Functional class of angina pectoris - description, classification and features

Specialists note a frightening increase in the number of heart diseases among the population. In addition, the age at which they first manifest has greatly decreased. As a rule, people do not pay attention to symptoms until a disaster strikes, but even a slight malaise can be a sign of a serious heart pathology. Classification according to the functional classes of angina shows well the "stealth" of the disease. Changes occur so gradually that people get used to them and do not consider it necessary to be treated.

Classification of stable angina pectoris

There are several varieties of angina pectoris, each of which has both common signs for the group and unique symptoms that make it possible to distinguish it from the rest. Stable angina pectoris is a type of angina pectoris. It is characterized by the appearance of pain during physical exertion and the disappearance of uncomfortable sensations at rest.

The following functional classes of angina are distinguished:

1. The first class - pains appear only with excessive loads and quickly pass at rest.
2. The second class is chest discomfort when walking more than 300 meters or climbing stairs.
3. Third class - pains appear after overcoming a distance of 150 meters or walking on the steps to one floor.
4. Fourth grade - seizures occur with mild exertion and at rest.

Unstable angina

Unlike the previous view, unstable angina is manifested by intense pain, not associated with physical exertion. In addition to the functional class, angina pectoris of this type is divided into four forms:

1. The first arising angina pectoris. It is considered such if the first attack occurred no later than two months ago. It is dangerous in that it can be a symptom or a harbinger of myocardial infarction. It can transform into a stable type of disease.
2. Progressive. Attacks become more and more frequent, signs of myocardial hypoxia appear on the cardiogram. It is possible to change the functional class to a lower one.
3. Early post-infarction. Chest pains persist for two weeks immediately after myocardial infarction.
4. Vasospastic. It is also called variant, or angina pectoris. This form is characterized by night attacks that are not associated with physical activity.

Braunwald classification

In order to determine the likelihood of myocardial infarction, use the classification proposed by Braunwald to characterize pain. It does not affect the functional class of angina in any way, but only expands the diagnostic capabilities of the doctor without the use of instrumental research methods.

The first class implies the first occurrence of angina pectoris, the symptoms of which intensify over the past two months.

The second class is angina pectoris or its subacute form, but only if it did not appear less than two days ago.

The third class includes acute angina pectoris and angina pectoris, which has manifested itself in the last forty-eight hours.

By provoking factors

There are several classifications of angina pectoris. Functional classes are not the only marker that determines the severity and course of the disease.

By the factors that can provoke the disease, the following varieties are distinguished:

• A - anemia, hypoxia, infection and other non-coronarogenic causes;
• B - primary angina pectoris of unknown etiology;
• C is a post-infarction variant of the disease that has developed within two weeks after an acute process.

In the first case (A), the doctor deals with secondary angina pectoris and is forced to treat not only it, but also the primary focus. In two other variants (B and C), the situation is different, since the causes of the disease lie directly in the organ itself.

Rizik classification

The functional classes of stable angina can be supplemented by the classification of Rizik, which, in addition to subjective sensations, also takes into account ECG readings.

1. The first A-class - the symptoms of angina are aggravated from attack to attack, but there are no changes on the cardiogram.
2. The first B-class - with an increase in the intensity of pain, objective changes on the ECG appear.
3. The second class - the cardiogram reflects changes characteristic of the first-appeared angina pectoris.
4. Third class - on the ECG there are signs of rest angina pectoris.
5. The fourth class - in addition to resting angina pectoris, a cardiogram shows a deterioration in the dynamics of the heart and myocardial hypoxia.

Canadian Cardiology Society Classification

One of the options for classifying angina pectoris according to functional classes was proposed by Canadian cardiologists in the mid-2000s. It includes five classes:

1. Zero when the symptoms of the disease are absent both during exercise and at rest.
2. First. Significant physical activity or emotional overstrain can provoke an attack of pain behind the sternum.
3. Second. Slight discomfort behind the sternum appears with intense physical exertion.
4. Third. Pain and shortness of breath occur regularly during daily activities.
5. Fourth. Symptoms can cause even the smallest load.

Doctors in the Western Hemisphere use this classification, for domestic doctors, the ranking that was given at the very beginning is more familiar, therefore, the diagnosis says, for example: "IHD: exertional angina, functional class 2". But this does not mean that our experts are not familiar with this division of functional classes.

Variant angina pectoris

Stable angina pectoris, the functional classes of which are described above, also includes a variant type of flow. It has many names, but the essence remains the same: bouts of sternal pain appear suddenly, without any connection with physical activity, usually at night or in the morning. Uncomfortable sensations are caused by spasm of the arteries that feed the heart, but at the same time they usually do not reveal any morphological changes that would indicate the presence of atherosclerosis.

Patients who regularly suffer from bouts of variant angina may not pay attention to the development of such a formidable disease as myocardial infarction, as the symptoms will be similar. Such negligence can cost a person his life if he is not provided with medical care. Correction of seizures is carried out using calcium antagonists or nitrates.

Types of angina pectoris

If functional classes (FC) of angina pectoris are distinguished, then there are other types of this disease. One of the classifications uses the features of the course to distinguish four variants of the manifestation of angina pectoris:

1. The first occurrence: pain lasts about a month (but no more than two), they are frequent and intense, are directly related to the physical activity of a person. Over time, this species becomes stable. An unfavorable option is considered when during an attack an increase in the ST segment on the cardiogram is observed.

2. Progressive: if the frequency and severity of pain attacks increase even during treatment, this indicates an aggravation of the disease, a decrease in the compensatory abilities of the body and a high risk of heart attack. Patients may experience anxiety and fear of death, asthma attacks.

3. The first occurrence of rest angina pectoris: if the heart muscle does not receive enough blood due to reduced cardiac output or coronary artery atherosclerosis, then angina attacks can be observed at rest. Most often, pain occurs in a dream, since the horizontal position of the body changes the amount of venous blood that returns to the heart, and consequently, the subsequent cardiac output.

4. Stable angina pectoris: the frequency and intensity of seizures do not change over time, the disease is well controlled by drugs and does not threaten critical conditions. But you should not treat this type of disease irresponsibly, because at any time a worsening of the condition is possible.