The ICD-10 code for acute coronary syndrome is I20.0 (unstable angina). These symbols describe a person’s state when the blood supply to the heart muscle suddenly weakens. Pathology is extremely dangerous. Statistics say that the probability of death in the first quarter of an hour, especially without qualified help, reaches 40%. The most reasonable method of minimizing risks is to know what ACS is, why the condition appears and how to prevent it.
General view
In ICD-10, the code for acute coronary syndrome I20.0 contains a disease in which fatty deposits form on the arterial walls. Normally, these vessels nourish the heart muscle - with blood, an influx of nutrients, oxygen, is provided here. The human heart can function normally under conditions of constant, stable blood flow, rich in essential substances. Acute coronary syndrome occurs if the artery is blocked. In the predominant percentage of cases, the cause is a blood clot. As soon as oxygen enters the myocardium, the cells begin to die, not having the most important chemical compound for life.
In medicine, a violation of the supply of full blood to organic tissues is called ischemia. With ACS, this process causes premature death of large volumes of muscle fibers that form the heart - a heart attack, heart attack occurs.
An acute coronary syndrome is possible, in which mass death of muscle cells does not occur, but the myocardium is inflicted significant harm. This condition can be single or chronic. If ACS does not cause ischemia, a characteristic of the patient's condition is unstable angina.
How to notice?
The acute coronary syndrome encoded by I20.0 symbols in the ICD is not just a disease that is dangerous by manifestations, but also a condition that comes suddenly. In a predominant percentage of cases, the attack begins unpredictable for the patient. The main manifestations of ACS:
- unpleasant, painful sensations in the chest, upper limbs, jaw, back, stomach;
- dizzy, headache;
- Sick and vomiting
- difficulty breathing;
- sweat is activated;
- dyspepsia.
The most striking sign of ACS is soreness in the chest. In each case, the set of manifestations of acute coronary syndrome is determined by the individual characteristics of the patient. The patient’s age, gender, general condition of the body, the presence of concomitant health disorders play a role.
Risk group
From statistics it is known that acute coronary syndrome often develops in people who are characterized by the following features, disorders:
- diabetes;
- genetic predisposition;
- middle and older age;
- the presence of bad habits;
- high blood pressure;
- high cholesterol in the circulatory system;
- sedentary lifestyle;
- overweight;
- malnutrition.
Of the bad habits, smoking is associated with the highest risk of ACS. The age groups and the likelihood of developing acute coronary syndrome are correlated as follows: for men, the probability is higher at the age of over 45 years, for the fair sex - after crossing the 55-year-old boundary.
We’ll check everything!
To verify the correctness of the proposed diagnosis and the ICD code I20.0 used, the acute coronary syndrome is specified using special studies. If the doctor has prescribed such measures, it is important to go through all the necessary procedures - this will help to identify in time the danger of ischemia and, therefore, take measures to ensure a long and healthy life.
If you suspect ACS, assessing the risk of a condition as high, be sure to refer the patient to an electrocardiogram. During the examination, they check how active the heart is. Special electrodes are used, fixing them on strictly defined parts of the body. If the study shows abnormal impulses or lack of regularity, it is likely that the organ is malfunctioning, malfunctioning. In the diagnosis of acute coronary syndrome, sometimes the information obtained through the ECG is enough to localize the location of the thrombus.
Clarification of the patient's condition is possible with the help of blood tests. If the cells die, damage is caused to the heart muscle, as a rule, in samples taken from the circulatory system, traces, enzymes characteristic of this condition can be seen. If the result is positive, enzymes are detected, we can confidently talk about heart attack, acute coronary syndrome. The code in the ICD of this state is I20.0.
Suspicion of ACS is an occasion to make a scintigraphy of the heart. The study assesses how much blood enters the main organ of the body. Doctors can understand how large-scale injuries are received by the muscle due to acute coronary syndrome without or without ST elevation.
It is sometimes recommended to undergo Holter monitoring. This is a long study - with devices that fix the specifics of the heart muscle, you will have to walk 24 hours. A special mechanism records the activity of the organ, and the doctor decrypts the received data. Using monitoring, you can understand what are the violations of the rhythm of the heartbeat, at what moments the heart does not receive the necessary volume of blood. A certain number of cases are known when timely medical care for acute coronary syndrome was not provided due to the absence of symptoms of this serious condition. Daily monitoring using the Holter method eliminates this situation.
