choose the one that you think is correct.
1. Which of the following is not typical for functional class I angina pectoris:
a) depression of the ST segment during the VEM test;
b) the occurrence of pain when lifting up to the 1st floor;
c) no ECG changes at rest;
d) irradiation of pain in the left shoulder;
e) pressing nature of pain.
2. What ECG changes reliably indicate coronary insufficiency during the VEM test:
a) reversion of the negative T wave;
b) prolongation of the PQ interval;
c) depression of the ST segment more than 2 mm;
d) the appearance of atrial extrasystole;
e) transient blockade of the right leg of the bundle of His.
3. What signs are not typical for variant angina pectoris:
a) transient rise of the ST segment on the ECG;
b) when coronary angiography in 10% of cases little changed or unaffected coronary arteries are detected;
c) seizures occur more often at night;
d) calcium antagonists are the most effective;
4. A 57-year-old patient complains that during the year 1-2 times a month in the morning there are chest pains of a compressive nature, extending under the left shoulder blade, which disappear within half an hour after taking nitroglycerin. With Holter monitoring: at the time of the attack, ST elevation in leads V2-V5 is 8 mm. The next day - ST on the isoline. What pathology does the patient have:
a) stable angina IV functional class;
b) myocardial infarction;
c) ischemic myocardial dystrophy;
d) variant angina;
e) progressive angina.
5. Which of the following variants of angina pectoris is an indication for hospitalization:
a) Prinzmetal's angina;
b) first appeared angina pectoris;
c) rapidly progressive angina pectoris;
d) frequent angina of exertion and rest;
e) all of the above.
6. In the event of an acute attack of pain in the epigastric region and behind the sternum in middle-aged men, the examination should begin with:
a) probing the stomach;
b) fluoroscopy of the gastrointestinal tract;
d) gastroduodenoscopy;
e) urine tests for uropepsin.
7. The following statements regarding painless myocardial ischemia are correct, except:
a) most often detected in persons with an established diagnosis of coronary artery disease;
b) the principles of treatment are the same as for typical angina pectoris;
c) the prognosis is the same as in the painful form of coronary artery disease;
d) the basis of the diagnosis are ECG changes;
e) monitoring ECG is important.
8. A 46-year-old patient, attacks of retrosternal pain began to occur at night, during which a transient rise in the ST segment was recorded on the ECG. Probable diagnosis:
a) Prinzmetal's angina;
b) repeated myocardial infarction;
c) development of post-infarction aneurysm;
d) seizures are not related to the underlying disease;
e) thromboembolism of the branches of the pulmonary artery.
9. A patient with acute myocardial infarction (day 1) developed an attack of palpitations, accompanied by severe weakness, a drop in blood pressure. On the ECG: the P wave is not defined, the QRS is widened (> 0.12 s) and deformed, the number of ventricular contractions is 150 per minute. Your diagnosis:
a) paroxysm of atrial fibrillation;
b) ventricular paroxysmal tachycardia;
c) atrial flutter;
d) sinus tachycardia;
e) supraventricular paroxysmal tachycardia.
10. A 48-year-old patient was brought to the clinic for acute transmural anterior septal myocardial infarction. Appeared shortness of breath, tachypnea, lowering blood pressure to 100/70 mm Hg. Art., tachycardia up to 120 per minute. Moist rales appeared in the lower parts of the lungs. In the 3rd-4th intercostal space along the left edge of the sternum, an intense systolic murmur with a gallop rhythm began to be heard. The oxygen saturation in the right ventricle is increased. Most likely diagnosis:
a) rupture of the outer wall of the ventricle;
b) pulmonary embolism;
c) rupture of the interventricular septum;
d) thromboendocarditis;
e) epistenocardiac pericarditis.
11. In which ECG leads is a posterolateral infarction detected:
a) AVL, V5-V6;
b) 2, 3 standard, AVF;
d) 2, 3 standard, AVF, V5-V6;
12. A 52-year-old patient with acute anterior myocardial infarction developed an asthma attack. On examination: diffuse cyanosis, in the lungs a large number of wet rales of various sizes. Heart rate - 100 beats / min. BP - 120/100 mm Hg. Art. What complication is most likely:
a) cardiogenic shock;
b) pulmonary embolism;
c) pulmonary edema;
d) rupture of the interventricular septum;
e) none of the above.
