Atherosclerotic cardiosclerosis is a pathology in which connective tissue proliferates in the heart due to atherosclerosis of the coronary arteries. Atherosclerotic cardiosclerosis ICD 10 code - I25.1.
Atherosclerosis-cardiosclerosis is one of the manifestations of ischemic heart disease. Atherosclerotic cardiosclerosis is manifested clinically by heart failure, conduction and heart rhythm disturbances, angina pectoris. Diagnosis of the disease includes a number of laboratory and instrumental studies.
Treatment of this form of cardiosclerosis is conservative. Therapy is aimed at relieving heart pain, lowering cholesterol, normalizing conduction and heart rate, and improving blood circulation.
The main cause of the disease is the formation of atherosclerotic plaques at the site of the damaged tissue of blood vessels. They form gradually as cholesterol builds up. Over time, the plaques increase in size, and the lumen of the vessel, accordingly, narrows. The result of this process is impaired blood circulation, curvature of the vessel, high blood pressure, insufficient oxygen supply to the tissues of the body.
Hypoxia of the heart occurs, which leads to the development of ischemic heart disease. With ischemic disease, myocardial function is impaired, muscle tissue is replaced by connective tissue, which does not have the necessary elasticity. As a result, pain in the heart appears and the heart rhythm is disturbed.
Atherosclerotic plaques are formed as a result of exposure to the following reasons:
There are the following forms of atherosclerotic cardiosclerosis (AK):
By types of AK can be:
The main danger of atherosclerotic cardiosclerosis is that at the initial stages of development, this disease is asymptomatic.
Since AK is one of the forms of ischemic heart disease, doctors usually focus on the clinical signs of this particular disease. However, there are a number of symptoms that can be used to diagnose atherosclerotic cardiosclerosis.
First of all, such symptoms include pain in the heart, which can be aching or sharp. Pain can be observed not only in the region of the heart, but also in the left arm or shoulder blade. In addition, with AK, the patient develops a feeling of constant fatigue, tinnitus, and headaches.
Shortness of breath is another characteristic symptom of the disease. It occurs gradually, first after a strong physical strain, then during normal walking or even at rest.
With AK, an exacerbation of cardiac asthma occurs, and tachycardia also develops (heart rate reaches 150 or more beats per minute in a calm state). One of the most striking symptoms of atherosclerotic cardiosclerosis is swelling of the extremities, which occurs due to liver problems.
In order to make an accurate diagnosis, the doctor interviews the patient and examines the history of his illness. The specialist is interested in a history of atherosclerosis, arrhythmias, ischemic heart disease and other pathological conditions. During the interview, the doctor finds out what the patient is complaining about and identifies the symptoms of the disease.
After that, a number of laboratory and instrumental studies are assigned to make an accurate diagnosis, the most common of which are:
It is impossible to completely get rid of such a pathology as ischemic heart disease, atherosclerotic cardiosclerosis. Treatment of this pathology consists in the prevention of exacerbations and relief of symptoms.
First of all, drugs are prescribed to lower blood cholesterol levels. Most often these are drugs from the statin group. The duration of the course of treatment and the dose of drugs are determined by the doctor. As a rule, treatment is long-term, and sometimes life-long.
In addition to statins, the appointment of vasodilators or drugs that strengthen the walls of blood vessels is indicated.
If the course of atherosclerotic cardiosclerosis is accompanied by angina pectoris or there is a threat of developing a heart attack, then it is possible to carry out an operation, during which the largest vascular plaques are removed.
In parallel with the main therapy, the doctor may prescribe the intake of tranquilizers or antidepressants.
It should be remembered that self-medication is unacceptable! The attending physician should prescribe certain drugs, determine their dosage and the duration of the course of treatment. Otherwise, the development of a number of serious complications and even the death of the patient is possible.
In severe cases, the possible outcome of the disease of atherosclerotic cardiosclerosis is death.
The prognosis is influenced by the degree of myocardial damage, the presence of concomitant diseases, arrhythmias. In severe cases, there are signs of ascites and pleurisy, heart failure develops. In the event of a ruptured aneurysm, atherosclerotic cardiosclerosis is the cause of the patient's death.
It is known that it is easier to prevent any disease than to treat it for a long time and painfully. This statement also applies to atherosclerotic cardiosclerosis. To prevent the development of this disease, as well as its complications, it is necessary, first of all, to eat right.
Atherosclerotic cardiosclerosis - diet:
In addition to diet, you must lead a healthy lifestyle and be sure to play sports (swimming, walking, and so on) to strengthen the heart muscle.
It is necessary to undergo preventive examinations at the clinic at least once a year. This makes it possible to detect most CVD diseases at an early stage, which greatly facilitates treatment and makes the prognosis more favorable. In the presence of the first signs of the disease, you should immediately seek help from a specialist.
PROFILE COMMISSION FOR THE SPECIALTY "PATHOLOGICAL ANATOMY" OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
RUSSIAN SOCIETY OF PATHOLOGOANATOMS
FGBNU "RESEARCH INSTITUTE OF HUMAN MORPHOLOGY"
GBOU DPO "RUSSIAN MEDICAL ACADEMY OF POSTGRADUATE EDUCATION" OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
State Budgetary Educational Institution of Higher Professional Education “MOSCOW STATE MEDICAL-DENTAL UNIVERSITY NAMED AFTER A.I. EVDOKIMOVA "MINISTRY OF HEALTH OF RUSSIA
GBOU HPE "Russian National Research Medical University named after N.I. Pirogov"
GBOU VPO "FIRST SAINT-PETERSBURG STATE MEDICAL UNIVERSITY NAMED AFTER ACADEMICIAN I.P. PAVLOV "MINISTRY OF HEALTH OF RUSSIA
The wording
pathological diagnosis
with ischemic heart disease
(class IX "diseases of the circulatory system" ICD-10)
Moscow - 2015
Compiled by:
Frank G.A., Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy of the State Budgetary Educational Institution of Higher Professional Education of the Russian Medical Academy of Postgraduate Education of the Ministry of Health of Russia, Chief Freelance Pathologist of the Ministry of Health of Russia, First Vice-President of the Russian Society of Pathologists;
Zayratyants O.V., Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy, Moscow State University of Medicine and Dentistry A.I. Evdokimova of the Ministry of Health of Russia, Vice-President of the Russian and Chairman of the Moscow Society of Pathologists;
Shpektor A.V., Doctor of Medical Sciences, Professor, Head of the Department of Cardiology FPDO GBOU VPO MGMSU named after A.I. Evdokimova of the Ministry of Health of the Russian Federation, chief freelance cardiologist of the Moscow Department of Health;
L.V. Kaktursky, Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Central Administrative Department of the Federal State Budgetary Scientific Institution of the Research Institute of Human Morphology, Chief Freelance Pathologist of Roszdravnadzor, President of the Russian Society of Pathologists;
Mishnev O.D., Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy and Clinical Pathological Anatomy, NI Pirogova of the Ministry of Health of Russia, Vice-President of the Russian Society of Pathologists;
Rybakova M.G., Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy, State Budgetary Educational Institution of Higher Professional Education First St. acad. I.P. Pavlova of the Ministry of Health of Russia, chief freelance pathologist of the Health Committee of St. Petersburg;
Chernyaev A.L., Doctor of Medical Sciences, Professor, Head of the Pathology Department of the Federal State Budgetary Institution Research Institute of Pulmonology, FMBA of Russia;
Orekhov O.O., Candidate of Medical Sciences, Head of the Pathological Department of City Clinical Hospital No. 67, Chief Freelance Pathologist of the Moscow City Health Department;
A.V. Losev, Candidate of Medical Sciences, Head of the Pathological Department of the State Budgetary Healthcare Institution Regional Clinical Hospital of the Ministry of Health of the Tula Region, the chief freelance pathologist of the Ministry of Health of the Tula Region and the Ministry of Health of Russia in the Central Federal District of the Russian Federation.
Abbreviations
Methodology
Methods used to collect / select evidence:
Search in electronic databases.
Description of methods used to collect / select evidence:
Methods used to assess the quality and strength of evidence:
Methods used to formulate the recommendations:
Expert consensus
Consultation and expert assessment:
The preliminary version was discussed at a meeting of the profile commission on the specialty "pathological anatomy" of the Ministry of Health of Russia on February 19, 2015, at a meeting of the Moscow Society of Pathologists on April 21, 2015, after which it was posted on the website of the Russian Society of Pathologists (www.patolog.ru) for wide discussion, so that specialists who did not take part in the profile commission and the preparation of recommendations have the opportunity to familiarize themselves with them and discuss them. The final approval of the recommendations was carried out at the VIII Plenum of the Russian Society of Pathologists (May 22-23, 2015, Petrozavodsk).
Working group:
For the final revision and quality control of the recommendations, they were re-analyzed by the members of the working group, who came to the conclusion that all the comments and comments of the experts were taken into account, the risk of systematic errors in developing the recommendations was minimized.
Method formula:
The rules for the formulation of the final clinical, pathoanatomical and forensic medical diagnoses, filling out the statistical registration document - the medical certificate of death in coronary heart disease in accordance with the requirements of the current legislation of the Russian Federation and ICD-10 are given. The adaptation of the domestic rules for the formulation of the diagnosis and diagnostic terminology to the requirements and codes of ICD-10 was carried out.
Indications for use:
Unified rules for the formulation of the final clinical, pathoanatomical and forensic medical diagnosis, registration of a medical certificate of death in coronary heart disease in accordance with the requirements of the current legislation of the Russian Federation and ICD-10 throughout the country are necessary to ensure interregional and international comparability of statistical data on morbidity and causes death of the population.
Logistics:
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), as amended for 1996-2015.
"" - approved by order of the Ministry of Health of the Russian Federation No. 241 dated 07.08.1998.
Clinical guidelines are intended for pathologists, forensic experts, cardiologists and doctors of other specialties, as well as for teachers of clinical departments, graduate students, residents and senior students of medical universities.
The recommendations are the result of a consensus between clinicians, pathologists and forensic experts and are aimed at improving the quality of diagnosis of nosological units included in the group concept of "coronary heart disease" (IHD), and their statistical accounting among the causes of mortality in the population. The purpose of the recommendations is to introduce into practice unified rules for the formulation of pathological diagnosis and registration of medical certificates of death in coronary artery disease in accordance with the provisions of the Federal Law of November 21, 2011, No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" and the requirements of the International Statistical Classification diseases and health problems of the 10th revision (ICD-10). The rules apply to final clinical and forensic diagnoses in connection with the underlying general requirements for the formulation and the need for their comparison (collation) when conducting clinical and expert work. Examples of construction (formulation) of pathological diagnoses and registration of medical death certificates are given.
Clinical guidelines were drawn up on the basis of summarizing literature data and the authors' own experience. The authors are aware that the construction and formulation of diagnoses may change in the future as new scientific knowledge accumulates. Therefore, despite the need to unify the formulation of the pathological diagnosis, some suggestions can serve as a reason for discussion. In this regard, any other opinions, remarks and wishes of specialists will be perceived by the authors with gratitude.
Diagnosis is one of the most important objects of standardization in healthcare, the basis for quality management of medical services, documentary evidence of a doctor's professional qualifications. The reliability of the data provided by the health authorities on the morbidity and mortality of the population depends on the unification and strict adherence to the rules for formulating diagnoses and issuing medical certificates of death. Particularly high is the responsibility assigned to pathologists and forensic experts.
The recommendations are the result of a consensus between clinicians, pathologists and forensic experts and are aimed at improving the quality of diagnosis of nosological units included in the group concept of "coronary heart disease" (IHD), and their statistical accounting among the causes of mortality in the population.
Their need is due to:
Ischemic heart disease (or coronary heart disease) - a group (generic) concept that includes pathological processes (nosological forms) arising from acute or chronic myocardial ischemia (a discrepancy between the level of oxygenated blood supply to the level of the heart muscle's need for it), caused by spasm, narrowing or obstruction of the coronary arteries in their atherosclerosis.
IHD in ICD-10 is included in class IX "Diseases of the circulatory system", which unites a large number of group (generic) concepts and nosological units, identified both on the basis of their etiology and pathogenesis, and on the basis of medical and social criteria (many pathogenetically represent are complications of atherosclerosis, arterial hypertension, diabetes mellitus). In particular, such the group concept is coronary heart disease. It includes a number of nosological forms, namely, types of angina pectoris, myocardial infarction, cardiosclerosis, etc. In ICD-10, even such nosological units as acute and recurrent myocardial infarction are divided by the localization of the pathological process and some other criteria into separate forms, which is necessary take into account when coding them.