What to do?
Treatment of acute coronary syndrome is possible only in a hospital setting. The patient needs first aid, and only specialists with education and access to equipment, medicines necessary in such a case can provide it. Primary measures are aimed at relieving pain and optimizing blood circulation - this will restore cardiac functionality. After emergency care for acute coronary syndrome, a comprehensive treatment program is prescribed. It is highly likely that doctors will recommend going to surgery. You will also have to take medicine.
Among medications for ACS, it is worth noting the categories:
- beta blockers;
- inhibitory angiotensin receptors;
- ACE inhibitors;
- nitroglycerine;
- corrective coagulability, blood viscosity of the substance;
- statins.
If medical care for acute coronary syndrome does not show the desired result, surgical intervention such as stenting, bypass surgery or angioplasty is recommended. If the doctor has directed for surgery, you should not delay: delay may cost the patient life.
Important Tips
Acute coronary syndrome requires a radical change in lifestyle and everyday habits from the patient. Since heart and vascular diseases can provoke ACS, they will have to start their treatment, as soon as the doctor warned of the risk of such a condition. In the absence of such diseases, ACS can be prevented if you completely abandon bad habits and lead an active lifestyle. The diet should be reviewed, excluding from it fatty and spicy, salty and canned. Instead, consume a lot of fruits and vegetables. Healthy foods are whole grain, protein dishes.
To keep fit, you should constantly give the body physical activity. The optimal mode is up to three hours a week. You should keep a pulse under control and regularly check the pressure, take tests to check the amount of cholesterol in the circulatory system, and take measures to prevent excess weight or its lack.
In order not to learn from experience what acute coronary syndrome is without or without an ST segment elevation, people who have already survived a heart attack will have to regularly use acetylsalicylic acid. This substance prevents the formation of blood clots. Doctors estimated that the risk of a recurrence of a heart attack due to Aspirin alone is reduced by almost a quarter.
Terms and nuances
Acute coronary syndrome in ICD 10 is encoded by the numbers I20.0. A feature of this clause of the classification system is its name. ACS, known to doctors and patients in our country, is not a terminology that is widely used internationally, so the world classifier knows only unstable angina pectoris. That is what the disease is listed in the ICD-10. However, only the difference in formulations (I20.0 also denotes an intermediate coronary syndrome) does not mean that the patient can be left without assistance or some other measures are required. With ACS, help should be done exactly as recommended for the diagnosis of ICD I20.0.
The code for acute coronary syndrome (I20.0) should be known to the doctors who draw up the patient’s medical history, but for the average person these symbols are not so important. It is much more significant to understand all the dangers associated with the pathological condition, to have an idea of the necessary assistance measures. Orientation on how to alleviate the patient’s condition should be made not only by persons assigned to the risk group for ACS, but also by their relatives, relatives and colleagues. In the event of an attack, it will be their responsibility to promptly call an ambulance and provide the patient with conditions in which you can wait for a doctor with minimal damage (as much as possible).
Disease: how does it all start?
Acute coronary syndrome without an ST segment elevation and with it can appear against the background of atherosclerosis. Doctors have established a sequence of events that lead to a high degree of ACS. It all begins (in a predominant percentage of cases) with infection. Infection is possible in a variety of ways:
- herpetic viruses;
- cytomegalovirus;
- flu
- adenoviruses.
A pathological agent provokes inflammatory processes on the inner vascular membranes, which means that the integrity of organic tissues is violated. This leads to the accumulation of low-density lipoproteins, a specific plaque is formed that narrows the vascular lumen and slows down the rate of blood flow. Platelets fuse, adhere to the vascular walls. These localizations become places of fibrin accumulation, and after some time a dense blood clot appears that does not allow blood to reach a specific area of the heart muscle.
Acute coronary syndrome without ST and with the rise of this segment is possible due to arterial spasm associated with strong feelings or a hypertensive crisis. A blockage of a vessel is possible due to the formation of a formation from another part of the circulatory system - a blood clot can appear in any artery, come off and begin its “journey” through the body.
There is a higher risk of experiencing acute coronary syndrome with an ST segment elevation, without it in individuals who regularly experience increased stress. These conditions give rise to the need for increased oxygen supply, and the circulatory system can not always provide the supply of the necessary chemical components. The increased coagulability of the main fluid of the human body - blood, can play its role. It is believed that women at the hormonal contraceptive level are considered to be at risk for ACS.