13. Which sign does not correspond to the diagnosis: hypertension 1 tbsp. in a 35-year-old patient:
a) no changes in the fundus of the eye;
b) glomerular filtration 80 ml/min;
c) the R wave in V5-V6 is 32 mm;
d) rapid normalization of blood pressure;
e) uric acid level = 7 mg% (0.40 mmol/l).
14. In what disease is arterial hypertension of paroxysmal type observed:
a) aldosteroma;
b) nodular periarteritis;
c) pheochromocytoma;
d) Itsenko-Cushing's syndrome;
e) acromegaly.
15. What is the cause of arterial hypertension in a patient with the following clinical signs: sudden onset of headache against the background of a sharp increase in blood pressure, accompanied by nausea, tachycardia, pallor of the skin, after an attack - polyuria:
a) Conn's syndrome;
b) Itsenko-Cushing's syndrome;
c) climacteric syndrome;
d) pheochromocytoma;
e) thyrotoxicosis.
16. Complete AV blockade is characterized by all signs, except for one:
a) pulse rate - 36 per minute;
b) correct rhythm;
c) increased heart rate during exercise;
d) increase in systolic blood pressure;
e) changing intensity of heart sounds.
17. A 42-year-old patient suffering from mitral heart disease developed frequent atrial extrasystoles after a sore throat, felt by the patient as unpleasant “shocks” in the chest. What threatens this violation of the rhythm:
c) the occurrence of paroxysmal tachycardia;
d) the appearance of coronary insufficiency;
e) the development of ventricular fibrillation.
18. The cause of atrial fibrillation can be all of the following diseases, except:
a) neurocirculatory asthenia;
b) rheumatism;
d) thyrotoxicosis;
e) dilated cardiomyopathy.
19. Detection on the ECG of PQ lengthening equal to 0.28 s indicates that the patient has:
a) blockade of sinoatrial conduction;
b) blockade of atrioventricular conduction of the 1st degree;
c) blockade of atrioventricular conduction of the 2nd degree;
d) blockade of atrioventricular conduction of the 3rd degree;
e) syndrome of premature excitation of the ventricles.
20. A 52-year-old patient complains of short-term pain in the region of the heart. Sick for 2 weeks. after ARI. On the ECG - a decrease in the ST segment by 1.5 mm and a negative T wave. ESR - 45 mm / h. Presumptive diagnosis:
a) climacteric cardiomyopathy;
d) myocarditis;
e) pericarditis.
21. A systolic murmur at the base of the heart has been noticed since childhood in a 22-year-old man. BP - 150/100 mm Hg. Art. Chest x-ray: left ventricular enlargement, uneven, jagged lower edges of 5-7 ribs on both sides. Reduced pulsation in the legs. Diagnosis:
a) stenosis of the aortic mouth;
b) atrial septal defect;
c) coarctation of the aorta;
22. An 18-year-old patient was sent for examination by the military registration and enlistment office. Developed normally. Above the base of the heart, a rough systolic murmur is determined with an epicenter in the 2nd intercostal space at the right edge of the sternum, carried out to the carotid arteries. The second tone over the aorta is weakened. Pulse - 64 per minute, rhythmic. BP of the brachial artery - 95/75 mm Hg. Art., on the femoral artery blood pressure - 110/90 mm Hg. Art. Your diagnosis:
a) stenosis of the aortic mouth;
b) combined heart disease;
c) coarctation of the aorta;
d) ventricular septal defect;
e) open ductus arteriosus.
23. A 19-year-old patient was referred for examination with a presumptive diagnosis of mitral heart disease. Examination revealed a systolic murmur at the apex of the heart. What method of examination is the most informative for confirming or excluding the diagnosis of heart disease:
b) echocardiography;
c) chest X-ray;
d) blood test for antistreptococcal antibody titers;
e) none of the listed methods.
24. A 42-year-old patient suffering from mitral heart disease developed atrial extrasystoles after angina. What threatens this violation of the rhythm:
a) the development of circulatory failure;
b) the appearance of atrial fibrillation;
c) the appearance of coronary insufficiency;
d) all of the above;
e) none of the above.
25. What parameter is the first to react to the functional inferiority of the left ventricle:
a) peripheral vascular resistance;
b) the level of pressure "jamming" in the pulmonary artery;
c) radiological signs of stagnation;
d) all of the above.
26. Which of the following seafood contains a large amount of cholesterol:
a) shrimp
b) mackerel;
c) trout;
Answers
1 - b. 2 - c. 3 - d. 4 - d. 5 - d. 6 - c. 7 - a. 8 - a. 9 - b. 10 - c. 11 - d. 12 - c. 13 - c. 14 - c. 15 - d. 16 - c. 17 - b. 18 - a. 19 - b. 20 - d. 21 - c. 22 - a. 23 - b. 24 - b. 25 - b. 26 - a.
