Ministry of health of republic of uzbekistan tashkent medical academy

Working classification of CHD
1. Sudden cardiac death (primary cardiac arrest).
2. Angina.
2.1. Stable angina (with functional class I to IV).
2.2. Unstable angina:
2.2.1. Onset angina (VVS). *
2.2.2. Worsening angina (UA).
2.2.3. Early post-operative or post-infarction angina.
2.3. Spontaneous (vasospastic, variant, Prinzmetal) angina. **
3. Silent myocardial ischemia. **
4. Microvascular angina ("syndrome X").
5. Myocardial infarction.
5.1. Myocardial infarction with tooth Q (macrofocal, transmural).
5.2. Myocardial infarction without wave Q (small focal).
6. Myocardial infarction.
7. Heart failure (with forms and stages).
8. Cardiac arrhythmias and conduction (with form).
Note:
* Sometimes-onset angina from the beginning has a stable flow;
** Some cases of silent myocardial ischemia, and severe bouts of spontaneous angina can be attributed to unstable angina.
Stable angina is one of the most common clinical form of CHD. It occurs usually in the background of stenotic coronary atherosclerosis in the presence of the large epicardial of "uncomplicated" plaque, which has a dense and strong connective tissue capsule. In these cases, the appearance of angina is usually triggered by an increase in myocardial oxygen demand, not accompanied by an adequate extension of the resistive SC (arterioles). Equally important is a spasm of the coronary vessels. Note that one of the factors that increase myocardial oxygen demand, include:
• increase in heart rate (HR);
• increase inotropizma (contractility) of the heart muscle, often associated with an increase in the activity of SAS;
• increasing afterload and thus systolic pressure in the left ventricle (eg high blood pressure);
• increase preload and end-diastolic LV volume;
• increased myocardial mass (hypertrophy of the heart muscle).
Thus, angina is provoked not only by exercise (brisk walking, running, climbing stairs), and by other factors that increase myocardial oxygen demand: emotional stress, stress, high blood pressure, an increase in venous flow to the heart, heart failure ( left ventricular volume overload), tachycardia, any origin, etc.
The first clinical manifestation of coronary heart disease can be different. According to the Framingham study, about 40% of men and 56% of women will debut stable angina. In these cases, angina usually begins gradually, and its intensity grows slowly. Since the start of the disease, it usually takes several weeks or months before a patient goes to meet doctor.
Complaints of pain. Angina pain has paroxysmal character, appearing as a rule, on the background of a relatively prosperous state of the patient, which causes the patient immediately pay attention to it, often causing marked anxiety and fear.
Typically, the pain is localized in the chest, usually in the region of its upper and middle thirds. Less often the pain occurs in the apex of the heart to the left of the sternum in the II-V intercostal space under the left shoulder blade, or even in the left arm, collarbone or in the left half of the lower jaw (atypical localization of pain).
The nature of pain is usually hot, constricting, and oppressive. Sometimes patients describe angina as "a feeling of discomfort in the chest." During an attack of angina, patients, usually, reticent and location of the pain show with palm or fist pressed against the sternum (symptom Levine).