Chemistry and medicine
Acute coronary syndrome with ST elevation is triggered by the formation of blood clots. This also explains the ACS without raising this segment. A feature of the process is the release of active components in thrombosis. Histamine, serotonin, and some other substances that have a local effect on the vessels are released into the circulatory system: the lumens decrease, which means that the blood flow becomes even weaker, the flow of fluid to the organs and tissues that need them is reduced.
At the same time, the circulatory system is affected by calcium and adrenaline. The work of components that prevent blood coagulation is inhibited, and enzymes are discharged into the liquid that violate the integrity of healthy cells near necrotic areas.
It is possible to prevent acute coronary syndrome with or without ST segment elevation if blood flow quality is restored. It is categorically difficult to reverse the processes, this requires complex treatment, but even the normalization of blood circulation can already slow down the negative progress of the situation. At the same time, doctors pay attention: the areas of myocardial necrosis are scarred, in the future they will not participate in contractile movements of the muscle, gradually heart failure will increase.
Forms and Features
Assistance in acute coronary syndrome is provided based on the characteristics of the patient's condition. It is accepted to distinguish three options for the development of the situation:
- unstable angina due to a decrease in blood supply to muscle tissue;
- heart attack, when dystrophic sites are formed, subject to necrotic changes due to the complete lack of blood supply;
- ventricular fibrillation.
The latter leads to clinical death. It is observed more often against the background of sudden changes, due to a violation of the ability of cells to be excited. The patient suffers from acute arrhythmia. It is necessary to provide emergency medical care in the conditions of resuscitation.
Features of manifestations
Assistance in acute coronary syndrome is possible after the removal of primary information by ECG. The analysis may indicate acute ischemia (this is expressed by an increase in the interval), there is ACS without an increase. The main clinical manifestation is pain; the strength of the syndrome varies greatly. Behind the sternum, the sensations worry a third of an hour or longer. Perhaps the spread of pain in the shoulder blades, neck. Nitroglycerin does not show a pronounced effect.
If ACS has developed in a person of advanced age, the main manifestation is general weakness. Pressure decreases, shortness of breath is observed. Sometimes the patient faints.
Nonclassical symptoms reported relatively rarely:
- abdominal pain;
- vomiting, nausea;
- stitching pains;
- intensification of pain on inspiration.
To provide adequate assistance to the patient, the doctor must know whether heart attacks have been suffered in the past, what are the primary symptoms, what kind of pain the pain has, how it changes over time.
Help and not harm
In acute coronary syndrome, the emergency algorithm is as follows:
- Give a tablet of acetylsalicylic acid and nitroglycerin.
- Lay the patient so that he is comfortable.
- Reassure the patient.
- Call an ambulance team by phone describing all the symptoms.
Upon arrival, doctors will remove the ECG, analyze the information received and provide primary measures to support vital functions. It is supposed to use painkillers - narcotic, nitrates, injections to eliminate spasms. They give drugs that reduce blood viscosity ("Reopoliglyukin", "Heparin"). All the necessary things for the doctors will be with them in a special set for primary care "Laying in acute coronary syndrome." Such kits are sold in most pharmacies in our country.
The patient is transferred to a hospital setting for special care. If the ECG shows normal or close to those data, choose methods of assistance based on the characteristics of the symptoms.
Styling to provide care for acute coronary syndrome is completed taking into account orders issued at the federal and regional levels. The responsibility for such instructions lies with the Ministry of Health and Social Development.
With ACS, the patient is taken to the intensive care unit. If the condition is relatively stable, a fairly intense therapeutic. The algorithms for the actions of doctors are described in the official documentation governing the work of the clinic. Doctors are required to obey established rules.
Heart attack
If a heart attack is established, it is necessary to give the patient a nitroglycerin tablet under the tongue. An alternative is an aerosol with this substance, used three times. Between the procedures withstand five-minute breaks. While maintaining the pain syndrome and a pressure of 90 units or more, the introduction of nitroglycerin into a vein through a dropper is indicated.
To somewhat alleviate the patient's condition, it is allowed to inject morphine sulfate mixed with saline into the vein. Acetylsalicylic acid, Clopidogrel, is used to reduce blood viscosity.