TASKS
Task #1
Man 56 years old. For 2 years, she has been experiencing shortness of breath, palpitations and headaches. However, he did not go to the doctors, maintaining his ability to work. Deterioration of health was noted during the last 3 weeks: shortness of breath increased significantly, began to disturb at rest, forcing the patient to sleep with the head of the head raised high.
Objectively: acrocyanosis, pale skin. Heart sounds are muffled, arrhythmic, accent II tone on the aorta. Weakened breathing in the lungs, single moist rales in the lower sections. Heart rate 130-150 bpm, pulse deficit 20, BP 210/130 mm Hg. Art. S=D. The liver is not enlarged. There are no peripheral edema.
ECG: Tachysystolic form of atrial fibrillation. Signs of LVH.
Fundus of the eye: hypertensive neuroretinopathy.
Blood test: cholesterol - 8.2 mmol / l, triglycerides - 2.86 mmol / l (otherwise - without features).
Urinalysis: no features.
Renal scintigraphy: the right kidney is without features. The left one is significantly reduced in size, the accumulation and excretion of the drug is sharply slowed down.
EchoCG: the aorta is sealed. LA=4.9 cm, CDR=6.7 cm, CSR=5.2 cm, TMZhP=1.7 cm, TCL=1.1 cm.
Questions:
1. What additional studies should be carried out to clarify the diagnosis?
2. Formulate the most likely diagnosis.
Task #2
The patient is 28 years old. From early childhood, according to the mother, they listened to the noise in the heart. However, the diagnosis was not specified. For the last 3 years, periodically began to notice episodes of dizziness, palpitations, "darkening" in the eyes and pressing pains behind the sternum during physical exertion, passing at rest.
Objectively: heart rate 80 bpm, blood pressure 120/80 mm Hg. Art. During auscultation of the heart, a systolic murmur is heard with a maximum at the Botkin point. The rest of the organs - without features.
ECG: sinus rhythm, 80 bpm. Single atrial extrasystole. Signs of LVH nature of overstrain.
Echocardiography: LA=4.4 cm, EDR=4.4 cm, ESR=2.8 cm, TMZhP=2.2 cm, TZS=1.1 cm. The systolic deflection of the anterior leaflet of the mitral valve and systolic cover of the right coronary leaflet are determined aortic valve. With D-EchoCG - high-speed turbulent current in the outflow tract of the left ventricle.
Questions:
1. Formulate a detailed diagnosis of the patient.
2. What additional studies should be carried out to clarify the features of the course of the disease?
Answers
Task #1
1. Abdominal aortography, determination of plasma renin activity.
2. Diagnosis: stenosing atherosclerosis of the left renal artery. Vasorenal hypertension (malignant course). Hypertonic heart. Atrial fibrillation (tachysystolic form). NC IIB Art. (III FC according to NYHA). Hyperlipidemia IIB type.
Task #2
1. Hypertrophic cardiomyopathy with obstruction of the outflow tract of the left ventricle. Relative coronary insufficiency. Atrial extrasystole.
2. Stress test, ECG monitoring, determination of blood lipids. With a tendency to increase blood pressure - a study of the fundus and blood pressure monitoring to exclude arterial hypertension and hypertensive heart.
Angina characterized by pain at rest with transient ST elevation is called variant angina. In addition, unstable angina is possible. This type of angina is caused by signs of transient spasm of the coronary arteries, so it usually occurs without regard to physical activity. In this article, we will look at the symptoms of angina pectoris and the main signs of angina pectoris in humans. Diagnosis of angina pectoris of various types is carried out according to a specific algorithm. More on this below.
Symptoms of angina pectoris
Symptoms of variant angina
Variant angina is characterized by the appearance of a typical symptom - anginal pain behind the sternum, more often at night or in the early morning hours, the duration of the attack can be more than 15 minutes. At the height of pain, ventricular arrhythmias or AV blockade may occur. Sublingual administration of nitroglycerin in most cases stops an attack of variant angina pectoris. Signs of variant angina may occur with stable exertional angina in 50% of patients. Often, its appearance is noted in patients in the acute period of myocardial infarction, as well as after coronary artery bypass surgery and percutaneous transluminal coronary angioplasty.
The prevalence of symptoms of angina pectoris is unknown, but the disease appears to be quite rare.
