The article will present a classification of unstable angina according to Braunwald.
With coronary heart disease, angina attacks almost always occur. Severe pain develops when the myocardium begins to lack oxygen. When the syndrome develops against the background of physical activity, we are talking about stable angina pectoris, which accompanies enhanced heart activity. However, the following situations also occur: severe symptoms in the form of painful pressure in the chest, burning and suffocation are in no way tied to the activity of the heart muscle. An anginal attack can overtake a person suddenly, and it is impossible to predict its appearance. In this case, we are talking about angina pectoris of an unstable type. In accordance with the tenth edition of the International Classification of Diseases, pathology refers to diseases of the circulatory system, has its own code 120.0.
Classification of unstable angina pectoris according to Braunwald will be presented below.
Angina stable and unstable type
The very name of unstable angina pectoris characterizes the complex of emerging symptoms. The condition can manifest itself without reference to physical activity, other provoking factors. This is precisely the main difference between this pathology and stable angina pectoris.
Stable angina is characterized by the presence of a certain set of provoking factors:
- Emotional stress.
- Bad weather with snow, rain, cold wind.
- The established boundaries of physical activity (for example, walking at a fast pace at a distance greater than half a kilometer, climbing stairs is higher than to the first floor).
Stable angina pectoris can have one of four functional classes, for each of which certain permitted levels of physical activity are established, and their own degree of severity of clinical symptoms.
The attack of stable angina pectoris ceases at rest, can last a maximum of 15 minutes, is effectively stopped by the use of "Nitroglycerin".
With unstable angina, there is a great danger to the patient’s life, since it is impossible to predict its occurrence and clinical picture, there is no way to determine the patient’s permissible level of stress, and it is difficult to identify provocative factors. Any of these attacks occurs suddenly, in its manifestation is unpredictable, threatens the onset of myocardial infarction, while the patient may die from sudden cardiac arrest. In this case, the symptoms are more severe. The attack can last up to half an hour, and Nitroglycerin is not always effective.
Reasons for the development of unstable angina
An attack with coronary artery disease occurs when there is a prerequisite - the patient has a violation of coronary circulation and narrowing of the arteries. Excess cholesterol settles on the vascular walls, atherosclerotic plaques occur, as a result of which the lumen of the artery decreases. Thus, not enough blood enters the heart. Under such conditions, the myocardium begins to work more intensively to make up for the insufficient level of blood supply, but the situation is only getting worse. This is due to the fact that the heart during intense activity requires an even greater amount of oxygen coming exclusively from the blood.
With a deterioration in arterial patency of more than 50%, hypoxia intensifies, which reaches critical limits. In cells, a violation of metabolic processes begins, which is accompanied by pathological changes in intracellular structures. A person in such moments experiences unbearable angina pain. Due to a protracted attack, tissue necrosis begins and spreads, resulting in myocardial infarction.
IHD and exertional angina (code for ICD 10 I20) develops with acute heart demand for large portions of oxygen (stress, physical activity), and damaged coronary vessels are not able to supply the heart muscle with sufficient blood volume.
With the growth of atherosclerotic plaque to an impressive size, there is a probability of a violation of its integrity. This happens in cases where it has a lot of deposits of fat and not enough collagen, and the vascular wall is inflamed or the blood has an increased viscosity. The detached part of the plaque is glued together by platelets, as a result of which a thrombus is formed, capable of partially or completely blocking the arterial lumen. This is the main reason for the occurrence of unstable angina. Such blood clots can migrate and enter any part of the coronary vessels.
Another reason for the development of coronary heart disease and angina pectoris (ICD code 10 I20) of the pathology is the sudden spasm of the coronary vessels, arising regardless of physical activity. At the same time, arteries that are not affected by atherosclerosis can narrow. A similar situation is characteristic of vasospastic angina (Prinzmetal), which is a rather rare pathology.
Provocative factors
In addition to the main reasons for the development of anginal attacks of an unstable type, experts identify some additional factors that can increase the risk of severe angina pectoris. Among them:
- Non-heart related diseases (diabetes mellitus, pathological changes in the thyroid gland, anemia of iron deficiency type).
- Pathologies of a cardiological nature (heart defects, hypertrophic cardiomyopathy, a state after a heart attack, insufficiency of chronic myocardial functionality).
- The harmful effects of ethyl, tobacco tar.
- Progressive hypertension.
- Strong mental stress, stressful situations, strong emotionality.
- Increased susceptibility of blood vessels to the effects of vasoactive substances, for example, serotonin.
- High blood cholesterol.
- Morphan disease.
- Adverse heredity.
- Obesity.
- Inadequate rest, night sleep disturbances.
- Lack of exercise.
- Excessive exercise.
Symptoms of angina pectoris
An attack of anginal pain with rest angina pectoris develops with complete physical calm, most often at night or in the early morning. From a sudden attack, the patient is forced to wake up from sudden asphyxiation or a feeling of constriction in the chest. The following symptoms accompany an attack of angina pectoris: a state of increased anxiety, anxiety, fear of death. The pain is intense, localized behind the sternum, has a compressive, compressive character, spreads to the jaw, left arm, shoulder blade.
Braunwald classification of unstable angina
What is this classification? What principle is it based on?
The most widespread classification according to the system of Eugene Braunwald. In accordance with it, several classes and levels of pathology are distinguished:
- Class "A" have secondary angina pectoris. Symptoms of pathology in this case develop under the influence of factors of extracoronary origin, which contribute to the aggravation of ischemia: strong emotional outbursts, poorly treatable hypertension, hypotension, instability of the heart rhythm, infectious attack, fever, anemia. How else are Braunwald heart diseases classified?
