Angina stabile
Table of Contents
Eziologia
L’angina stabile o angina cronica da sforzo è un tipo di angina caratterizzata da dolore toracico secondario ad attacchi di ischemia miocardica acuta. L’angina stabile è la forma più frequente di angina pectoris.L’angina pectoris è la manifestazione clinica più frequente della cardiopatia ischemica e la sua causa principale è l’aterosclerosicoronarica.Come regola generale si considera che la presenza di ischemia da sforzo si associa aplacche ateromatose che riducono il lume vascolare di circa il 70%, mentre riduzioni del lume vascolare dell’ 80-90% si associano alla comparsa di ischemia a riposo.
Sintomatologia
La sintomatologia anginosa si caratterizza per la presenza di:
- Dolore oppressivo retrosternale, che può irradiare albraccio sinistro, alcollo, allamandibolao allaregione interscapolare.
Generalmente è accompagnata da sintomi vagali come:
- Nausea
- Vomito
- Sudore freddo.
Inoltre, tipicamente, nell’angina stabile il dolore è provocato da unostress fisico o emotivoe regredisce con la cessazione dello sforzo (o con l’assunzione di nitroglicerina). Per poter parlare diangina stabile, è necessario che la sintomatologia mantenga le stesse caratteristiche (durata, intensità, soglia di sforzo che scatena i sintomi per almeno due mesi). La sintomatologia tuttavia può presentarsi anche in maniera atipica, sia nella localizzazione del dolore (epigastrico,emitorace destro,lombare), che nelle sue forme (dispnea,asteniamarcata,nausea)sono considerati degli equivalenti anginosi soprattutto nei pazienti diabetici anziani.
Nei pazienti con angina stabile gli episodi anginosi mostrano una tipica distribuzione circadiana, conun picco principale nelle ore del mattinoe un secondo picconelle ore pomeridiane.Ciò dipende dall’andamento analogo sia dei maggiori determinanti del consumo miocardico di ossigeno, sia del tono vascolare, che risulta aumentato in queste ore per una più elevata attività α-adrenergica.
Diagnosi
La diagnosi diangina pectorisè clinica e generalmente è possibile porla sulla base della sola anamnesi. Il fatto che il dolore sia alleviato dainitratio dagliantiacidi(patologia peptica) e il fatto che aumenti con il movimento o con la pressione (dolore osteomuscolare) sono elementi utili nella valutazione clinica, ma non sono sufficienti per formulare diagnosi definitiva. Di solito l’esame obiettivo non contribuisce in modo significativo alla diagnosi di angina pectoris e ciò per due motivi: solo raramente è possibile esaminare il paziente durante un attacco anginoso sia durante la crisi, sia soprattutto nei periodi intervallari, l’obiettività di solito è negativa.
Esami strumentali
Nella diagnostica strumentale dell’angina stabile si utilizzano varie indagini, alcuni semplici ( come gli esami di laboratorio e l’ECG a riposo) altre più complesse quali:
- Metodiche elettrocardiografiche (ECG da sforzo, ECG dinamico secondo Holter).
- Metodiche scintigrafiche: scintigrafia miocardica.
- Metodiche ecocardiografiche, a riposo e da stress farmacologico, o anche da sforzo.
- Cateterismo cardiaco e angiografia coronarica.
Esami di laboratorio
Gli esami di laboratorio, in particolare ilprofilo glicemico e l’assetto lipidico, contribuiscono a definire il profilo di rischio cardiovascolare. Se suggerito dal quadro clinico è opportuno valutare la presenza di patologie che possono facilitare l’ischemia miocardica come l’anemia(che riduce l’apporto di ossigeno al cuore) e l’ipertiroidismo (che determina attivazione adrenergica associata a un aumento del consumo miocardico di ossigeno).
Prognosi
Mediamente la prognosi dell’ angina cronica stabile è buona. Sia la mortalità sia gli eventi coronarici acuti hanno un’incidenza ormai inferiore al 2% per anno. Alcuni sottogruppi di pazienti, tuttavia, presentano un rischio più elevato, che può aggirarsi anche attorno al 5%.
Terapia
Iltrattamento farmacologicodell’angina pectoris si basa sulla prevenzione degli eventi coronarici acuti mediante l’utilizzo difarmaci antiaggregantiestatine. Per il trattamento sintomatico invece si utilizzano farmaciantianginosi.
Terapia dell’ episodio acuto:nitroglicerina sublinguale.
Terapia cronicacon l’obiettivo di ridurre il numero di episodi anginosi:Beta-bloccanti.
La presenza di angina refrattaria al trattamento medico rappresenta indicazione alla coronarografia diagnostica con l’obiettivo che rivascolarizzare le eventuali stenosi coronariche severe.
VEDI ANCHE:
I like what you guys are up too. Such intelligent work and reporting! Keep up the superb works guys I’ve incorporated you guys to my blogroll. I think it’ll improve the value of my site :).
I’d have to examine with you here. Which is not one thing I usually do! I take pleasure in reading a post that may make folks think. Additionally, thanks for permitting me to comment!
It’s appropriate time to make some plans for the future and it is time to be happy. I have read this post and if I could I want to suggest you some interesting things or advice. Perhaps you can write next articles referring to this article. I want to read more things about it!
You made the point.
casino en ligne fiable
Tips well taken.!
casino en ligne francais
Seriously tons of valuable advice.
casino en ligne France
Kudos. I appreciate it!
casino en ligne fiable
You stated it wonderfully.
casino en ligne
Info well utilized..
casino en ligne France
Thank you, Excellent stuff!
casino en ligne France
Nicely put, Thank you.
casino en ligne fiable
You actually said this well.
casino en ligne
You explained this really well.
casino en ligne
Very interesting information!Perfect just what I was searching for!
