Ischemic heart disease symptoms. Postinfarction cardiosclerosis Ischemic heart disease according to ICD 10

2. DIAGNOSTICS OF CHRONIC CAD

2.1. The diagnosis of IHD is formed on the basis of:

Questioning and collecting anamnesis;
Physical examination;
Instrumental research;
Laboratory research.

2.2. Tasks of the doctor during the diagnostic search:

Make a diagnosis and determine the form of IHD;
Determine the prognosis of the disease - the likelihood of complications;
Based on the degree of risk, determine the tactics of treatment (medical, surgical), the frequency and volume of subsequent outpatient examinations.

In practice, diagnostic and prognostic evaluations are carried out simultaneously, and many diagnostic methods contain important prognostic information.

The degree of risk of complications in chronic coronary artery disease is determined by the following main indicators:

Clinical picture (severity of myocardial ischemia) of the disease
Anatomical prevalence and severity of atherosclerosis of large and medium coronary arteries;
Systolic function of the left ventricle;
General health, presence of comorbidities and additional risk factors.

2.3. IHD classifications

There are several classifications of IBS. In Russian clinical practice, a classification based on the International Classification of Diseases IX revision and the recommendations of the WHO Expert Committee (1979) is widely used. In 1984, with the amendments of the VKNTs AMS of the USSR, this classification was adopted in our country.

IHD classification (according to ICD-IX 410-414.418)

1. Angina pectoris:
1.1. First-time angina pectoris;
1.2. Stable exertional angina with indication of the functional class (I-IV);
1.3. Angina pectoris progressive;
1.4. Spontaneous angina (vasospastic, special, variant, Prinzmetal);
2. Acute focal myocardial dystrophy;
3. Myocardial infarction:
3.1. Large focal (transmural) - primary, repeated (date);
3.2. Small-focal - primary, repeated (date);
4. Postinfarction focal cardiosclerosis;
5. Violation of the heart rhythm (indicating the form);
6. Heart failure (indicating the form and stage);
7. Painless form of coronary artery disease;
8. Sudden coronary death.

Notes:

Sudden coronary death- death in the presence of witnesses, occurring instantly or within 6 hours from the onset of a heart attack.

New onset angina pectoris- the duration of the disease up to 1 month. since its inception.

stable angina- the duration of the disease is more than 1 month.

Progressive angina- an increase in the frequency, severity and duration of seizures in response to the usual load for this patient, a decrease in the effectiveness of nitroglycerin; sometimes changes on the ECG.

Spontaneous (vasospastic, variant) angina pectoris- attacks occur at rest, are difficult to respond to nitroglycerin, can be combined with angina pectoris.

Postinfarction cardiosclerosis- is placed no earlier than 2 months after the development of myocardial infarction.

Cardiac arrhythmias and conduction disorders(indicating the form, degree).

Circulatory failure(indicating the form, stage) - is made after the diagnosis of "postinfarction cardiosclerosis".

2.4. Examples of the formulation of the diagnosis

IHD, atherosclerosis of the coronary arteries. First-time angina pectoris.
IHD, atherosclerosis of the coronary arteries. Angina pectoris and (or) rest, FC IV, ventricular extrasystole. HK0.
ischemic heart disease. Vasospastic angina.
IHD, atherosclerosis of the coronary arteries. Angina pectoris, functional class III, postinfarction cardiosclerosis (date), violation of intracardiac conduction: atrioventricular block I degree, left bundle branch block. Circulatory insufficiency II B stage.

In the International Classification of Diseases X revision, stable coronary artery disease is in 2 headings.

(I00-I99) CLASS IX. DISEASES OF ORGANS CIRCULATIONS
	(I20-25) ISCHEMIC HEART DISEASE
		I25 Chronic ischemic heart disease
			I25.0	Atherosclerotic cardio- vascular disease, so described
			I25.1	atherosclerotic heart disease
			I25.2	Past heart attack myocardium
			I25.3	heart aneurysm
			I25.4	Aneurysm of the coronary artery
			I25.5	Ischemic cardiomyopathy
			I25.6	Asymptomatic myocardial ischemia
			I25.8	Other forms of ischemic heart diseases
			I25.9	Chronic ischemic disease heart, unspecified

In clinical practice, it is more convenient to use the WHO classification, since it takes into account different forms of the disease. For statistical needs in health care, ICD-10 is used.