- Angina syndromes of a primary nature are assigned to class “B”. They develop against the background of cardiac pathologies and disorders in the coronary circulatory system.
- According to the Braunwald classification of unstable angina, class C is classified as pathology, which is diagnosed against the background of an experienced myocardial infarction (within the first two weeks after it).
Classes of angina of an unstable type, in accordance with this classification, reflect the circumstances of the development of symptoms of ischemia, characterized by an unstable manifestation.
The classification table for unstable angina according to Braunwald is presented in the article.
Classification according to severity of the attack
Also, the pathology is classified into groups characterizing the severity of the resulting anginal attack:
- The first group includes angina pectoris, which was recorded for the first time within a month before the day the patient went to the doctor. Such angina pectoris appears stably in conditions of physical activity.
- The second group includes subacute syndromes. Arising seizures have a more severe course, can manifest themselves at rest. Occur within a month before contacting a specialist, with the exception of the last two days.
- Angina pectoris of the third group is characterized by an acute manifestation of symptoms. Angina pectoris occurs without reference to physical activity during the last two days.
Many are interested in what it is pectoral toad. Her symptoms are very unpleasant. A sudden attack of acute pain behind the sternum in most cases is a sign of chronic angina pectoris (other names - angina pectoris, angina pectoris, acute angina pectoris).
It is the paroxysmal nature of the pain that allows you to accurately diagnose the disease. Angina pectoris is considered a form of cardiac ischemia. The most formidable complication of the disease is myocardial infarction.
Symptoms of unstable angina pectoris
There is no difference between the symptoms of angina pectoris of different species. With any type of pathology, the patient indicates the manifestation of the following symptoms:
- Sudden jumps in blood pressure.
- Nausea.
- Weakness.
- Dizziness.
- The appearance of disturbing thoughts.
- Heart palpitations.
- Increased sweating.
- Feeling of suffocation.
- Chest pain, compressive heart.
- Pain in the lower back, shoulder blades, teeth, abdomen, hands.
These are the symptoms of angina pectoris. What is it now clear.
Differences in unstable angina
Unstable angina can be distinguished by the following signs:
- Symptoms during the attack progresses, the attack is more severe, pain affects the adjacent areas (jaw, back, neck, left arm).
- An anginal attack has acute manifestations (a feeling of heaviness in the chest, fever, squeezing) and, along with suffocation, occurs more often.
- For an attack every time less and less load is required, angina can occur even at rest.
- Signs of acute ischemic disorder were detected after coronary artery bypass grafting, no later than 90 days before contacting a specialist.
- The pain is poorly controlled by the use of Nitroglycerin.
- Paroxysm lasts more than a quarter of an hour.
- Prinzmetal angina is found, as a rule, in males, and it develops regardless of their physical activity. Between seizures, the patient is able to withstand strong muscle tension without consequences. More often, heart pain manifests in the morning. They provoke spasms in the coronary arteries, atherosclerotic changes in which are not always observed. The pathological condition is characterized by rapid progression, carries a high risk of myocardial infarction.
How to get rid of heart pain with angina pectoris?
Diagnostics
The diagnosis is established on the basis of patient complaints about the progression of angina attacks, medical history, the results of various laboratory and instrumental studies:
- Analyzes of samples of biological fluids.
- Coronary Angiography
- Echocardiography.
- Scintigraphy.
- Holter daily monitoring.
Due to the fact that the symptoms can be atypical, differential diagnosis should be made and myocarditis, mitral defect, pneumonia, esophagitis, pleurisy, osteochondrosis, pancreatitis, and gastrointestinal tract disorders should be ruled out.
Treatment
Therapy of unstable angina should be carried out exclusively in stationary conditions. When an attack occurs, the patient should call emergency care, in anticipation of which it is necessary to take "Nitroglycerin" and "Aspirin". After admission to the hospital, the patient is assisted by the following algorithm:
- Elimination of pain.
- Elimination of obstacles for normal blood circulation.
- Providing measures to prevent sudden cardiac arrest, the onset of the acute phase of the myocardium.
- Rehabilitation therapy to stabilize the condition.
Medicines
After stopping the attack, the patient is prescribed a special diet, bed rest, complete emotional rest, taking special medications, including:
- Nitrates ("Isosorbide dinitrate", "Nitroglycerin"). They are able to expand coronary arteries, reduce myocardial oxygen demand.
- Antiplatelet agents, anticoagulants ("Fraksiparin", "Aspirin"). To prevent blood clots, increase blood flow.
- Metabolic drugs.
- Inhibitors of calcium channels (Verapamil, Cinnarizine), which improve patency in the coronary arteries.
- Painkillers (of narcotic origin, antipsychotics), for example, Fentanyl, Droperidol. Indicated for the relief of acute pain.
- Statins ("Lovastatin", "Rosuvastatin"), which reduce cholesterol, prevent the formation and compaction of cholesterol plaques.
- Beta-blockers (Proprnalol, Carvedilol), which reduce the heart rate, improve blood flow.
Conclusion
If conservative treatment is not effective, coronary artery bypass grafting is considered.
It is important to note that it is always difficult for doctors with unstable angina to assess the degree of risk and make a prognosis, since this pathology appears unpredictably and can progress rapidly.