Classification of ischemic heart disease (ihd)

1. Sudden cardiac death.

2. Angina pectoris:

stable angina pectoris;

vasospastic angina (Princmetala's);

unstable angina.

3. Myocardial infarction (Ml):

acute Q-wave Ml;

acute non-Q-wave MI;

-subendocardial MI;

acute MI (undetected);

• recurrent MI (3-28 days);

• repeated MI (after 28 days).

4. Postinfarction cardiosclerosis faction.

6. Cardiac arrhythmia.

7. Painless form of the IHD.

Stable angina

The 2002 American College of Cardiology/American Heart Association (ACC/AHA) guideline update defined chronic stable angina as a clinical syndrome characterized by discomfort in the chest or adjacent areas caused by myocardial ischemia typically aggravated by exertion or emotional stress and relieved by rest or by nitroglycerin. Patients often describe their symptom as discomfort rather than pain.

Clinical features

The main parameters of pain in patients with stable angina are: location, character, intensity, duration, frequency, radiation, associated symptoms and cause of onset, aggravating and relieving factors. The typical location of angina is mid or lower part of sternum. Less typically, discomfort may occur in the epigastric area. The discomfort is usually described as pressure, tightness, heaviness, strangling, constricting, burning, squeezing, suffocating and crushing.

The severity of the discomfort varies greatly. The pain may radiate in arm to the wrist and fingers, lower jaw or teeth, throat, between the shoulder blades. The duration of the discomfort is brief, not more than 10 min in the majority of cases and more commonly even less. Angina equivalents are common and include dyspnea, faintness, and syncope. Chest discomfort may be accompanied by less specific symptoms such as nausea, burping, restlessness, or a sense impending doom. Frequency of the pain may be different.

An important characteristic is the relation to exercise, specific activities, or emotional stress. Symptoms classically triggered by increased levels of exertion, such as walking up an incline or against a breeze, and rapidly disappear within a few minutes, when these causal factors abate. Exacerbations of symptoms after a heavy meal or work are classical features of angina. Buccal or sublingual nitrates rapidly relieve angina.

For patient with stable angina it is useful to classify the symptoms using a grading system which was devised by the Canadian Cardiovascular Society, based on the severity of the angina stressor.

Canadian Cardiovascular Society classification of stable angina

Class	Severity of exertional stress including angina	Limitation ordinary activity
I	Strenuous rapid or prolonged exertion at work or recreation	None
II	Walking or climbing stairs rapidly, walking uphill, walking or stair climbing	Slight
III	Walking one to two blocks on the level and climbing one flight of stairs in normal condition and at a normal pace	Marked
IV	Symptoms may be present at rest	Discomfort in all activity performed

Objective examination. During the attack of stable angina the patient's condition is moderate, clear consciousness, standing up right position (if the patient walking), or sitting position with hand placed over sternum. Patient's face is pale with cyanotic tint. Arcus senilis, xanthelasma are revealed. Extremities are cold.

In auscultation of lung may be detected bilateral basal rales. Apex beat displaced outside. The left border of relative cardiac dullness displaced. Both heart sounds are decreased, paradoxically split S, and sometimes may be arrhythmia. premature beat, atrial fibrillation. The clinical features of stable angina are abnormal carotid pulse, decreased peripheral pulse, jugular venous distension. In some patients observe hepatomegaly, pedal edema.