Hypertension and secondary arterial hypertension with the diseases that caused them cannot be diagnosed as independent nosological forms in the diagnosis if nosological units from the IHD group are diagnosed (as well as from the groups of cerebrovascular diseases, ischemic lesions of the intestines, limbs and other main arteries).
Class IX includes a number of terms, such as "hypertensive disease", "atherosclerotic heart disease", "past myocardial infarction", etc. For them there are domestic analogues: "hypertension" or "arterial hypertension", "atherosclerotic cardiosclerosis" or "diffuse small focal cardiosclerosis", "postinfarction cardiosclerosis" or "large focal cardiosclerosis". When formulating a diagnosis, it is permissible to use the terms adopted in domestic classifications, and to issue a medical death certificate - their analogs from ICD-10 with the corresponding codes.
Not used in diagnoses, since they represent group and / or unspecified pathological conditions in IHD (given in ICD-10 not for their use in a detailed diagnosis): acute ischemic heart disease, unspecified (I24.9), atherosclerotic cardiovascular disease, as described (I25 .0), chronic ischemic heart disease, unspecified (I25.9).
Can't figure as an underlying disease pathological processes that represent complications or manifestations of coronary artery disease and some other nosological forms (syndromes, symptoms): current complications of acute myocardial infarction (I23.0-I23.8), heart failure (I50), arrhythmia variants (I44-I49), in addition to congenital rhythm and conduction disturbances leading to fatal asystole, most of the pathological processes from the group of "complications and ill-defined heart diseases" (I51), acute (but not chronic) heart aneurysm, pulmonary embolism (pulmonary embolism, except for obstetric practice for which in ICD-10 there is a special class XV "Pregnancy, childbirth and the postpartum period" and the corresponding codes), cor pulmonale (acute or chronic), pulmonary hypertension (except for primary, idiopathic, which is a nosological form), phlebothrombosis (but not thrombophlebitis) and etc. .
As a nosological unit - the main disease in case of lethal outcomes (the initial cause of death) are not used the following pathological processes present in the ischemic heart disease group in class IX of ICD-10: coronary thrombosis, which does not lead to myocardial infarction (I24.0), circulatory system disorders after medical procedures, not elsewhere classified (I97).
With any mention in the headings of the clinical diagnosis of atherosclerosis of the coronary arteries, it is advisable (if appropriate vascular studies were carried out, for example, angiography), and in the pathological or forensic diagnoses, it is necessary to indicate:
Additionally, it is advisable to indicate the stage of atherosclerosis and its degree (lesion area). There are 4 stages of atherosclerosis: I - lipid spots, II - lipid spots and fibrous plaques, III - lipid spots, fibrous plaques and "complicated lesions" (hemorrhages in fibrous plaques, atheromatosis, their ulceration, thrombotic complications), IV - the presence of atherocalcinosis with pre-existing changes. There are 3 degrees of severity of atherosclerosis of the aorta and arteries: moderate, affection of up to 25% of the intimal area, pronounced, the area of the lesion is from 25% to 50%, pronounced, the area of the lesion is more than 50%.
It is unacceptable to replace the term "atherosclerosis" with the terms "calcification" or "sclerosis" of the artery, since such lesions can be caused not only by atherosclerosis, but also by vasculitis or hereditary diseases.
Nosological units from the IHD group are excluded if the revealed myocardial damage (angina pectoris syndrome, MI, cardiosclerosis) is not caused by atherosclerosis of the coronary arteries, but by other causes (coronary and non-coronary necrosis and their outcomes). In such cases, myocardial damage is indicated in the diagnosis under the heading "Complications of the underlying disease", or, when it is dictated by the logic of constructing a diagnosis, as part of the manifestations of the underlying disease.
When formulating a diagnosis, you should choose one of the nosological forms that make up IHD. It is unacceptable to indicate several such units at the same time in different headings of the diagnosis, for example, MI in the heading "Main disease", and postinfarction cardiosclerosis - "Concomitant disease", or postinfarction and atherosclerotic cardiosclerosis, even in one heading.
The modern clinical classification of ischemic heart disease does not correspond to all morphological and ICD-10:
1. Acute forms of ischemic heart disease:
1.1. Acute (sudden) coronary death;
1.2. Acute coronary syndrome:
1.2.1 .. Unstable angina pectoris;
1.2.2. MI without ST-segment elevation (non-ST-elevation myocardial infarction - NSTEMI);
1.2.3. ST-elevation myocardial infarction (STEMI) MI.
2. Chronic forms of ischemic heart disease:
2.1. Angina pectoris (except unstable),
2.2. Atherosclerotic (diffuse small focal) cardiosclerosis;
2.3. Ischemic cardiomyopathy;
2.4. Large focal (postinfarction) cardiosclerosis;
2.5. Chronic aneurysm of the heart.
2.6. Other rare forms (painless myocardial ischemia, etc.).
The term "focal myocardial dystrophy" is excluded from use and is absent in the classifications and ICD-10("Acute focal ischemic myocardial dystrophy") proposed by A.L. Myasnikov (1965). In the diagnosis, instead of this term, MI (as its ischemic stage) should be indicated, and not always as part of IHD.
Angina pectoris is a group of isolated clinically nosological units included in the ICD-10 (I20.0-I20.9). Its morphological substrate can be a variety of acute and chronic changes in the myocardium. It is not used in the final clinical, postmortem and forensic diagnoses.
Ischemic cardiomyopathy(code I25.5) - an extreme manifestation of prolonged chronic myocardial ischemia with its diffuse lesion (severe diffuse atherosclerotic cardiosclerosis, similar to dilated cardiomyopathy). The diagnosis of ischemic cardiomyopathy is established with severe dilatation of the left ventricular cavity with impaired systolic function (ejection fraction 35% and below). The use of this diagnosis is advisable only in specialized cardiological medical institutions.
Diagnosis "Chronic heart aneurysm"(in ICD-10 - "Aneurysm of the heart" with code I25.3) does not require additional indication of the presence of postinfarction cardiosclerosis, if it is limited to the walls of the aneurysm. Diagnosis "Postinfarction (large focal) cardiosclerosis does not require additional indication of the presence of atherosclerotic (diffuse small focal) cardiosclerosis.
Painless myocardial ischemia(asymptomatic ischemia, code I25.6) is diagnosed in a patient when episodes of myocardial ischemia are detected on the ECG, but in the absence of angina attacks. Like angina pectoris, painless myocardial ischemia is not may appear in the final clinical, postmortem or forensic diagnoses.
Syndrome X in the clinical diagnosis is established in a patient who, in the presence of angina attacks, does not detect coronary artery disease (angiographically, etc.), there are no signs of vasospasm, and other causes of angina pectoris syndrome that are not included in the IHD group are excluded. Stunned myocardium- dysfunction of the left ventricle of the heart after episodes of acute ischemia without myocardial necrosis (including, after myocardial revascularization). "Hibernating", "asleep" (hibernating) myocardium- the result of a prolonged decrease in coronary perfusion while maintaining the viability of the myocardium (but with its pronounced dysfunction). In the diagnosis, the terms "syndrome X", "stunned" and "hibernating" myocardium are not used, there are no ICD-10 codes for them.
In foreign literature, instead of terms "Atherosclerotic cardiosclerosis" and "diffuse small focal cardiosclerosis" use essentially similar concepts: "Diffuse or small focal atrophy of cardiomyocytes with interstitial myocardial fibrosis" or "Atherosclerotic heart disease." The last term included in ICD-10 (code I25.1).
Avoid unjustified overdiagnosis of atherosclerotic (diffuse small focal) or postinfarction (large focal) cardiosclerosis as the main or competing or combined disease. So, often this diagnosis is mistakenly established with insufficiently professionally performed autopsy and superficial analysis of thanatogenesis, especially in observations of acute death, when the true primary cause of death is acute (sudden) coronary death. It is also important to differentiate brown myocardial atrophy (with pronounced perivascular sclerosis and myofibrosis) in various severe diseases and in deceased seniors, and diffuse small-focal cardiosclerosis as a form of ischemic heart disease. Often, nosological units from the group of chronic IHD that do not play a significant role in thanatogenesis are incorrectly recorded as competing or combined diseases. They should be listed under the heading "Concomitant diseases" (examples 1 - 5).
Medical death certificate
I. a) Cerebral edema.
b) Pneumococcal bilateral pneumonia (J 13)
II. Chronic alcohol intoxication (F10.1).
Medical death certificate
I. a) Cachexia
b) Atherosclerotic (discirculatory) encephalopathy (I67.8).
Medical death certificate
b) Breakthrough of blood into the ventricles of the brain.
c) Intracerebral hematoma (I61.0).
II. Hypertension (I10).
Medical death certificate
I. a) Edema of the brain with dislocation of its trunk.
Medical death certificate
I. a) Focal confluent pneumonia.
b) Residual effects after intracerebral hemorrhage (I69.1).
II. Hypertension (I10).
The term "acute coronary syndrome" (ACS) was proposed by V. Fuster et al. (1985), however, its definition has undergone a number of changes in recent years. Currently ACS is a group clinical concept within ischemic heart disease, which combines various manifestations of acute myocardial ischemia caused bycomplicated unstable atherosclerotic plaque of the coronary artery of the heart... The introduction of the concept of ACS into practice led to the elimination of the term "acute coronary insufficiency", which still appears in the ICD-10 in the group "other acute forms of coronary artery disease" with the general code I24.8. Terms such as "pre-infarction state" and "acute coronary insufficiency" are not used in the diagnosis.
ACS includes the following nosological forms:
Unstable angina
MI without ST-segment elevation (non-ST-elevation myocardial infarction - NSTEMI);
ST-elevation myocardial infarction (STEMI) MI.
They can result in acute (sudden) coronary (cardiac) death, which in some classifications is included in the ACS. However, it should be borne in mind that acute coronary, and even more so, cardiac death is not limited to ACS, as well as MI. The symptom previously used in the clinic in the form of the appearance of a pathological Q wave on the ECG is no longer a criterion for the diagnosis and classification of ACS. ACS, as a group concept, and absent in ICD-10, cannot figure in the diagnosis. This is a preliminary diagnosis, a "logistic" concept indicating the need for certain emergency medical and diagnostic measures. In case of a lethal outcome, unstable angina pectoris cannot be indicated in the diagnosis. In the final clinical, pathological or forensic medical diagnoses, depending on the specific situation, either acute (sudden) coronary death (ICD-10 code - I24.8) or MI (ICD-10 codes - I21.- and I22.-). In pathological and forensic diagnoses, changes in the ST segment in MI are indicated only if there is appropriate data in the final clinical diagnosis, with the reference "according to the card of an inpatient or outpatient patient", "according to the history of the disease").
The reason for the development of ACS is acutely developed partial (with unstable angina pectoris and MI without ST segment elevation) or complete occlusion (with MI with ST segment elevation) of the coronary artery of the heart by a thrombus in complicated unstable atherosclerotic plaque. Complications of an unstable atherosclerotic plaque include hemorrhage into the plaque, erosion or rupture, stratification of its lining, thrombus, thrombotic or atheroembolism of the distal parts of the same artery. Clinical criteria for diagnosing the causes of ACS in terms of damage to the coronary arteries of the heart are limited to the concepts of "complicated unstable atherosclerotic plaque" or "atherothrombosis", which are often used synonymously. However, it should be clarified that endothelial damage with the development of coronary artery thrombosis can also be observed in atherosclerotic plaques that do not meet the morphological criteria of their instability. In this regard, from a general pathological point of view, it is more correct to speak of “complicated atherosclerotic plaque”.
Complicated (more often unstable) atherosclerotic plaque of the coronary artery of the heart is a mandatory morphological criterion for diagnosing nosological forms included in ACS. It is important to note that stenosis of coronary arteries by atherosclerotic plaques before their complications develop in 50% of patients is not significantly expressed and is less than 40%. Due to autothrombolysis or thrombolytic therapy, an autopsy may no longer detect thrombi of the coronary arteries of the heart diagnosed during life (angiographically, etc.). Even without thrombolytic therapy, after 24 hours, blood clots persist in only 30% of patients. Therefore, at autopsy, it is of fundamental importance to detect a complicated unstable atherosclerotic plaque, even without coronary artery thrombosis.