Beta-blockers can be used if tests confirm the absence of atrioventricular block, and there is no mention of asthma or acute heart failure in the medical history. Widespread means "Egilok", "Propranolol."
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What to do next?
Continuation of therapy is selected based on the effectiveness of primary measures. If it was possible to stabilize the patient’s condition, to ease the pain syndrome, while the heart beats rhythmically, with adequate speed, and the pressure is maintained at an average level, a classic treatment for ischemia is enough. It is necessary to constantly take ECG indicators to monitor the patient's condition.
When a seizure and arrhythmia recur, in a situation where the ECG shows negative changes in the activity of the heart muscle, the patient should be urgently sent to intensive care for surgical intervention. It is possible to install a shunt or stent. A specific option is selected based on the characteristics of the case.
ACS is currently recognized as one of the most dangerous pathological conditions for human life. The patient needs emergency care in the conditions of resuscitation. Procrastination, incorrect actions - all this can provoke a fatal outcome.
ACS: features
The pathological condition manifests itself in severe, acute pain. Seizures are possible. With angina pectoris, patients describe the seizures as short-term, burning, as if compressing in the chest. A heart attack is accompanied by pain shock. The patient needs urgent hospitalization.
ACS manifests itself:
- cold sweat;
- excitement;
- panic fear;
- pallor of the skin.
With such symptoms, it is important not only to call an ambulance team in a timely manner, but also to be with the patient until the doctors arrive. You can not leave the patient alone - this significantly increases the risk of death. Particular attention should be paid to a person who is sick and vomits, as well as prone to loss of consciousness.
If, according to the results of the patient’s condition assessment, it was decided to resort to surgery, the method most suitable for the case is chosen. Stenting is an intervention in which the artery is narrowed, the catheter is brought here using a small balloon, and the lumen of the blood vessel is dilated. For fixation, a stent is used - a special mesh that is not torn away by the tissues of the human body.
If bypass surgery is indicated, then part of the coronary arteries are removed, implants are installed instead. Timely and correctly performed surgery is the best way to prevent a heart attack.
The condition has stabilized: what's next?
If a person has survived ACS, he will have to adhere to restrictions and rules all his life, otherwise the likelihood of a recurrence of the situation is high, and the risk of death in this case becomes even higher. General rules of conduct:
- until the condition shows a steady improvement, adhere to bed rest;
- exclusion from life of stress factors, strong emotions;
- refusal of physical activity.
When the condition is stabilized so that doctors allow motor activity, it is recommended to walk outdoors every day. You will have to walk slowly, and the walks themselves should be short, otherwise there will be more harm from them than good.
We'll have to reconsider the diet, exclude spicy and salty, sweets and fat, any heavy foods. Strongly unacceptable to drink alcohol. Minimize the percentage of products of animal origin, and salt is used per day in an amount of not more than 6 g. You can not eat plentifully seasoned food, spicy dishes. You must follow these rules in the rehabilitation period and after it - in a word, all your life.
If you deviate from the doctor’s recommendations, ACS will cause complications, and relapse is associated with an increased likelihood of death.
Consequences of ACS
Against the background of ACS, the probability is increased:
- failures in the rhythm of the heartbeat in various forms;
- failure of the functioning of the heart muscle in an acute form;
- inflammation of the heart membranes;
- aortic aneurysm;
- fatal outcome.
Even with first aid in the shortest possible time, the risk of relapse is quite high, as is the likelihood of complications. To reduce the risk to themselves, after ACS will have to regularly visit a cardiologist for a full systematic examination. It is important to follow the doctor's recommendations - this will extend the life.
How to warn?
Prevention of ACS involves the rejection of bad habits and the transition to a limited diet with the exception of fatty and salty, spicy. You should constantly give yourself physical activity, avoid stress and overwork. Those who are at increased risk of ACS are advised to go for walks on weekends, you can even go on non-sports trips - such are regularly organized by amateurs in almost any city in our country.
People assigned to the risk group for ACS should have a tonometer at home and monitor pressure indicators, regularly donate blood to detect cholesterol concentration. The therapist at the reception will tell you which specialized doctors will have to come for an examination, with what frequency you need to visit doctors. To warn ACS, you will have to follow the tips. Any identified diseases, especially those affecting the vessels and heart, need to be treated in a timely manner.