Symptoms of unstable angina
The leading clinical symptom of unstable angina is pain. The main condition from which unstable angina should be differentiated is myocardial infarction, and in the first place - small-focal (without Q wave).
In the United States, about 750,000 patients are hospitalized with a diagnosis of unstable angina during the year.
Signs of angina pectoris
Signs of variant angina
A characteristic concomitant symptom of variant angina is migraine, which occurs in 25% of patients. In 25% of patients, variant angina is combined with signs of Raynaud's phenomenon. Syncope due to ventricular arrhythmias or AV block may be diagnostic of variant angina. From the anamnesis, it can be found out in patients that the pain appears at night or early in the morning without connection with external factors. The disease can proceed in waves - without any special signs and symptoms, after several attacks, a long period of remission is possible, and then the resumption of attacks of variant angina pectoris.
Signs of unstable angina
- Unstable angina is manifested by signs of typical attacks, but when taking an anamnesis, characteristic signs of progression of angina pectoris can be identified.
- Over the past 1-2 months, the number, severity and duration of angina attacks have increased.
- Attacks have never occurred before, appeared no more than 1 month ago (first-time angina pectoris, de novo angina pectoris).
- Attacks of stenocardia began to appear at rest or at night.
- An important clinical sign of unstable angina is the absence or weakening of the effect of nitroglycerin, which previously stopped angina attacks.
Causes of angina pectoris
Causes of signs of variant angina pectoris
The tone of the coronary vessels with symptoms of angina pectoris depends on the balance of vasodilating and vasoconstrictive factors. Vasodilating signs include nitric oxide (NO), the so-called endogenous relaxing factor. In the presence of signs of atherosclerosis and hypercholesterolemia, the production of this factor by the endothelium apparently decreases, or it decays to a greater extent, i.e. decreased endothelial vasodilator function. This leads to an increase in the activity of vasoconstrictive agents, which contributes to the development of spasm of the coronary arteries. Severe spasm causes symptoms of transmural ischemia, which is characterized by signs: dyskinesia of the left ventricular wall, detected by echocardiography, and elevation of the ST segment on the ECG.
Causes of signs of unstable angina
The etiology of the symptoms of unstable angina is similar to that of exertional angina. The main mechanism for the development of unstable angina is the rupture of the fibrous plaque capsule in the cardiac artery. The presence of a thrombus in angina pectoris prevents adequate blood supply to the myocardium, which leads to the appearance of a pain symptom and a detailed clinic of unstable angina pectoris. The rupture of the fibrous plaque is facilitated by the accumulation of a large amount of lipids and an insufficient content of collagen in it, inflammation and hemodynamic factors. Other signs of angina responsible for the development of unstable angina are:
- intraplaque hemorrhage due to vasa vasorum rupture;
- increased platelet aggregation;
- decrease in antithrombotic properties of the endothelium;
- local vasoconstriction due to the release of vasoactive agents, such as serotonin, thromboxane A2, endothelium, in response to the violation of the integrity of the fibrous plaque.
Diagnosis of angina pectoris
ECG in the diagnosis of variant angina pectoris
If it is possible to record an ECG during a pain attack, then an increase in the ST segment is recorded (more often in several leads at once), returning to the isoline after relief of the pain syndrome. 24-hour ECG monitoring for the diagnosis of angina pectoris can also detect episodes of ST elevation. The symptom of variant angina pectoris on the ECG during the exercise test provokes angina pectoris with ST segment elevation in 30% of patients in the active phase of the disease.
Provocative tests in the diagnosis of variant angina pectoris
For the diagnosis of variant angina pectoris, provocative tests are used: cold, hyperventilation test, pharmacological tests with dopamine, acetylcholine. A cold test can detect an attack of angina pectoris and ECG changes in 10% of patients (place the hand to the middle of the forearm in water at a temperature of 4 ° C for 3-5 minutes; the test is considered positive if ischemic signs appear on the ECG during the dive or during the next 10 minutes) .
Coronary angiography in the diagnosis of variant angina pectoris
Coronary angiography reveals symptoms of a transient local spasm of the coronary artery, usually located at the site of an atherosclerotic lesion (regardless of its severity).