The definitions of ACS and type 1 MI (see below) dictate the requirements for the study of the coronary arteries of the heart at autopsy: it is imperative to cut the coronary arteries longitudinally, limiting only to transverse sections is unacceptable... It is advisable to use the method of opening the heart according to G.G. Avtandilov. In pathological and forensic diagnoses, it is necessary to indicate the localization, type (stable, unstable) and the nature of complications of atherosclerotic plaques, the degree of stenosis of specific arteries, and the description of the stage and degree (area) of atherosclerotic lesions of the arteries is optional.
So, for example, the entry: “Acute MI (localization, prescription, size) is inadmissible. Atherosclerosis of the coronary arteries of the heart (2nd degree, II stage, stenosis up to 30%, thrombosis of the left coronary artery) ”. An example of a recommended entry can be the following wording: “Acute MI (localization, prescription, size). Stenosing atherosclerosis of the coronary arteries of the heart (complicated unstable atherosclerotic plaque with rupture of the lining, red obstructing thrombus 1 cm long of the left coronary artery at a distance of 1.5 cm from its mouth; atherosclerotic plaques, stenosing the lumen of mainly the left circumflex artery up to 40%) ”.
For the pathological diagnosis of nosological forms in the composition of the ACS, morphological verification of focal myocardial ischemia is required. Although irreversible necrotic changes in cardiomyocytes develop after 20-40 minutes of ischemia, the rate of development of necrosis is influenced by the state of collaterals and microvasculature, as well as the cardiomyocytes themselves and individual sensitivity to hypoxia. In addition, macro- and microscopic morphological signs of necrosis, which do not require the use of special diagnostic methods, appear no earlier than 4-6 hours (up to 12 hours).
If you suspect myocardial ischemia of any genesis, it is necessary to conduct a macroscopic test, for example, with nitro blue tetrazolium or potassium tellurite. Histological diagnosis of myocardial ischemia is less specific and more laborious, depending on the correct choice of the myocardial area suspicious for ischemia and research methods. More reliable is polarizing microscopy, which can, to a certain extent, replace a macroscopic sample.
It should be borne in mind that positive results of macroscopic tests or relatively specific histological changes appear approximately 30 minutes after the onset of the development of acute myocardial ischemia. They are also not a criterion for qualifying the focus of ischemia or necrosis as a nosological form of myocardial damage from the ischemic heart disease group.
Under the term "Acute (sudden) coronary death"in the clinic, they mean sudden death within one hour (according to other definitions - from 6 to 12 hours) from the moment of the onset of the first symptoms (signs) of myocardial ischemia in IHD... In the ICD-10 it is included in the group of "other acute forms of coronary artery disease" (code I24.8). Pathological or forensic diagnosis of acute (sudden) coronary death is established by excluding other causes of death based on clinical and morphological analysis... It is necessary to exclude focal myocardial ischemia. In cases where there is clinical and laboratory data on ACS or MI, and an autopsy reveals a complicated atherosclerotic plaque of the coronary arteries and focal myocardial ischemia, type I MI, its ischemic stage, is diagnosed. If an autopsy reveals a coronary or non-coronary focal myocardial ischemia not associated with ischemic heart disease, the diseases that caused it are diagnosed, which become the underlying disease.
Concept"Acute (sudden) cardiac death" defined as sudden "cardiac" death (primary circulatory arrest), unexpected in nature and time of occurrence, even in the case of a previously established heart disease, the first manifestation of which is loss of consciousness within one hour (according to other definitions - from 6 to 12 hours.) from the moment the first symptoms appear. More often it is caused by lethal arrhythmias (ventricular tachycardia, turning into ventricular fibrillation, primary ventricular fibrillation, bradyarrhythmias with asystole). In the clinic, the terms "acute cardiac death" and "acute coronary death" are often used synonymously, and acute (sudden) cardiac death is a broader concept, a clinical syndrome in any heart disease. but in ICD-10, the term "acute (sudden) cardiac death" excludes acute coronary death and the presence of coronary artery disease . Diagnosis "acute (sudden) cardiac death" (ICD-10 code - I46.1) - "diagnosis of exclusion", allowed after the absolute exclusion of the violent nature of death, acute coronary death, any heart disease and other nosological forms, when the nature of the pathological process and the corresponding morphological substrate underlying heart damage cannot be established (examples 6, 7).
Medical death certificate
I. a) Acute coronary death (let's say the term "sudden coronary death") (I24.8).
Medical death certificate
I. a) Sudden cardiac death (I46.1).
MI is a coronary (ischemic) myocardial necrosis, which can be both a nosological form in the composition of coronary artery disease, and a manifestation or complication of various diseases or injuries accompanied by impaired coronary perfusion (coronaryitis, thrombosis and thromboembolism of coronary arteries, their developmental abnormalities, etc.) .).
Modern definition, clinical diagnostic criteria and classification of myocardial infarction, called "The third universal definition of myocardial infarction" were the result of the 3rd international consensus reached in 2012 between the European Society of Cardiology, the American College of Cardiology Foundation, the American Heart Association and the World Heart Federation (Joint ESC / ACCF / AHA / WHF Task Force for the Universal Definition of Myocardial Infarction). They are based on refined provisions first outlined in the materials of the 2nd international consensus in 2007 (Joint ESC / ACCF / AHA / WHF Task for the Redefinition of Myocardial Infarction, 2007). Some of the definitions presented in the ICD-10 have been retained.
IM is considered acute 28 days old. and less.
Recurrent MI should be called with a recurrence of an ischemic attack more than 3 days later. and in less than 28 days. after the previous one.
Repeated MI is recognized when it develops after 28 days. after the primary. Both recurrent and repeated MI in ICD-10 have a common code (I22), the fourth sign of which depends on the localization of the necrosis focus.
In accordance with the "Third Universal Definition", "The term acute myocardial infarction should be used when there are proven signs of myocardial necrosis resulting from prolonged acute ischemia." The IM classification includes 5 types. It is advisable to indicate the types of myocardial infarction in the diagnosis, although they do not have special codes in the ICD-10 .
Spontaneous MI (MI type 1) is caused by rupture, ulceration or stratification of an unstable atherosclerotic plaque with the development of intracoronary thrombosis in one or more coronary arteries, leading to a decrease in myocardial perfusion with subsequent necrosis of cardiomyocytes. As already mentioned in the section "acute coronary syndrome", due to thrombolysis (spontaneous or induced), an intracoronary thrombus may not be detected at autopsy. On the other hand, coronary artery thrombosis can also develop when a stable atherosclerotic plaque is damaged. In addition, type 1 MI can develop with atherocalcinosis of the coronary arteries of the heart, due to plasmorrhage and cracking of petrification, leading to a rapid increase in the degree of arterial stenosis and / or thrombosis.
Type 1 myocardial infarction is included in the group concept of ACS and is always a nosological form as part of coronary artery disease, therefore, the diagnosis is indicated under the heading "Main disease" or a competing or combined disease (examples 8 - 11).
Medical death certificate
I. a) Hemotamponade of the pericardium.
b) Rupture of the anterior wall of the left ventricle of the heart.
c) Acute anterior apical myocardial infarction (I21.0).
II. Renal arterial hypertension (I15.1).
Medical death certificate
I. a) Pulmonary edema.
b) Recurrent myocardial infarction, posterolateral with transition to the right ventricle (I21.2).
Medical death certificate
I. a) Cardiogenic shock.
b) Separation of the posterior papillary muscle of the left ventricle of the heart
c) Recurrent myocardial infarction of the posterior wall and interventricular septum (I22.1).
II. Renovascular arterial hypertension (I15.0).
Medical death certificate
I. a) Focal pneumonia.
b) Ischemic cerebral infarction (I63.3).
II. Acute subendocardial myocardial infarction (I21.4). Hypertension (I10).
MI secondary to ischemic imbalance (type 2 MI) develops when a condition other than coronary artery disease leads to an imbalance between oxygen demand and / or its delivery (endothelial dysfunction, coronary spasm, embolism, tachy / bradyarrhythmias, anemia, respiratory failure, hypotension or hypertension with or without myocardial hypertrophy). Complicated unstable atherosclerotic plaques or atherothrombosis are absent at autopsy.
MI type 2 in most cases is not a nosological form in the composition of coronary artery disease and in the diagnosis it should be indicated in the heading "Complications of the underlying disease". Comorbidity is of paramount importance in its pathogenesis (and diagnosis): the presence, in addition to atherosclerosis of the coronary arteries and ischemic heart disease, combined diseases and / or their complications, which contribute to the development of ischemic myocardial imbalance. Such combined diseases can be lung diseases, oncological diseases, etc. Even with a severe syndrome of chronic cardiovascular insufficiency in a deceased person with atherosclerotic or postinfarction cardiosclerosis with ischemic heart disease, foci of ischemia or myocardial necrosis (with postinfarction cardiosclerosis, usually along the periphery of the scars) should be regarded as a complication of the underlying disease, and not as a recurrent myocardial infarction as part of ischemic heart disease. Recurrent myocardial infarction is diagnosed when signs of type 1 myocardial infarction are found.
The formulation of the diagnosis is based on the results of clinical and morphological analysis. There are no specific criteria that would make it possible to morphologically differentiate small-sized MI in IHD from large-focal myocardial necrosis of hypoxic and mixed genesis, which can develop in patients, for example, with severe anemia and the presence of atherosclerosis (but not atherothrombosis, as in type 1 MI) coronary arteries of the heart. In such observations in the pathological diagnosis under the heading "Complications of the underlying disease", it is more appropriate to use the term type 2 myocardial infarction rather than "myocardial necrosis", although non-coronary hypoxic factor plays an important role in its pathogenesis (examples 12, 13).
Medical death certificate
b) COPD in the acute stage with bronchopneumonia (J44.0).
II. Large focal cardiosclerosis (I25.8)
Hypertension (I10).
Medical death certificate
I. a) Chronic cardiovascular failure
b) Large focal cardiosclerosis (I25.8)
II. Hypertension (I10).
In rare cases, type 2 myocardial infarction can be classified as a form of ischemic heart disease and is listed in the "Main disease" heading in the absence of any diseases and their complications causing hypoxic or metabolic damage to the myocardium (absence of comorbidity) and the presence of atherosclerosis of the coronary arteries of the heart with their stenosis. lumen by more than 50%. An example is circular subendocardial myocardial infarction, which developed in atherosclerotic lesions of 2 or 3 coronary arteries of the heart without complicated plaque or atherothrombosis (Example 14).
Medical death certificate
I. a) Acute cardiovascular failure
b) Acute myocardial infarction, posterolateral with transition to the right ventricle (I21.2).
II. Hypertension (I10).
MI type 3 (MI resulting in death when cardiac biomarkers are not available)- this is cardiac death with symptoms suspicious of myocardial ischemia and, presumably, new ischemic changes on the ECG or new blockade of the left bundle branch, if death occurred before taking blood samples, or before the level of cardiospecific biomarkers should increase, or in those rare situations when they are not investigated.
MI type 3 is a clinical concept. Autopsy may diagnose acute coronary death, type 1 or 2 myocardial infarction, as well as other coronary or non-coronary myocardial necrosis of various pathogenesis. Depending on this, this type of myocardial necrosis can appear in various headings of the diagnosis.
MI type 4, a is a percutaneous coronary intervention (PCI) MI, or PCI-associated MI.
MI type 4b is an MI associated with stent thrombosis of the coronary artery of the heart.
Type 5 MI is a coronary artery bypass graft (CABG)-associated MI, or CABG-associated MI.
MI types 4 a, 4 b and 5 are nosological forms in the composition of coronary artery disease, develop as a complication of various types of percutaneous coronary interventions or CABG surgery performed for atherosclerotic lesions of the coronary arteries of the heart in patients with coronary artery disease. In the diagnosis, these types of myocardial infarction are indicated as the underlying disease, and changes in the coronary arteries of the heart and the type of intervention - as its manifestation, if there is no reason to formulate the diagnosis as in iatrogenic pathology.
Thus, in the final clinical, pathoanatomical or forensic medical diagnoses, MI can be presented as an underlying disease (or as a competing or combined disease), only if it is qualified as a nosological form from the IHD group. All other types of myocardial necrosis (including, apparently, most type 2 MI) are a manifestation or complication of various diseases, injuries or pathological conditions.