I went over this site and I think you have a lot of fantastic information, bookmarked (:.
Thank you for every other magnificent post. The place else may anybody get that kind of info in such an ideal means of writing? I’ve a presentation next week, and I am on the look for such info.
Nice post. I learn something more challenging on different blogs everyday. It will always be stimulating to read content from other writers and practice a little something from their store. I’d prefer to use some with the content on my blog whether you don’t mind. Natually I’ll give you a link on your web blog. Thanks for sharing.
I cling on to listening to the news bulletin lecture about getting free online grant applications so I have been looking around for the most excellent site to get one. Could you tell me please, where could i acquire some?
you are really a good webmaster. The site loading speed is incredible. It seems that you’re doing any unique trick. Also, The contents are masterpiece. you’ve done a excellent job on this topic!
An interesting discussion is worth comment. I think that you should write more on this topic, it might not be a taboo subject but generally people are not enough to speak on such topics. To the next. Cheers
Hi there this is somewhat of off topic but I was wanting too know
if blogs use WYSIWYG editors or if you have to manually code
with HTML. I’m starting a blog soon but have no coding
experience so I wanted to get guieance from someone with experience.
Any help would bbe greatly appreciated!https://Glassiindia.wordpress.com
Remarkable issues here. I am very satisfied to see your article.
Thanks a llot andd I aam having a look forward to touch you.
Will you kindly drop me a e-mail?https://www.Pakalljobz.com/companies/tonebet-casino/
I’ve been absent for a while, but now I remember why I used to love this blog. Thank you, I?¦ll try and check back more frequently. How frequently you update your website?
I love what you guys tend to be up too. This sort of clever work and coverage! Keep up the great works guys I’ve you guys to blogroll.
We are a bunch of volunteers and opening a new scheme in our community. Your web site offered us with useful information to work on. You’ve done an impressive job and our entire neighborhood can be thankful to you.
You are my inhalation, I have few web logs and occasionally run out from to brand.
I have been examinating out some of your posts and i can state pretty clever stuff. I will make sure to bookmark your website.
Thanks so much for providing individuals with an extraordinarily memorable opportunity to discover important secrets from this web site. It is always so sweet plus full of a great time for me personally and my office mates to search your website particularly thrice in a week to read through the newest issues you will have. Of course, I’m just always satisfied considering the splendid guidelines you give. Certain two points on this page are clearly the best we have had.
Wonderful website. Plenty of helpful information here. I am sending it to a few buddies ans also sharing in delicious. And naturally, thank you in your effort!
Hiya very cool website!! Guy .. Beautiful .. Wonderful .. I will bookmark your site and take the feeds also?KI’m satisfied to search out numerous useful info here in the post, we’d like work out more techniques on this regard, thanks for sharing. . . . . .
Excellent read, I just passed this onto a colleague who was doing a little research on that. And he just bought me lunch as I found it for him smile So let me rephrase that: Thank you for lunch! “No one can wear a mask for very long.” by Seneca.
Great post, you have pointed out some great points, I as well believe this s a very good website.
I like what you guys are up too. Such clever work and reporting! Carry on the superb works guys I¦ve incorporated you guys to my blogroll. I think it will improve the value of my website 🙂
I have been absent for a while, but now I remember why I used to love this web site. Thanks , I will try and check back more frequently. How frequently you update your website?
Thank you a lot for providing individuals with an extremely marvellous opportunity to read from this web site. It can be so excellent and packed with amusement for me personally and my office fellow workers to search your site at the very least 3 times in 7 days to see the newest issues you will have. Of course, we are at all times happy with all the stunning creative ideas you give. Selected 3 areas on this page are particularly the best we’ve ever had.
I liked up to you’ll obtain performed right here. The sketch is tasteful, your authored subject matter stylish. nonetheless, you command get bought an impatience over that you wish be turning in the following. ill indubitably come further before once more as exactly the similar just about very steadily inside of case you defend this hike.
Great web site. Lots of helpful information here. I am sending it to a few friends ans additionally sharing in delicious. And naturally, thank you to your sweat!
good post.Never knew this, appreciate it for letting me know.
Hey, I think your website might be having browser compatibility issues. When I look at your blog site in Firefox, it looks fine but when opening in Internet Explorer, it has some overlapping. I just wanted to give you a quick heads up! Other then that, great blog!
There is apparently a bundle to realize about this. I believe you made various good points in features also.
I would like to thnkx for the efforts you have put in writing this blog. I am hoping the same high-grade blog post from you in the upcoming as well. In fact your creative writing abilities has inspired me to get my own blog now. Really the blogging is spreading its wings quickly. Your write up is a good example of it.
I like this post, enjoyed this one appreciate it for putting up.
I like this website because so much useful stuff on here :D.
Wohh exactly what I was looking for, appreciate it for posting.
Throughout the awesome design of things you’ll get a B+ for effort. Where exactly you actually lost me ended up being on the facts. You know, people say, the devil is in the details… And it couldn’t be much more correct in this article. Having said that, let me tell you just what exactly did do the job. Your writing is definitely rather convincing which is probably why I am making the effort in order to comment. I do not make it a regular habit of doing that. Secondly, even though I can see a leaps in reason you make, I am not convinced of exactly how you seem to unite the details that help to make the actual conclusion. For right now I will, no doubt yield to your position but hope in the future you connect your dots much better.
Greetings! Very helpful advice on this article! It is the little changes that make the biggest changes. Thanks a lot for sharing!