Enzyme diagnostics for symptoms of unstable angina
The CPK MB fraction increases after 6-12 hours, the myoglobin content increases after 3 hours, troponin T and I react simultaneously with the CPK MB fraction after cardiomyocyte necrosis, which makes it possible to differentiate the symptoms of unstable angina from signs of myocardial infarction. With signs of angina pectoris, there is no significant increase in enzyme activity (more than 40% of the initial level). Normal biochemical parameters do not exclude the presence of unstable angina. Echocardiography is not very informative in diagnosing the symptoms of unstable angina, since the pathological movement of the walls of the left ventricle, detected by this method, can only be detected during a painful episode.
Coronary angiography is indicated in patients when the issue of surgical treatment of unstable angina pectoris is being discussed (percutaneous transluminal coronary angioplasty or coronary bypass grafting), or in patients with unfavorable prognostic signs of the course of the disease. Angiographic diagnosis can reveal signs of thrombi in the coronary arteries (in 40% of patients) and stenosis of the coronary arteries (in 40-60% of patients). At the same time, 15% of patients may have hemodynamically insignificant stenosis of the coronary arteries (narrowing of the artery lumen by less than 60%), which confirms the greater importance of the nature of the fibrous plaque in the development of unstable angina than the severity of stenosis.
Negative T wave reversal
Prolongation of the PQ interval
ST segment depression greater than 2 mm
The appearance of atrial extrasystole
Transient blockade of the right leg of the bundle of His
115. Which of the following variants of angina pectoris is an indication for hospitalization?
Prinzmetal's angina
New onset angina pectoris
Rapidly progressive angina
Frequent exertional and rest angina
All of the above
None of the above
116. If an acute attack of pain occurs in the epigastric region and behind the sternum in middle-aged men, the examination should begin:
With gastric sounding
X-ray of the gastrointestinal tract
With gastroduodenoscopy
Urine test for uropepsin
117. A 40-year-old patient complains of prolonged aching pain in the precordial region, not clearly associated with unrest, sensations of "punctures" in the left half of the chest. On examination, no pathology was detected, the ECG was without features. What research should be used to start the examination of the patient?
Blood tests for sugar and cholesterol
From a blood test to lipoproteins
With echocardiography
With bicycle ergometry
With phonocardiography
118. The following judgments regarding painless myocardial ischemia are correct, except:
It is most often detected in individuals with an established diagnosis of coronary artery disease.
The principles of treatment are the same as for typical angina pectoris.
The prognosis is the same as for the painful form of coronary artery disease
Diagnosis is based on ECG changes
Monitoring ECG is important
119. A 45-year-old patient receives heparin injections for unstable angina pectoris. As a result of an overdose of the drug, gastrointestinal bleeding developed. To neutralize heparin, you must apply:
fibrinogen
Aminocaproic acid
protamine sulfate
All of the above is incorrect
120. Which statement regarding Prinzmetal's variant angina is true?
ECG showing ST segment depression
An attack of variant angina is most often provoked by physical activity.
Variant angina occurs as a result of spasm of the coronary arteries
To prevent seizures, it is advisable to use beta-blockers
Variant angina refers to stable forms of coronary artery disease
121. A 46-year-old patient, attacks of retrosternal pain began to occur at night, during which a transient elevation of the segment was recorded on the ECG. ST. Likely diagnosis?
Prinzmetal's angina
Recurrent myocardial infarction
Development of postinfarction aneurysm
Seizures are not related to the underlying disease
Thromboembolism of the branches of the pulmonary artery
122. All of the following factors increase the risk of developing coronary artery disease, except:
Increasing the level of high density lipoproteins
Diabetes
arterial hypertension
Hereditary burden
123. The most characteristic ECG sign of variant angina pectoris:
Horizontal ST depression
Upward ST depression and asymmetric T wave
ST lift
Deep Q waves
Expands coronary vessels
Reduces myocardial oxygen demand
Reduces myocardial contractility
Reduces plasma renin activity
Increases OPS
The assumption of chronic CAD becomes most likely when:
Described a typical angioedema
There are symptoms of circulatory failure
Rhythm disturbances detected
There are risk factors for coronary artery disease
Cardiomegaly detected
Which of the following does not correspond to angina pectoris?
Irradiation of pain in the lower jaw
Pain when climbing stairs (more than 1 floor)
Pain duration 40 min. and more
Identification of coronary artery stenosis
Pain is accompanied by a feeling of lack of air
The pathogenetic mechanisms of angina pectoris are as follows, except:
Stenosis of the coronary arteries
Thrombosis of the coronary arteries
Spasm of the coronary arteries
Excessive increase in myocardial oxygen demand
Insufficient collateral circulation in the myocardium
The most characteristic hemodynamic disorders in mitral stenosis:
Increase in EDV of the left ventricle
Increased pressure in the left atrium
Increase in cardiac output
Decreased pressure in the left ventricle
Which of the following research methods is the most important for the diagnosis of coronary artery disease in doubtful cases?
load test
Phonocardiography
echocardiography
Tetrapolar rheography
Which of the following symptoms can be observed in postinfarction cardiosclerosis?