Myocardial necrosis is a heterogeneous group of focal irreversible myocardial damage in terms of etiology, pathogenesis and morphogenesis, as well as in terms of the extent of lesion, clinical manifestations and prognosis. From the standpoint of general pathology, myocardial necrosis is usually divided into coronary (ischemic, or MI [the term “MI” is not equivalent to its nosological form as part of IHD]) and non-coronary (hypoxic, metabolic, etc.). According to clinical criteria, in accordance with the "Third International Consensus", myocardial damage (mainly non-coronary) and myocardial infarction are distinguished. In connection with the introduction into clinical practice of highly sensitive tests for determining the level of cardiospecific biomarkers in the blood (especially, cardiac troponin I or T), it should be borne in mind that they can increase with minimal coronary and non-coronary myocardial damage (Table 1).
Table 1
Myocardial injury with elevated cardiac troponin levels
Damage caused by primary myocardial ischemia
Rupture of unstable atherosclerotic plaque of the coronary artery of the heart
Intracoronary thrombosis
Damage secondary to ischemic imbalance in the myocardium
Tachy / bradyarrhythmias
Dissecting aneurysm, ruptured aortic aneurysm, or severe aortic valve disease
Hypertrophic cardiomyopathy
Cardiogenic, hypovolemic, or septic shock
Severe respiratory distress
Severe anemia
Arterial hypertension with or without myocardial hypertrophy
Spasm of the coronary arteries
Thromboembolism of the coronary arteries of the heart or coronariitis
Endothelial dysfunction with damage to the coronary arteries of the heart without hemodynamically significant stenosis
Lesions not associated with myocardial ischemia
Myocardial injury, heart surgery, radiofrequency ablation, pacing and defibrillation
Rhabdomyolysis with myocardial involvement
Myocarditis
Effects of cardiotoxic drugs (eg, anthracyclines, herceptin)
Multifactorial or unexplained myocardial injury
Heart failure
Stress cardiomyopathy (takotsubo)
Massive PE or severe pulmonary hypertension
Sepsis and the terminal state of the patient
Renal failure
Severe neurological pathology (stroke, subarachnoid hemorrhage)
Infiltrative diseases (eg, amyloidosis, sarcoidosis)
Physical stress
The pathogenesis of myocardial necrosis is often mixed, therefore, the allocation of their coronary and non-coronary species is often rather arbitrary. For example, the pathogenesis of myocardial necrosis in diabetes mellitus is associated with both ischemic and microcirculatory disorders, metabolic, hypoxic and neurogenic factors.
Coronary (ischemic) myocardial necrosis develop as a result of a violation of the blood supply to the myocardium associated with damage to the coronary arteries of the heart. The main reasons for the development of ischemic necrosis that are not included in the IHD group are as follows:
In particular, congenital aneurysm of the coronary artery of the heart with rupture (code Q24.5 according to ICD-10) and the development of heart hemotamponade should not be attributed to diseases from the IHD group. The diagnosis allows both the use of the term "MI", which is more consistent with their general pathological essence, and "myocardial necrosis" (examples 15, 16).
Medical death certificate
I. a) Myocardial infarction
b) Paraneoplastic syndrome
c) Subtotal gastric cancer (adenocarcinoma) with metastases, T4N1M1 (C16.8)
Medical death certificate
I. a) Myocardial infarction
b) Polyarteritis nodosa (M30.0)
Non-coronary necrosis develop while maintaining coronary blood flow due to:
Relative hypoxia occurs in various arrhythmias, myocardial hypertrophy, arterial hypo- and hypertension, pulmonary hypertension, heart defects, as well as many other conditions, including surgery and trauma. Non-coronary necrosis of the myocardium can be observed in cardiomyopathies, severe diseases with heart, renal, hepatic, pulmonary or multiple organ failure, severe anemia, sepsis and shock of any genesis, as well as in the postoperative period, terminal state and in resuscitation disease (examples 17-23).
Medical death certificate
I. a) Pancreatogenic shock
b) Alcoholic pancreatic necrosis (K85)
II. Chronic alcohol intoxication (F10.2)
Operation of laparotomy, debridement and drainage of the omental bursa and abdominal cavity (date).
Medical death certificate
I. a) Foci of myocardial necrosis
b) Empyema of the pleura
c) Cancer of the left upper lobe bronchus with extensive metastases (T4N1M1) (C34.1).
II. COPD in acute stage with bronchopneumonia (J44.0).
Medical death certificate
I. a) Foci of myocardial necrosis
b) Focal pneumonia
c) Cancer of the left breast with widespread metastases (T4N1M1) (C50.8).
II. Chronic bilateral pyelonephritis in acute stage (N10)
Medical death certificate
I. a) Uremia.
b) Hypertension with damage to the heart and kidneys (I13.1).
Medical death certificate
I. a) Hemorrhagic shock
b) Necrosis of metastasis in the lymph node with arthrosis of the artery and
bleeding.
c) Cancer of the floor of the oral cavity with metastases (T4N1M0) (C04.8).
Medical death certificate
I. a) Sepsis, septic shock
b) Phlegmon of the upper and middle third of the thigh (L03.1)
II. Type 2 diabetes mellitus (E11.7)
Medical death certificate
I. a) Foci of myocardial necrosis
b) Hepatic renal failure
c) Acute phlegmonous perforated calculous cholecystitis (K80.0)
II. Operation laparotomy, cholecystectomy, sanitation and drainage of the abdominal cavity (date)
With the development of myocardial necrosis in the first 4 weeks after surgery and the absence of complicated unstable atherosclerotic plaques in the coronary arteries of the heart (atherothrombosis), they should be regarded as a complication and indicated in the "Complications of the underlying disease" section. The exception is the detection of morphological signs of type 1 myocardial infarction.
Thus, the only specific morphological diagnostic criterion for MI as a nosological form in IHD is a complicated, predominantly unstable atherosclerotic plaque of the coronary artery of the heart. In other cases, the qualification of myocardial necrosis should be the result of clinical and morphological analysis.
In the differential diagnosis of coronary and non-coronary necrosis with MI as a nosological form in the composition of coronary artery disease, the following clinical and morphological criteria should be taken into account :
For mortality statistics, it covers the period from the onset of an ischemic attack to the onset of death.
Included: with mention of hypertension (I10-I15)
If necessary, indicate the presence of hypertension, use an additional code.
Included: myocardial infarction, specified as acute or for an established duration of 4 weeks (28 days) or less from onset
Excluded:
Excludes: myocardial infarction, specified as chronic or with an established duration of more than 4 weeks (more than 28 days) from onset (I25.8)
Excluded: the listed conditions:
Excluded:
In Russia, the International Classification of Diseases of the 10th revision (ICD-10) has been adopted as a single normative document to take into account the incidence, reasons for the population's appeals to medical institutions of all departments, and causes of death.
ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170
A new revision (ICD-11) is planned by WHO in 2017 2018.
As amended and supplemented by WHO
Processing and translation of changes © mkb-10.com
Heart and vascular disease are the leading causes of sudden death and disability. Vitrum Cardio Omega-3 allows you to avoid the consequences of heart disease - heart attack or stroke.
The medicine maintains the elasticity of blood vessels and ensures optimal functioning of the heart muscle. The release form is soft gelatin capsules of dark yellow color, filled with an oily composition that has a peculiar smell.
Vitrum Cardio Omega-3 medicine contains components, each of them is an important component, without which the effect of the drug would be incomplete. Ethyl esters of omega-3 fatty acids in a dose of 1000 mg are indispensable in the human body. The drug contains eicosapentaenoic and docosahexaenoic acids, which reduce the amount of triglycerides in the blood serum.
Vitamin E (tocopherol) has strong antioxidant properties. The drug enhances the synthesis of thromboxane A2, slows down the development of atherosclerosis, regulates fat and carbohydrate metabolism. The drug normalizes the amount of low density lipoproteins.
Gelatin and glycerin, which are part of the preparation, are used in a ratio depending on the chemical composition of the capsule. In the manufacture of drugs, dyes are used. To prevent the growth and development of microorganisms, stabilizers and preservatives are introduced into the capsules.
The pharmacological action of the drug is due to the properties of its constituent components. The drug has a lipid-lowering effect, lowers the level of cholesterol and fatty acids in the body, normalizes blood viscosity and prevents the formation of blood clots.
The drug prevents premature aging of tissues, increases the permeability of the cell membrane. The drug accelerates the oxidation of cholesterol and its removal from the body.
The use of capsules helps to reduce the level of a harmful substance in the blood by 13%, especially in people engaged in physical labor. The drug has a higher safety level than statins.
For rehabilitation after myocardial infarction and severe arrhythmia, it is necessary to regularly take a medication containing omega-3 fatty acids.
The main reasons for choosing a drug are as follows:
The cost of the complex is quite high and is comparable to other products of the same composition. The price of a package with 60 capsules ranges from 1200 to 1400 rubles, depending on the pharmacy.
Cardiac patients complain of symptoms associated with the work of the heart. Most often, a person suffers from the consequences of excess serum cholesterol and hypovitaminosis.
The drug is prescribed with an increase in beta-lipoproteins, the most dangerous substances in terms of the development of atherosclerosis. Taking the medicine is indicated for patients suffering from:
It is prescribed to women during the period of age-related restructuring of the body in combination with any antioxidant - alpha-lipoic acid or Astaxanthin, Resveratrol to provide the body with the necessary microelements.
The drug is recommended for patients suffering from diseases of the central nervous system and memory problems. Unsaturated fatty acids have a beneficial effect on the function of the brain, help to restore strength and increase efficiency, and activate the thought process.
The medicine is prescribed by the doctor after examining the patient and establishing the diagnosis. Some patients take the drug on their own. It could cost them their health. It is not allowed to use the drug in patients suffering from the following diseases:
Taking medication for cholelithiasis leads to a sharp deterioration in the patient's condition. The patient has a fever, a headache, vomiting with an admixture of bile. The use of the drug by a person suffering from chronic pancreatitis leads to the development of undesirable side effects, an increase in the permeability of blood vessels and a decrease in blood pressure.
The drug is not prescribed to patients with mental disorders, since the patient develops tearfulness, irritability, depression.
In some cases, the drug causes the following symptoms:
Complications develop in patients suffering from the following pathology:
The side effect of the drug depends on the stage of development of the concomitant disease. Serious complications arise when a large dose of the drug is taken. The drug causes the appearance of changes in the blood formula.
Some patients have nosebleeds. The likelihood of developing side effects increases several times if the patient takes the following medications:
A side effect is manifested if the patient, during treatment with a drug containing omega-3 polyunsaturated fatty acids, consumes large doses of alcohol.
Instructions for use suggest taking the drug for the prevention of diseases associated with an increased content of triglycerides, 1 capsule per day before meals. Its effectiveness increases if the prophylactic course lasts at least 3 months. Vitamin D deficiency and high blood pressure suggest a different dosage. It is recommended to take 1 capsule 3 times a day.
Do not open the cachet (capsule), mix its contents with juice or tea. The medicine is washed down only with boiled water. Course admission lasts 1 month.
Therapy with a special dietary supplement in case of a lack of omega-3 fatty acids takes place under the supervision of a doctor, and the daily dose is allowed within a range not exceeding 7-8 g.
If the patient is taking an analogue of the drug, for example, Omega-3 vitamins made in Finland, you should carefully study the instructions, since the medicine not only affects the work of the heart muscle, but also strengthens bones and joints. In the morning, the patient takes 2 capsules after breakfast. The drug should only be purchased from pharmacies or health food stores to avoid counterfeiting.
Taking a large dose of a drug containing omega-3 polyunsaturated fatty acids causes symptoms of acute poisoning. A small cut or wound becomes a problem for the patient. They do not heal for a long time, they bleed.
Large bruises develop under the skin after an impact, and a small fall in winter on a slippery road is fatal due to bleeding.
If the dose of the drug is significantly exceeded, the patient complains of lethargy, weakness, a drop in muscle tone, and a decrease in blood pressure. After a blow, hemorrhage in the joint sometimes develops - hemarthrosis.
Overdose occurs with the simultaneous treatment with capsules containing omega-3-polyunsaturated fatty acids, and the consumption of large amounts of seafood that are part of the Japanese diet.
