CHEST PAIN SYNDROME

Neset Uzairi

Abstract

Introduction: Cardiovascular diseases are in the first place in the statistics of the western countries as the cause of death. Coronary arteries diseases are the main cause of pain in chest known as angina pectoris, a clinical syndrome characterized by retrosternal pain tending to spreading toward the shoulders, left hand, lower jaw, neck and back, often with atypical symptomatology. In addition to aa coronary disease there are other cardiovascular factors such as diseases of aortas. Mitral valve prolapse, cardiomyopathies, pericards, emboli and pulmonic hypertension and other. As neuromuscular, digestive gastrointestinal, pleurites and anxious states. Ischemia of myocardia happens because of the inability of coronary arteries to supply the heart muscle with blood and oxygen requirements because of the aa. coronary atherosclerosis that lead to their stenosis or occlusion of the spasm of a coronary. According to Statistics for 2005 from cardiovascular disease have died 17.5 million, while 7.5 million for heart attack situation similar to 2017. The Republic of Macedonia is closer to European trends regarding morbidity and mortality of these diseases. Aim of this paper: is to present data concerning the appearance of morbidity and mortality of coronary syndrome and to bring a conservative view on the strategy and data along with invasive world authors in this area. Materials and Methods: There were analyzed 64 patients with heart ischemic disease; 37 men and 27 women aged 25-78; the average age for women was 56.5 years old and 54.9 years old for men who were treated in the above-mentioned institution in Tetovo, clinical hospital and cardiology clinic in Skopje in the last five years. Based on methods used as objective history and examination, monitoring and screening for cardiovascular risk factors of arterial blood pressure, diabetes and hyperlipidemia, ECG with specific changes as omission of ST-T segment and negative T wave, dynamic ECG, coronary stress test Echocardiography, laboratory and enzymatic methods, AST, ALT,, LDH, CK and CK_MB, troponins, invasive methods such as selective coronagraph and myocardium coronarography with TL 201 that was done in the cardiology clinic in Skopje and Tetovo in the doubtful cases. Results: Judging on this data anamnesis was positive for cardiovascular diseases and risk factors were present in the overwhelming part. Objective data were scarce almost negative, rapid increase of arterial blood pressure and transitional extra systolic arrhythmia; ECG changes had specific S_T segment and negative T-wave. We found coronagraph stenosis changes 50-80% of coronary 13 (20.3%) of cases with dominance of the LAD in 60% of cases, while other branches of RCA, CX-4, with LMCA with less attacks while in 2 (3.1%) cases chorography was normal. Myocardial scintigraphy of was in positive correlation with selective coronagraph in detecting the ischemic disease at 9 (14%) of cases. Most attacked age for men 50-60 years and 60-70 years for females. Discussion and conclusion: Apart from elimination of risk factors mentioned as hypertension, diabetes hyperlipidemia should look at thyroid glands, anemia and aortas diseases. Drug therapy started with Nitrates, ASA, Beta blockaders, calcium antagonists, ACE inhibitors, diuretics, antithrombotic and others. The invasive therapy consisted of, PTCA, stenting, myocardial revascularization. Judging by the published data in European centers and in our country, there are two strategies in the treatment of these conditions: the early conservative strategy and early invasive strategy. At patients with elevations of ST segment intervening therapy is first. Patients at risk high, increased enzyme, rhythm disorders, ST segment dispersion to be treated 48-72 hours invasively because of the hemodynamic instability. Despite continuous screening these diseases and risk factors of these diseases are increasing.

Pages: 25 - 36