Rhythm disturbance
Left ventricular failure
Right ventricular failure
Aneurysm of the left ventricle
All of the above
None of the above
Negative T wave reversal
Prolongation of the PQ interval
ST segment depression greater than 2 mm
The appearance of atrial extrasystole
Transient blockade of the right leg of the bundle of His
115. Which of the following variants of angina pectoris is an indication for hospitalization?
Prinzmetal's angina
New onset angina pectoris
Rapidly progressive angina
Frequent exertional and rest angina
All of the above
None of the above
116. If an acute attack of pain occurs in the epigastric region and behind the sternum in middle-aged men, the examination should begin:
With gastric sounding
X-ray of the gastrointestinal tract
With gastroduodenoscopy
Urine test for uropepsin
117. A 40-year-old patient complains of prolonged aching pain in the precordial region, not clearly associated with unrest, sensations of "punctures" in the left half of the chest. On examination, no pathology was detected, the ECG was without features. What research should be used to start the examination of the patient?
Blood tests for sugar and cholesterol
From a blood test to lipoproteins
With echocardiography
With bicycle ergometry
With phonocardiography
118. The following judgments regarding painless myocardial ischemia are correct, except:
It is most often detected in individuals with an established diagnosis of coronary artery disease.
The principles of treatment are the same as for typical angina pectoris.
The prognosis is the same as for the painful form of coronary artery disease
Diagnosis is based on ECG changes
Monitoring ECG is important
119. A 45-year-old patient receives heparin injections for unstable angina pectoris. As a result of an overdose of the drug, gastrointestinal bleeding developed. To neutralize heparin, you must apply:
fibrinogen
Aminocaproic acid
protamine sulfate
All of the above is incorrect
120. Which statement regarding Prinzmetal's variant angina is true?
ECG showing ST segment depression
An attack of variant angina is most often provoked by physical activity.
Variant angina occurs as a result of spasm of the coronary arteries
To prevent seizures, it is advisable to use beta-blockers
Variant angina refers to stable forms of coronary artery disease
121. A 46-year-old patient, attacks of retrosternal pain began to occur at night, during which a transient elevation of the segment was recorded on the ECG. ST. Likely diagnosis?
Prinzmetal's angina
Recurrent myocardial infarction
Development of postinfarction aneurysm
Seizures are not related to the underlying disease
Thromboembolism of the branches of the pulmonary artery
122. All of the following factors increase the risk of developing coronary artery disease, except:
Increasing the level of high density lipoproteins
Diabetes
arterial hypertension
Hereditary burden
123. The most characteristic ECG sign of variant angina pectoris:
Horizontal ST depression
Upward ST depression and asymmetric T wave
ST lift
Deep Q waves
Expands coronary vessels
Reduces myocardial oxygen demand
Reduces myocardial contractility
Reduces plasma renin activity
Increases OPS
The assumption of chronic CAD becomes most likely when:
Described a typical angioedema
There are symptoms of circulatory failure
Rhythm disturbances detected
There are risk factors for coronary artery disease
Cardiomegaly detected
Which of the following does not correspond to angina pectoris?
Irradiation of pain in the lower jaw
Pain when climbing stairs (more than 1 floor)
Pain duration 40 min. and more
Identification of coronary artery stenosis
Pain is accompanied by a feeling of lack of air
The pathogenetic mechanisms of angina pectoris are as follows, except:
Stenosis of the coronary arteries
Thrombosis of the coronary arteries
Spasm of the coronary arteries
Excessive increase in myocardial oxygen demand
Insufficient collateral circulation in the myocardium
The most characteristic hemodynamic disorders in mitral stenosis:
Increase in EDV of the left ventricle
Increased pressure in the left atrium
Increase in cardiac output
Decreased pressure in the left ventricle
Which of the following research methods is the most important for the diagnosis of coronary artery disease in doubtful cases?
load test
Phonocardiography
echocardiography
Tetrapolar rheography
Which of the following symptoms can be observed in postinfarction cardiosclerosis?
Rhythm disturbance
Left ventricular failure
Right ventricular failure
Aneurysm of the left ventricle
All of the above
None of the above