During pregnancy and lactation, a drug overdose is possible if the patient suffers from concomitant pathology:
A woman complains of headache, stomach discomfort, thirst, muscle weakness, diarrhea, increased blood pressure. In case of poisoning, medical attention is required.
Patients ask a doctor what drugs can replace a medicine containing fatty acids of the Omega-3 family. Among the analogues, the most popular are:
Omacor effectively reduces the amount of triglycerides. Not recommended for elderly patients. Sikod in capsules of 300 mg, pack of 100, contains cod liver oil. Reduces blood cholesterol levels. It is used to treat diseases of the eyes, skin, mucous membranes, in acute respiratory viral infections.
Revight (garlic pearls) is a herbal remedy. Used in elderly patients to normalize the function of the heart and blood vessels. While taking the medication, the patient follows a diet low in fat and carbohydrates. Treatment takes place under the supervision of a physician.
Taking analogues of the Vitrum Cardio Omega-3 drug does not have side effects on the patient's body.
Feedback from people helps to make the right choice.
“I suffered from a severe headache and my heart was working intermittently. I feel great after taking the medicine. No pills needed, blood pressure is normal. The headaches disappeared. I have enough strength for everything, I have time to do all the homework. "
Anna, Sol-Iletsk, Orenburg region:
“She suffered three heart attacks, had high blood pressure, and lost consciousness. Doctors diagnosed angina and ischemia. After drinking the drug with Omega-3 fatty acids, the pressure has stabilized, is 130/80, I do not take pills. I recommend it to everyone suffering from hypertension. "
Atherosclerotic cardiosclerosis is considered one of the most common forms of non-infectious pathology of the cardiovascular system. It is based on diffuse proliferation of connective tissue in the thickness of the myocardium (heart muscle) due to impaired blood flow through the arteries feeding it, which results in symptoms of heart pain, rhythm disturbances, and heart failure.
Atherosclerotic cardiosclerosis is the basis of coronary heart disease, which affects a significant proportion of people of mature and elderly age, especially men. By the age of 50, fully able-bodied representatives of the stronger sex mostly have certain signs of pathology, and some of them have already suffered such a severe form as myocardial infarction, which entails not only restriction of habitual life activity, but also disability.
Ischemic heart disease and atherosclerotic cardiosclerosis reduce the overall life expectancy, increase the number of disabled citizens, require significant material costs for treatment both from the patient and the state. In most countries of the world, active promotion of a healthy lifestyle, preventive work by cardiologists of the polyclinic health care unit is being carried out, which allows early identification of persons at risk and their systematic observation.
However, morbidity and mortality rates continue to be disappointing. In many ways, the blame for this lies with the patients themselves, who neglect the simplest advice regarding lifestyle, nutrition, bad habits. Not everyone runs to a doctor when their heart stabs or their blood pressure rises, and even more so it is unlikely that all men after 45 strive to undergo an annual electrocardiographic examination.
Symptoms of atherosclerotic cardiosclerosis may be absent for a long time, therefore, it is not so easy to suspect it in oneself by manifestations or external signs in the initial stage. Examination methods such as ECG and biochemical blood tests can be very helpful in early diagnosis, so they should not be avoided.
Many people know that myocardial sclerosis develops not only with damage to the coronary arteries. The reason may be a past inflammation, rheumatism, or a systemic disease of the connective tissue, but in the vast majority of cases, the cardiologist deals precisely with the atherosclerotic nature of the disease.
Ischemic heart disease and atherosclerotic cardiosclerosis go "hand in hand", making up a single whole and having common complications. The ICD 10 code is in headings I20-25, which includes both chronic and acute manifestations of coronary artery disease. Atherosclerotic heart disease is coded as I25.1, which includes the actual atherosclerosis of the coronary vessels.
The main cause of atherosclerotic cardiosclerosis is the narrowing of the lumen of the coronary arteries by fatty plaques, which can be located both locally and circularly along the entire artery wall. If there is an increase in blood pressure, stress, smoking, then the concomitant vasospasm further aggravates the violation of their patency.
Against the background of chronic hypoxia, connective tissue cells, fibroblasts, are activated in the heart, which are able to form collagen fibers in conditions of a lack of oxygen. Gathering in bundles, the fibers form the basis of dense connective tissue, which diffusely grows in the thickness of the muscle.
Atherosclerotic cardiosclerosis is usually diffuse, although with significant vascular occlusion, small foci of sclerosis (small focal cardiosclerosis) can be detected. The process begins and is much more pronounced in the left half of the heart, which has a large thickness and a high workload.
Symptoms of atherosclerotic cardiosclerosis may be absent for a long time, and only physical activity can cause manifestations of pathology. For a long time, the heart tries to compensate for the lack of nutrition by thickening the myocardium, increasing and accelerating the frequency of contractions.
With the progression of muscle damage, symptoms appear such as:
Dyspnea is recognized as one of the first manifestations of heart failure associated with atherosclerotic cardiosclerosis. It manifests itself years later from the onset of ischemic changes, but after a heart attack, shortness of breath will make itself felt much faster.
Dyspnea is more pronounced with physical effort, in a supine position, with emotional experiences. Over time, it does not weaken at the time of rest and becomes a constant companion of atherosclerotic heart disease.
Respiratory disorders can occur with a dry, excruciating cough, aggravated by shortness of breath. In severe cases, such a cough may indicate an attack of cardiac asthma and the possible development of pulmonary edema in the absence of urgent medical care.
Rhythm disorder is another common symptom of cardiosclerosis. Arrhythmia will be more pronounced when foci of connective tissue spread to the elements of the cardiac conduction system, blocking the passage of a nerve impulse through them. Violation of the rhythm of contractions usually indicates a running sclerotic process and a high probability of decompensation of the heart.
Often, against the background of atherosclerotic cardiosclerosis, extrasystoles, atrial fibrillation, various types of blockade, tachy- or bradycardia are diagnosed. Arrhythmia gives subjective unpleasant sensations in the form of interruptions, short-term cardiac arrest, premature tremors or freezing in the chest. It aggravates shortness of breath, edema syndrome, promotes thrombus formation with the risk of embolic complications.
Patients with atherosclerotic cardiosclerosis complain of rapid fatigue both at work and at home, as well as memory impairment, poor concentration, and weakness.
Against the background of a decrease in the pumping function of the heart, edema becomes noticeable, first appearing on the legs by the end of the day, and then rising higher and not going away against the background of drug treatment. Stagnation of blood in the venous part of the large circle aggravates trophic disorders, which can cause skin changes up to trophic ulcers. With severe insufficiency of the sclerosed heart, fluid accumulates not only in soft tissues, but also in cavities - abdominal, chest, pericardial.
Dizziness is more often characteristic of the later stages of pathology or arrhythmias. Even fainting is possible, especially with blockages of impulse conduction through the myocardium.
Ischemic changes and sclerosis inevitably cause pain, which is characterized as angina pectoris - in the left side of the chest, spreading to the left arm, scapula. With a heart attack, it will become unbearable, "dagger".
Complications of atherosclerotic cardiosclerosis can be fatal arrhythmias and cardiac arrest, blockage of cerebral vessels by thromboemboli, but the most frequent consequence and cause of death of patients is considered to be chronic heart failure that is increasing over the years.
Atherosclerotic cardiosclerosis has a chronic progressive long-term course. Periods of relative well-being are followed by episodes of deterioration of blood flow through the coronary arteries, which is accompanied by an increase in symptoms.
It is not so easy to diagnose atherosclerotic cardiosclerosis at the initial stages of changes in the heart. The reason for this is the practically absent symptomatology, and the scarcity of objective data that can be obtained during laboratory and instrumental examination, because most of the tests known to date turn out to be insensitive to minor sclerotic changes.
A targeted search for sclerosis in the myocardium (after a heart attack, for example) can give the expected result, while most people with incipient structural changes remain without a diagnosis for a long time. In the later stages, an additional examination only confirms the doctor's guesses regarding the pathology, which is fully manifested clinically.
To diagnose atherosclerotic cardiosclerosis, the following are carried out:
During the examination, the cardiologist finds out complaints, information regarding the lifestyle and previous diseases, including close blood relatives, and then listens to the heart, palpates the chest, measures the pulse and pressure. An external examination draws attention to the color of the skin, the presence of edema, the degree of development of subcutaneous fat.
Instrumental examination includes ECG, ultrasound of the heart. Echo-KG shows the degree of myocardial contractility, the presence of inactive areas of connective tissue, the thickness of the myocardium, the features of the valves, the size and shape of the organ.
For a long time, the ECG may not show ischemic processes in the myocardium, however, indirect signs may be a decrease in the voltage of the teeth, a displacement of the ST segment below the isoline, which are clearly visible in severe cardiosclerosis. In case of arrhythmia, a specialist will establish its type and source.
X-ray is not required, however, in the case of severe changes in the myocardium, aneurysm can provide a sufficient amount of information regarding the size and location of the heart in the chest. CT and MRI are considered more accurate, but their use is also limited due to the constant contractions of the organ, distorting the real morphological picture.
In large clinics, it is possible to conduct scintigraphy, which shows the state of cardiomyocytes by accumulating contrast. This study is expensive, so it was not widely disseminated.
Laboratory tests are complementary in nature, since they do not allow one to accurately judge the state of the muscle tissue of the heart or the patency of blood vessels, but they can indicate a tendency to an atherosclerotic process. So, patients with suspected coronary artery disease and cardiosclerosis are required to study the lipid spectrum of the blood - the level of total cholesterol and lipid fractions.
Treatment of atherosclerotic cardiosclerosis should be not only comprehensive, aimed primarily at the pathogenetic mechanisms of pathology, but also as early as possible. It is impossible to rid the patient completely of the already existing ischemic changes, but to a large extent slow down the progression of the disease, prolong the time of active life and work capacity, "push back" the threatening heart failure - the main task of the therapist and cardiologist.
Complex therapy of atherosclerotic cardiosclerosis includes a number of measures, both medicinal and general. The first thing the patient should start with is the regimen, diet and physical activity corresponding to the functional capabilities of the myocardium.
Pathogenetic therapy is aimed at eliminating ischemic influences from the coronary arteries, that is, its purpose will be to combat atherosclerosis and restore the maximum possible level of blood circulation by prescribing statins, antiplatelet agents or anticoagulants.
Symptomatic treatment includes the appointment of drugs against certain manifestations of the disease - diuretics, nitrates, antiarrhythmics, vasodilators, etc. Drug therapy is complemented by physiotherapeutic measures, sanatorium treatment.
In the absence of an effect and according to the indications, the patient may be offered surgical assistance - vascular stenting, shunting, installation of a pacemaker, RFA, etc.
No matter how much many patients want to get rid of the disease on their own, this can hardly be considered possible even with the use of the most sophisticated recipes of traditional medicine. Of course, lovers of unconventional methods can use some methods, however, it is worth remembering that it will not work to improve their condition without a well-designed medication scheme and clear control of the heart by a specialist.
Immediately after establishing the diagnosis of atherosclerotic heart disease, the patient will have to part with bad habits, among which smoking has the most harmful effect on the heart. Smoking provokes arterial spasm, which further aggravates the existing ischemic changes and hypoxia, against which the production of collagen fibers by fibroblasts occurs.
Alcohol consumption can cause fluctuations in blood pressure and increase the stress on the myocardium, so alcoholic beverages should also be excluded, as well as coffee with strong tea.
Nutrition should correspond to the needs of the body for vitamins and minerals, so you should not deny yourself vegetables and fruits. Bananas, dried apricots, nuts, baked potatoes contain heart-healthy magnesium and potassium, tomatoes and broccoli are rich in antioxidants.
Given that the cause of atherosclerotic cardiosclerosis lies primarily in the disorder of fat metabolism, the patient needs to significantly limit the use of fried and fatty foods, as well as baked goods and confectionery. The need for unsaturated fatty acids is successfully replenished by vegetable oil, fish, and seafood.
To reduce the load on the heart by the volume of pumped blood and control the normotonia, the patient is recommended to limit table salt (no more than 5 grams per day) and the amount of liquid to one and a half liters, which includes not only water, but also the first courses.
The total daily calorie content of food is usually about 2,000 kilocalories, which are provided by cereals, lean meat, fruits and vegetables. With exhaustion, it can be increased, in the case of concomitant obesity, on the contrary, it can be reduced. For such categories of patients, the diet is individually compiled by a nutritionist in accordance with the needs and functionality of the heart.
In addition to making dietary changes, it is important to maintain a level of physical activity that does not tire the heart while still allowing it to carry out the work it needs. In severe forms of cardiosclerosis that have caused complications, the doctor may recommend minimizing the stress, but in the case when heart failure has not yet been diagnosed, moderate activity in the form of walking will even be useful.
One of the general measures in the fight against pathology is the prevention and avoidance of stress and emotional overstrain. Stress contributes to an increase in blood pressure, tachycardia, which increases the heart's need for oxygen, while the vessels are not able to fully provide them. If it is impossible to cope with experiences on your own, or the work is associated with constant stress, psychotherapeutic techniques and drug therapy with tranquilizers will come to the patient's aid.
It is impossible to improve the prognosis without regular monitoring of the state of the cardiovascular system and lipid metabolism, therefore, at least once every 3 months, you need to visit a cardiologist, even if the patient feels well and no correction of therapy is required.
Medical treatment of atherosclerotic cardiosclerosis is prescribed only after a thorough and complete examination. Self-medication or taking drugs that "help a neighbor" is highly discouraged, because drugs against cardiovascular pathology have side effects and in some cases cannot be used simultaneously.
The main groups of drugs prescribed for cardiosclerosis are:
When cardiosclerosis occurs with cardiac arrhythmias, antiarrhythmics (verapamil, amiodarone) may be indicated, and attacks of ischemia with pain are relieved by taking nitrates.
Since one of the main dangers in cardiosclerosis is the possibility of thrombosis of the coronary arteries, absolutely all patients need antiplatelet therapy. Usually, it is based on aspirin (thrombotic Ass, cardiomagnyl, aspirin cardio), prescribed for constant intake. At a high risk of thrombosis and thromboembolism (transplanted valve, atrial fibrillation, etc.), anticoagulants (warfarin, clexane) are indicated.
Severe forms of atherosclerotic cardiosclerosis may require surgical correction:
Theoretically, a heart transplant could restore normal hemodynamics, but this operation is unlikely to be effective, given the pathogenesis of atherosclerotic cardiosclerosis. In conditions of damage to the coronary vessels, it is difficult to establish blood flow in the organ, even after transplanting it from a donor, therefore, transplantation is practically not used in this category of patients.
The prognosis for atherosclerotic cardiosclerosis depends on the severity of vascular lesions, age, concomitant pathology, but how the patient himself participates in the fight against pathology is of no small importance. Regular visits to the doctor and strict adherence to all appointments helps not only to stabilize the course of the disease, but also to prevent very dangerous complications.
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Atherosclerosis is a common disease that affects one third of the world's population. Atherosclerotic cardiosclerosis is a syndrome, the occurrence of which is due to the progression of coronary heart disease against the background of the development of atherosclerosis. Atherosclerotic coronary artery disease leads to the development of scar tissue in the myocardium. As a result of such changes, the functioning of the heart muscle is disrupted. In the advanced stage of the disease, internal organs begin to suffer from insufficient blood supply.
In medicine, cardiosclerosis is understood as a diffuse proliferation of connective tissue in the fibers of the myocardial muscles. This is a serious pathology of the heart muscle, which, depending on the location of the lesion, is divided into: coronary cardiosclerosis and aortocardiosclerosis. As a manifestation of ischemic heart disease, atherosclerotic cardiosclerosis is characterized by a slow and prolonged course.
With atherosclerosis of the coronary arteries or stenosing coronary sclerosis, metabolic processes in the myocardium fail. If treatment is not started in a timely manner, the disease will progress and eventually lead to atrophy of muscle fibers. In the future, violations of the heart rhythm and disruptions in the transmission of impulses lead to the development of coronary heart disease. Most often, this disease is found in middle-aged and elderly men.
The International Classification of Diseases (ICD-10 code) does not contain an exact code for the definition of this disease. However, for ICD-10, atherosclerotic cardiosclerosis is referred to by doctors as atherosclerotic heart disease, coded I25.1.
The exact cause of the disease is unknown to doctors. However, experts say that the determining factor in the development of the disease is an increase in the amount of low-density lipids (bad cholesterol) in the blood and vascular pathology (inflammatory processes, changes in blood pressure, etc.). A special role in the development of the disease is played by the formation of atherosclerotic plaques, which block the vessels.
Due to the proliferation of connective tissue and an increase in the concentration of lipids in the blood, the heart muscle gradually increases in size. All this leads to increasing symptoms of the disease. Pathological changes develop under the influence of a number of unfavorable factors:
The presence of at least one factor increases the risk of atherosclerotic changes in muscle tissue. Moreover, this pathology always develops gradually, its timely detection largely depends on an attentive attitude to one's own health. Therefore, it is important to know how the development of atherosclerotic cardiosclerosis occurs.
The first sign of the development of the disease is a change in the composition of the blood. There is a gradual increase in the volume of "bad" cholesterol in the blood, which is detrimental to blood vessels. At the same time, the number of useful high-density lipoproteins decreases. Such changes lead to the formation of fatty strips on the walls of the arteries. At the initial stage, their detection is impossible, and they do not yet provoke characteristic symptoms.
Subsequently, harmful lipids are combined with platelets. Together they settle in the area of the stripes. This is the formation of plaques, the growth of which can lead to partial occlusion of the artery. At this stage, a person may be disturbed by the first symptoms of coronary artery disease.
If the patient does not react in any way to such changes and does not take lipid-lowering drugs to lower cholesterol levels, the disease progresses. Finally, atherosclerotic cardiosclerosis takes on the shape of a full-fledged disease. The nature of the spread of lesions is diffuse - plaques can be located in different parts of the heart muscle.
With the rapid development of the disease, an increase in the volume of connective tissue occurs. It grows over time and replaces the normal myocardium. The remaining muscle cells try to maintain the functionality of the heart by increasing in size. Such changes lead to organ failure and cause acute symptoms.
At the initial stages of the pathological process, the symptoms of the disease do not appear. In the future, the patient has pain in the chest area. This is the most important diagnostic criterion. The pain is most often pulling or aching. The patient gradually increases the feeling of discomfort in the chest area. Some patients complain of pain radiating to the left arm, left shoulder, or left shoulder blade.
With further progression of cicatricial-sclerotic processes, complaints about general health appear. Patients complain of increased fatigue and shortness of breath even with normal walking. Often, patients have symptoms of cardiac asthma and bronchospasm.
Aching and pulling pains begin to take on a long-term nature (up to several hours). Concomitant symptoms appear in the form of headaches, dizziness and tinnitus, indicating a violation of oxygen transport to the brain.
At the initial stage of the development of the disease, some patients experience edema. As a rule, at first they appear only in the areas of the feet and legs. In the future, edema can spread throughout the body and affect internal organs.
With severe cardiosclerosis, there is a change in the condition of the skin and nails. Patients complain of dry skin and cold extremities. With a significant change in the myocardium, a decrease in blood pressure occurs. The patient's indicators are below 100/700 mm. rt. Art. Dizziness becomes more frequent, periodic fainting is possible.
Atherosclerotic cardiosclerosis progresses slowly. The patient may experience periods of relative improvement in the condition for several years. Despite this, at the first signs of the disease, it is necessary to consult a doctor. The patient should undergo a full diagnostic examination, receive the necessary recommendations and begin treatment aimed at preventing complications leading to a significant deterioration in the condition.
At the initial appointment, the cardiologist listens to the patient's complaints and collects an anamnesis. The patient must donate blood for biochemical examination. After receiving the result of the analysis, the doctor necessarily studies several indicators:
In atherosclerotic cardiosclerosis, the value of cholesterol, LDL and triglycerides is higher than normal, and the amount of HDL in the blood decreases. Simultaneously with a biochemical blood test, the doctor may prescribe a urine test to detect the level of leukocytes and bicycle ergometry in order to clarify the stage of myocardial disturbance.
To confirm the diagnosis - atherosclerotic cardiosclerosis, doctors resort to instrumental diagnostics. The most common techniques are:
If, as a result of a set of diagnostic measures, the diagnosis was confirmed, the doctor prescribes treatment. Timely completion of all procedures, detection of the disease and therapeutic measures help stop the development of the disease, reduce the severity of symptoms and reduce the risk of myocardial infarction.
Treatment of this disease is reduced to the treatment of individual syndromes. The doctor prescribes medications to eliminate heart failure, arrhythmias, hypercholesterolemia, decrease the excitability of pathological foci and dilatation of the coronary arteries. As a rule, complex treatment consists of several groups of drugs:
The traditional treatment regimen for atherosclerotic cardiosclerosis can be supplemented with other drugs. The need to take certain medications, their dosage and duration of treatment are determined by the attending physician.
If drug therapy for atherosclerotic cardiosclerosis does not improve and does not reduce the severity of symptoms, the patient is recommended to have surgery. Surgical treatment is carried out to improve the blood supply to the myocardium and is carried out in two ways:
An important factor in the success of the complex therapy of the disease is diet therapy. Patients need to make changes in their diet. Doctors recommend giving up the use of fatty foods, fried meat dishes, sweets, strong coffee and tea, carbonated drinks. From drinks, preference is given to tea with mint, St. John's wort or rosehip broth. The menu includes low-fat meats, fish, vegetable salads with vegetable oil. All kinds of cereals, dairy products (cottage cheese, kefir) and fruits are useful as a source of vitamins.
Physical activity plays an important role in restoring heart rate and metabolism. A set of exercises is selected for the patient, long walks in the fresh air are recommended. Excessive physical activity is prohibited.
As a rule, with successful treatment and adherence to all recommendations, the patient returns to a normal, fulfilling life. At the same time, the mortality rate among people who neglect the advice of doctors is quite high. Therefore, after undergoing a course of therapy, the patient needs to be observed by a doctor for a long time. If recurrent symptoms are found, the patient should immediately report this to the attending physician.
The likelihood of developing this disease is high, especially in the presence of a hereditary predisposition. That is why preventive measures should be taken from a young age. They consist in simple ways of correcting your lifestyle. Doctors give several recommendations, observing which you can prevent the risk of developing atherosclerosis and vascular damage:
Consult your doctor before using any medication!
Acquired coronary arteriovenous fistula
Excludes1: congenital coronary (artery) aneurysm (Q24.5)
In Russia, the International Classification of Diseases of the 10th revision (ICD-10) has been adopted as a single normative document to take into account the incidence, reasons for the population's appeals to medical institutions of all departments, and causes of death.
ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Ministry of Health of Russia dated 05/27/97. No. 170
A new revision (ICD-11) is planned by WHO in 2017 2018.
As amended and supplemented by WHO
Processing and translation of changes © mkb-10.com
The disease of atherosclerotic cardiosclerosis is a serious disorder that is associated with changes in the muscle tissue of the myocardium. The disease is characterized by the formation of cholesterol plaques on the walls of veins and arteries, which increase in size and, in severe cases, begin to interfere with normal blood circulation in the organs. Often other diseases of the cardiovascular system become the cause of atherosclerotic cardiosclerosis.
The medical term "cardiosclerosis" means a serious disease of the heart muscle associated with the process of diffuse or focal proliferation of connective tissue in the muscle fibers of the myocardium. Distinguish varieties of the disease at the site of the formation of disorders - aortocardiosclerosis and coronary heart disease. The disease is characterized by a slow spread with a long course.
Atherosclerosis of the coronary arteries, or stenosing coronary sclerosis, causes severe metabolic changes in the myocardium and ischemia. Over time, muscle fibers atrophy and die, ischemic heart disease worsens due to a decrease in impulse excitation and rhythm disturbances. Cardiosclerosis often affects older or middle-aged men.
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According to the tenth International Classification of Diseases (ICD 10), which helps to indicate the diagnosis in the medical history and choose the treatment, there is no exact code for atherosclerotic cardiosclerosis. Doctors use the I 25.1 coding for atherosclerotic heart disease. In some cases, the designation 125.5 is used - ischemic cardiomyopathy or I20-I25 - ischemic heart disease.
For a long time, atherosclerotic cardiosclerosis may not be detected. Symptoms of discomfort are often mistaken for simple malaise. If signs of cardiosclerosis begin to bother you regularly, you should consult a doctor. The following symptoms are the reason for treatment:
A rare sign of atherosclerotic cardiosclerosis is a slight enlargement of the liver. The clinical picture of the disease is difficult to determine, guided only by the patient's feelings, they are similar to the symptoms of other diseases. The difference is that over time, the progression of seizures develops, they begin to appear more often, to be of a regular nature. In patients with atherosclerotic plaques in a post-infarction state, the likelihood of repeated complications is high.
The main cause of atherosclerotic cardiosclerosis is the appearance of scars, impaired blood flow to the heart. Atherosclerotic plaques, or fatty plaques, increase in size, overlap vascular areas and pose a serious threat to the patient. Due to insufficient intake of nutrients, an increase in blood lipids, proliferation of pathological connective tissue, the size of the heart increases, a person begins to feel the growing symptoms of the disease.
This change is influenced by internal factors caused by other diseases in the body, and external, due to the wrong way of life of a person. Possible causes include:
It is noted that in women before the onset of menopause, atherosclerotic cardiosclerosis occurs less frequently than in men. After reaching age, the chances of hearing from the doctor the diagnosis of "atherosclerotic cardiosclerosis" are equalized. People with heart disease are at increased risk. These diseases are called both the cause and the effect of cardiosclerosis. When plaques appear in the vessels, causing oxygen starvation, the likelihood of complications increases, which can lead to the death of the patient.
In order to make a diagnosis, the doctor is guided by the data of the anamnesis - the presence or absence of previous heart diseases and the patient's complaints. Analyzes that are prescribed to clarify the clinical picture include:
As an additional examination for atherosclerotic cardiosclerosis, daily monitoring is prescribed using echocardiography, coronary angiography, rhythmography. At the discretion of the doctor, MRI of the heart and blood vessels, chest X-ray, ultrasound examination of the pleural and abdominal cavities are performed. Comprehensive diagnostics help you quickly choose the right treatment.
Methods of therapy for atherosclerotic cardiosclerosis are aimed at restoring coronary circulation, eliminating cholesterol plaques in the arteries and vessels, as well as treating certain diseases - atrioventricular blockade, arrhythmias, heart failure, coronary artery disease, angina pectoris. For this purpose, the doctor prescribes medicines:
For people who are overweight, it is necessary to select a special diet with the replacement of fatty foods, change the daily routine, get rid of physical exertion during treatment. With the formation of an aneurysmal heart defect, surgical actions to remove the aneurysm are indicated. The introduction of a pacemaker will help solve the problem with rhythm disturbances.
When making a further prognosis, the doctor is guided by the clinical data of the diagnostic study. In most cases, if the patient is successfully treated and follows the recommendations, then he can return to normal life. However, among people who disregard the doctor's advice, the mortality rate is high. After undergoing a course of therapy, the patient must be observed by a specialist for a long time, report any ailment.
Prevention of atherosclerotic cardiosclerosis is recommended to start from a young age if there is a genetic predisposition to the disease. Adequate nutrition, timely treatment of colds, correct daily regimen, rejection of bad habits will not allow the formation of atherosclerotic changes in the vessels of the heart. People with a tendency to heart disease are advised to engage in physical exercise, which increases endurance.
The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment based on the individual characteristics of a particular patient.
Cardiosclerosis is a pathological process associated with the formation of fibrous tissue in the heart muscle. This is facilitated by a postponed myocardial infarction, acute infectious and inflammatory diseases, atherosclerosis of the coronary arteries.
Cardiosclerosis of atherosclerotic genesis is caused by a violation of lipid metabolism with the deposition of cholesterol plaques on the intima of elastic-type vessels. In the continuation of the article, it will be considered about the causes, symptoms, treatment of atherosclerotic cardiosclerosis and its classification according to ICD-10.
At the same time, it is customary to consider all nosologies according to the international classification of diseases of the tenth revision (ICD-10). This guide is divided into sections, where each pathology is assigned a digital and letter designation. The grading of the diagnosis is as follows:
As mentioned above, the main cause of pathology is a violation of fat metabolism.
Due to atherosclerosis of the coronary arteries, the lumen of the latter narrows, and signs of atrophy of myocardial fibers appear in the myocardium with further necrotic changes and the formation of scar tissue.
This is also accompanied by the death of receptors, which increases myocardial oxygen demand.
Such changes contribute to the progression of coronary artery disease.
It is customary to single out the factors leading to a violation of cholesterol metabolism, which are:
The clinical manifestations of atherosclerotic cardiosclerosis are characterized by the following symptoms:
Violation of coronary blood flow is manifested by myocardial ischemia. Patients feel pain behind the sternum, aching or pulling in nature, radiating to the left arm, shoulder, and lower jaw. Less often, pain is localized in the interscapular region or radiates to the right upper limb. An anginal attack is provoked by physical exertion, psychoemotional reaction, and as the disease progresses, it occurs at rest.
You can relieve pain with nitroglycerin preparations. In the heart there is a conducting system, thanks to which a constant and rhythmic contractility of the myocardium is provided.
An electrical impulse moves along a certain path, gradually covering all departments. Sclerotic and cicatricial changes represent an obstacle to the propagation of the excitation wave.
As a result, the direction of movement of the impulse changes and the contractile activity of the myocardium is disrupted.
Patients with atherosclerotic atherosclerosis are concerned about such types of arrhythmias as extrasystole, atrial fibrillation, blockade.
IHD and its nosological form atherosclerotic cardiosclerosis has a slowly progressive course, and patients may not feel any symptoms for many years.
However, all this time irreversible changes occur in the myocardium, which ultimately leads to chronic heart failure.
In case of stagnation in the pulmonary circulation, shortness of breath, cough, orthopnea are noted. With stagnation in the systemic circulation, nocturia, hepatomegaly, and edema of the legs are characteristic.
Treatment of atherosclerotic cardiosclerosis involves lifestyle correction and the use of medications. In the first case, it is necessary to focus on activities aimed at eliminating risk factors. For this purpose, it is necessary to normalize the mode of work and rest, to reduce weight in obesity, not to avoid dosed physical exertion, to follow a hypocholesterol diet.
In case of ineffectiveness of the above measures, drugs are prescribed that contribute to the normalization of lipid metabolism. Several groups of drugs have been developed for this purpose, but statins are more popular.
Their mechanism of action is based on the suppression of enzymes involved in the synthesis of cholesterol. Means of the latest generation also contribute to an increase in the level of high density lipoproteins, or, more simply, "good" cholesterol.
Another important property of statins is that they improve the rheological composition of the blood. This prevents the formation of blood clots and avoids acute vascular catastrophes.
Morbidity and mortality from cardiovascular pathology is growing every year, and anyone should have an idea of such a nosology and the correct methods of correction.
Cardiosclerosis is a pathological change in the structure of the heart muscle and its replacement by connective tissue, arises after inflammatory diseases - myocarditis, infective endocarditis, after myocardial infarction. Also, atherosclerosis leads to the occurrence of cardiosclerosis, pathological changes occur due to tissue ischemia and impaired blood flow. This condition occurs most often in adults or the elderly, with concomitant diseases such as angina pectoris and hypertension.
Atherosclerotic cardiosclerosis develops as a result of a combination of several factors, such as diet disorders - the predominance of foods rich in fats and cholesterol and a decrease in the diet of vegetables and fruits, reduced physical activity and sedentary work, smoking and alcohol abuse, regular stress, family tendency to cardiovascular diseases systems.
Men are more likely to develop atherosclerosis, since female sex hormones, such as estrogen, have a protective effect on the walls of blood vessels and prevent the formation of plaques. In women, coronary heart disease and hyperlipidemia are observed, but after 45 to 50 years after menopause. These factors lead to spasm and narrowing of the lumen of the coronary vessels, ischemia and hypoxia of myocytes, their dystrophy and atrophy.
Against the background of a lack of oxygen, fibroblasts are activated, forming collagen and elastic fibers instead of destroyed cells of the heart muscle. Gradually altered muscle cells are replaced by connective tissue, which does not perform contractile and conductive functions. With the progression of the disease, more and more muscle fibers atrophy and deform, which leads to the development of compensatory left ventricular hypertrophy, life-threatening arrhythmias, such as ventricular fibrillation, chronic cardiovascular failure, and circulatory failure.
Atherosclerotic cardiosclerosis in ICD 10 is not an independent nosology, but one of the forms of coronary heart disease.
To facilitate the diagnosis in an international format, it is customary to consider all diseases according to the ICD 10 classification.
It is organized as a reference book with alphabetic and numerical categorization, where each group of diseases is assigned a unique code.
Diseases of the cardiovascular system are designated by codes I00 through I90.
Chronic ischemic heart disease, according to ICD 10, has the following forms:
For the localization and prevalence of the process, diffuse cardiosclerosis is also distinguished - the connective tissue is evenly located in the myocardium, and cicatricial or focal - the sclerotic areas are denser and located in large areas.
The first type occurs after infectious processes or due to chronic ischemia, the second - after myocardial infarction at the site of necrosis of the muscle cells of the heart.
Both of these types of damage can occur at the same time.
Symptoms of the disease appear only with significant obliteration of the vascular lumen and myocardial ischemia, depending on the spread and localization of the pathological process.
The first manifestations of the disease are short-term pain behind the breastbone or a feeling of discomfort in this area after physical or emotional stress, hypothermia. The pain is squeezing, aching or stitching in nature, accompanied by general weakness, dizziness, cold sweat may be observed.
Sometimes the patient's pain radiates to other areas - to the left shoulder blade or arm, shoulder. The duration of pain in coronary heart disease is from 2 to 3 minutes to half an hour, it subsides or stops after rest, taking Nitroglycerin.
With the progression of the disease, symptoms of heart failure are added - shortness of breath, swelling of the legs, cyanosis of the skin, cough with acute left ventricular failure, enlargement of the liver and spleen, tachycardia or bradycardia.
Shortness of breath often occurs after physical and emotional stress, in a supine position, decreases at rest, while sitting. With the development of acute left ventricular failure, shortness of breath increases, a dry, painful cough joins it.
Edema is a symptom of decompensation of heart failure; it occurs when the venous vessels of the legs are overflowed with blood and the pumping function of the heart decreases. At the onset of the disease, edema of only the feet and legs is observed, with progression they spread higher, and can be localized even on the face and in the chest, pericardial, abdominal cavity.
Symptoms of cerebral ischemia and hypoxia are also observed - headaches, dizziness, tinnitus, fainting. With a significant replacement of the myocytes of the cardiac conduction system with connective tissue, conduction disturbances - blockade, arrhythmias may occur.
Subjectively, arrhythmias can be manifested by sensations of interruptions in the work of the heart, premature or delayed contractions, and a feeling of palpitations. Against the background of cardiosclerosis, conditions such as tachycardia or bradycardia, blockade, atrial fibrillation, atrial or ventricular extrasystoles, and ventricular fibrillation may occur.
Cardiosclerosis of atherosclerotic genesis is a slowly progressive disease that can occur with exacerbations and remissions.
Diagnosis of the disease consists of anamnestic data - the time of onset of the disease, the first symptoms, their nature, duration, diagnostics and treatment. It is also important to make a diagnosis for the patient's life history - past illnesses, operations and injuries, family tendencies to illness, the presence of bad habits, lifestyle, professional factors.
Clinical symptoms are the main ones in the diagnosis of atherosclerotic cardiosclerosis, it is important to clarify the prevailing symptoms, the conditions for their occurrence, the dynamics throughout the disease. Complement the information obtained with laboratory and instrumental research methods.
Additional methods are used:
In this test, liver and kidney tests are also determined, which may indicate damage to these organs during prolonged ischemia.
X-ray of the chest organs - makes it possible to determine cardiomegaly, deformation of the aorta, aneurysms of the heart and blood vessels, congestion in the lungs, their edema.Angiography is an invasive method, carried out with the introduction of intravenous contrast agent, allows you to determine the level and localization of vascular obliteration, blood supply to certain areas, development of collaterals. Doppler ultrasonography of blood vessels or triplex scanning, carried out using ultrasound waves, allows you to determine the nature of blood flow and the degree of obstruction.
Be sure to conduct electrocardiography - it determines the presence of arrhythmias, hypertrophy of the left or right ventricle, systolic overload of the heart, the onset of myocardial infarction. Ischemic changes are visualized on the electrocardiogram by a decrease in the voltage (size) of all teeth, depression (decrease) of the ST segment below the isoline, negative T wave.
An echocardiographic study, or ultrasound of the heart, complements the ECG - it determines the size and shape, myocardial contractility, the presence of immovable areas, calcifications, the work of the valve system, inflammatory or metabolic changes.
The most informative method for diagnosing any pathological processes is scintigraphy - a graphic image of the accumulation of contrasts or labeled isotopes by the myocardium. Normally, the distribution of the substance is uniform, without areas of increased or decreased density. Connective tissue has a reduced ability to capture contrast, and sclerosing areas are not visualized in the image.
For the diagnosis of vascular lesions in any area, magnetic resonance scanning and multislice computed tomography remain the method of choice. Their advantage is their great clinical significance, the ability to display the exact localization of the obstruction.
In some cases, for a more accurate diagnosis, hormonal tests are performed, for example, to determine hypothyroidism or Itsenko-Cushing's syndrome.
Treatment and prevention of ischemic heart disease begins with lifestyle changes - adherence to a hypocaloric balanced diet, rejection of bad habits, physical education or exercise therapy.
The diet for atherosclerosis is based on a dairy-plant diet, with a complete rejection of fast food, fatty and fried foods, semi-finished products, fatty meats and fish, confectionery, chocolate.
Mainly consumed products - sources of fiber (vegetables and fruits, cereals and legumes), healthy unsaturated fats (vegetable oils, fish, nuts), cooking methods - cooking, baking, stewing.
Medicines used for high cholesterol and coronary heart disease - nitrates for relieving angina attacks (Nitroglycerin, Nitro-long), antiplatelet agents for the prevention of thrombosis (Aspirin, Thrombo Ass), anticoagulants in the presence of hypercoagulability (Heparin, Enoxyparine) , Ramipril), diuretics (Furosemide, Veroshpiron) - to relieve edema.
Statins (Atorvastatin, Lovastatin) or fibrates, nicotinic acid are also used to prevent hypercholesterolemia and progression of the disease.
For arrhythmias, antiarrhythmic drugs (Verapamil, Amiodarone), beta-blockers (Metoprolol, Atenolol) are prescribed, for the treatment of chronic heart failure - cardiac glycosides (Digoxin).
Cardiosclerosis is described in the video in this article.
Atherosclerosis of the aorta of the heart is considered one of the most common problems in the elderly.
It can be determined by the constant uptake of lipoproteins moving through the vessels of a very slight density.
For this reason, atherosclerosis of the heart is classified as a chronic vascular inflammation.
Atherosclerosis is the common name for the pathology of blood vessels, caused by the formation of cholesterol deposits from the inside of large and medium arteries. As fatty plaques accumulate in the intima (inner walls of the arteries), the interval of the bloodstream narrows, hemodynamics is inhibited.
A high-risk group is considered to be representatives of the stronger sex after the age of forty-five years, in which, according to statistics, atherosclerosis is found four times more often than in the fairer sex.
Every person should be aware of the causes of the development of this disease, regardless of age and gender. The exact cause of the disease has not been established to this day. But still, there are a number of factors that affect the formation of cholesterol plaques.
But this does not mean that they should be completely excluded.
You can simply limit their intake. People with a family member with the disease or diabetes mellitus are at risk of developing the disease more often than others.
This disease leads to other heart conditions as well. First of all, it should be noted atherosclerotic cardiosclerosis. According to the tenth International Classification of Diseases (ICD-10), there is no code for this disease.
There are three stages of the disease:
Myocardial infarction can also be a consequence of atherosclerosis. According to the ICD - 10 classification, it includes angina pectoris, primary, repeated and old infarction, sudden death and heart failure. Coronary heart disease according to ICD - 10 has a code 125 and is noted in the history of the disease.
The heart is one of the most sensitive organs. Symptoms in atherosclerosis of the heart are manifested at the initial stage and are manifested by angina pectoris. Signs occur intermittently and include:
The frequency of symptoms depends on the severity of the disease and the general well-being of the body.
Clinical trials are ordered to determine the stage of the disease. Blood biochemistry in atherosclerosis varies greatly. In addition, it is necessary to pass a general blood test. It will help to establish the number of blood cells. In this case, important indicators will be:
The most effective treatment of the disease will be immediately after the detection of the disease, namely at the initial stage. Treatment is performed using the recommendations listed below.
This type of treatment includes working to eliminate the factors leading to the disease:
It is used in the event that the above methods did not bring any result. The operation is performed to bypass the coronary aorta. It helps to remove ischemia and restore blood circulation in the blocked places of the vessels.
These are new therapies that are performed under local anesthesia. They help restore blood flow in the arteries.
Prevention should include the following measures:
Atherosclerosis of the heart arteries can be the main cause for cardiac arrest. Death may be unexpected, but often ischemic disease and arterial hypertension in a person indicate the mandatory implementation of the doctor's advice. However, therapy and prevention of ischemic heart disease are not performed and ignored, which leads to sad consequences.
If atherosclerotic disease of the coronary arteries is detected, then all the patient's actions should be aimed at resuming blood flow through the vessels, because only this can continue life until old age. The sooner the conclusion is determined, the more successful the therapy will be. The characteristic condition for success is the desire of the patient to get rid of the problem.
Refusal of harmful habits, the transition to proper nutrition, physiological activity always bring positive results. In the later stages of pathology, specific surgery is presented with further rehabilitation in sanatoriums.
Atherosclerotic cardiosclerosis is a type of coronary heart disease, which is characterized by impaired blood supply. It develops against the background of progressive atherosclerosis in the coronary arteries of the myocardium. There is an opinion that this diagnosis is made to all persons over the age of 55 and who have at least once faced pain in the region of the heart.
As such a diagnosis "atherosclerotic cardiosclerosis" has not existed for a long time and you will not hear it from an experienced specialist. This term is used to refer to the consequences of coronary heart disease in order to clarify pathological changes in the myocardium.
The disease is manifested by a significant increase in the heart, in particular, its left ventricle, and rhythm disturbances. Symptoms of the disease are similar to those of heart failure.
Before atherosclerotic cardiosclerosis develops, the patient may suffer from angina pectoris for a long time.
The disease is based on the replacement of healthy tissues in the myocardium with scar tissue, as a result of atherosclerosis of the coronary vessels. This is due to a violation of the coronary circulation and insufficient blood supply to the myocardium - ischemic manifestation. As a result, in the future, many foci are formed in the heart muscle, in which the necrotic process began.
Atherosclerotic cardiosclerosis often "coexists" with chronic high blood pressure, as well as with sclerotic damage to the aorta. Often the patient has atrial fibrillation and cerebral atherosclerosis.
When a small cut appears on the body, we all try to make it less noticeable after healing, but the skin will still no longer have elastic fibers in this place - scar tissue is formed. A similar situation occurs with the heart.
A scar on the heart can appear for the following reasons:
The main reason for the development of pathology is the formation of cholesterol plaques inside the vessels. They increase in size over time and interfere with the normal movement of blood, nutrients and oxygen.
When the gap becomes very small, heart problems begin. It is in a constant state of hypoxia, resulting in ischemic heart disease, and then atherosclerotic cardiosclerosis.
Being in this state for a long time, the cells of muscle tissue are replaced by connective tissue, and the heart stops contracting correctly.
Risk factors provoking the development of the disease:
There are two forms of atherosclerotic cardiosclerosis:
In this case, the disease is divided into 3 types:
Atherosclerotic cardiosclerosis is a disease that has a long course, but steadily progresses without proper treatment. In the early stages, the patient may not feel any symptoms, therefore, abnormalities in the work of the heart can only be noticed on an ECG.
With age, the risk of vascular atherosclerosis is very high, therefore, even without a previous myocardial infarction, it can be assumed that there are many small scars in the heart.
The diagnosis of atherosclerotic cardiosclerosis is made on the basis of the collected anamnesis (previous myocardial infarction, the presence of coronary heart disease, arrhythmias), manifested symptoms and data obtained through laboratory studies.
For a more accurate diagnosis of atherosclerotic cardiosclerosis, the following studies can be carried out: 24-hour ECG monitoring, cardiac MRI, ventriculography, ultrasound of the pleural cavities, ultrasound of the abdominal cavity, chest X-ray, rhythmocardiography.
There is no such treatment for atherosclerotic cardiosclerosis, because the damaged tissue cannot be restored. All therapy is aimed at relieving symptoms and exacerbations.
Some drugs are prescribed to the patient for life. Necessarily prescribed drugs that can strengthen and expand the walls of blood vessels. If indicated, an operation can be performed, during which large plaques on the vascular walls will be eliminated. The mainstay of treatment is proper nutrition and moderate exercise.
In order to prevent the development of the disease, it is very important to start monitoring your health on time, especially if there have already been cases of atherosclerotic cardiosclerosis in the family history.
The primary prevention is proper nutrition and prevention of overweight. It is very important to exercise every day, not to be sedentary, see your doctor regularly, and monitor your blood cholesterol levels.
Secondary prevention is the treatment of diseases that can provoke atherosclerotic cardiosclerosis. If the disease is diagnosed at the initial stages of development and subject to all the doctor's recommendations, cardiosclerosis may not progress and will allow a person to lead a full life.
Cardiosclerosis is a pathological process associated with the formation of fibrous tissue in the heart muscle. This is facilitated by a postponed myocardial infarction, acute infectious and inflammatory diseases, atherosclerosis of the coronary arteries.
Cardiosclerosis of atherosclerotic genesis is caused by a violation of lipid metabolism with the deposition of cholesterol plaques on the intima of elastic-type vessels. In the continuation of the article, it will be considered about the causes, symptoms, treatment of atherosclerotic cardiosclerosis and its classification according to ICD-10.
At the same time, it is customary to consider all nosologies according to the international classification of diseases of the tenth revision (ICD-10). This guide is divided into sections, where each pathology is assigned a digital and letter designation. The grading of the diagnosis is as follows:
As mentioned above, the main cause of pathology is a violation of fat metabolism.
Due to atherosclerosis of the coronary arteries, the lumen of the latter narrows, and signs of atrophy of myocardial fibers appear in the myocardium with further necrotic changes and the formation of scar tissue.
This is also accompanied by the death of receptors, which increases myocardial oxygen demand.
Such changes contribute to the progression of coronary artery disease.
It is customary to single out the factors leading to a violation of cholesterol metabolism, which are:
The clinical manifestations of atherosclerotic cardiosclerosis are characterized by the following symptoms:
Violation of coronary blood flow is manifested by myocardial ischemia. Patients feel pain behind the sternum, aching or pulling in nature, radiating to the left arm, shoulder, and lower jaw. Less often, pain is localized in the interscapular region or radiates to the right upper limb. An anginal attack is provoked by physical exertion, psychoemotional reaction, and as the disease progresses, it occurs at rest.
You can relieve pain with nitroglycerin preparations. In the heart there is a conducting system, thanks to which a constant and rhythmic contractility of the myocardium is provided.
An electrical impulse moves along a certain path, gradually covering all departments. Sclerotic and cicatricial changes represent an obstacle to the propagation of the excitation wave.
As a result, the direction of movement of the impulse changes and the contractile activity of the myocardium is disrupted.
Patients with atherosclerotic atherosclerosis are concerned about such types of arrhythmias as extrasystole, atrial fibrillation, blockade.
IHD and its nosological form atherosclerotic cardiosclerosis has a slowly progressive course, and patients may not feel any symptoms for many years.
However, all this time irreversible changes occur in the myocardium, which ultimately leads to chronic heart failure.
In case of stagnation in the pulmonary circulation, shortness of breath, cough, orthopnea are noted. With stagnation in the systemic circulation, nocturia, hepatomegaly, and edema of the legs are characteristic.
Treatment of atherosclerotic cardiosclerosis involves lifestyle correction and the use of medications. In the first case, it is necessary to focus on activities aimed at eliminating risk factors. For this purpose, it is necessary to normalize the mode of work and rest, to reduce weight in obesity, not to avoid dosed physical exertion, to follow a hypocholesterol diet.
In case of ineffectiveness of the above measures, drugs are prescribed that contribute to the normalization of lipid metabolism. Several groups of drugs have been developed for this purpose, but statins are more popular.
Their mechanism of action is based on the suppression of enzymes involved in the synthesis of cholesterol. Means of the latest generation also contribute to an increase in the level of high density lipoproteins, or, more simply, "good" cholesterol.
Another important property of statins is that they improve the rheological composition of the blood. This prevents the formation of blood clots and avoids acute vascular catastrophes.
Morbidity and mortality from cardiovascular pathology is growing every year, and anyone should have an idea of such a nosology and the correct methods of correction.