2.5. Forms of chronic ischemic heart disease

2.5.1. Angina pectoris;

Symptoms

Signs of typical (undoubted) exertional angina (all 3 signs):

pain in the sternum, possibly radiating to the left arm, back or lower jaw, lasting 2-5 minutes. Pain equivalents are shortness of breath, a feeling of "heaviness", "burning".
The pain described above occurs during times of severe emotional stress or physical exertion;
The above pain quickly disappears after the cessation of physical activity or after taking nitroglycerin.

There are atypical variants of irradiation (to the epigastric region, to the shoulder blade, to the right half of the chest). The main symptom of angina pectoris is a clear dependence of the onset of symptoms on physical activity.

The equivalent of angina pectoris can be shortness of breath (up to suffocation), a feeling of "heat" in the sternum, attacks of arrhythmia during exercise.

The equivalent of physical activity can be a crisis increase in blood pressure with an increase in the load on the myocardium, as well as a heavy meal.

Signs of atypical (possible) angina pectoris

The diagnosis of atypical angina is made if the patient has any 2 of the 3 above signs of typical angina.

Nonanginal (nonanginal) chest pain

Pain is localized to the right and left of the sternum;
The pains are local, "point" in nature;
After the onset of pain lasts more than 30 minutes (up to several hours or days), it can be constant or “suddenly piercing”;
Pain is not associated with walking or other physical activity, but occurs when tilting and turning the body, in the prone position, with a long stay of the body in an uncomfortable position, with deep breathing at the height of inspiration;
Pain does not change after taking nitroglycerin;
Pain is aggravated by palpation of the sternum and / or chest along the intercostal spaces.

2.5.1.1. Functional classes of angina pectoris

During the questioning, depending on the physical activity tolerated, 4 functional classes of angina pectoris are distinguished (according to the classification of the Canadian Society of Cardiology):

Table 2. "Functional classes of angina pectoris"

2.5.1.2. Differential diagnosis in angina pectoris

Cardiovascular diseases: severe myocardial hypertrophy in arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy, coronaritis, dissecting aortic aneurysm, vasospastic angina pectoris, pulmonary embolism, pericarditis
Acute and chronic diseases of the upper gastrointestinal tract: reflux esophagitis, spasm of the esophagus, erosive lesions, peptic ulcer and tumors of the esophagus, stomach and duodenum, hiatal hernia, cholecystitis, pancreatitis;
Acute and chronic diseases of the upper respiratory tract: acute bronchitis, tracheitis, bronchial asthma;
Lung diseases: pleurisy, pneumonia, pneumothorax, lung cancer;
Injuries and post-traumatic diseases of the chest, osteochondrosis of the cervicothoracic spine with radicular syndrome;
Psychogenic disorders: neurocirculatory dystonia, hyperventilation syndrome, panic disorders, psychogenic cardialgia, depression;
Intercostal neuralgia, myalgia;
Arthritis of the sternocostal joints (Tietze's syndrome);
Acute infectious diseases (herpes zoster)

2.5.2. Painless myocardial ischemia

A significant part of episodes of myocardial ischemia occurs in the absence of symptoms of angina pectoris or its equivalents - up to the development of painless MI.

Within the framework of chronic coronary artery disease, 2 types of painless myocardial ischemia (SIMI) are distinguished:

Type I - completely painless myocardial ischemia
Type II - a combination of painless and painful episodes of myocardial ischemia

Episodes of MIMS are usually identified during exercise testing and 24-hour ECG monitoring.

Completely painless myocardial ischemia is detected in approximately 18-25% of individuals with proven coronary artery atherosclerosis. With concomitant diabetes mellitus, the likelihood of type I and type II MIMS is higher. According to 24-hour ECG monitoring, most episodes of MIMS occur during the day, which is explained by an increased average heart rate during vigorous activity. At the same time, episodes of MIH often occur at night, against the background of normal and even reduced heart rate, which, apparently, reflects the role of dynamic coronary artery stenoses (spasms). It is believed that if BBMI occurs both at night and in the morning, this is a characteristic sign of multivessel atherosclerosis, or damage to the trunk of the left coronary artery.

Diagnostic tests for painless myocardial ischemia

In the diagnosis and evaluation of IMIM, stress tests and 24-hour ECG monitoring complement each other.

Treadmill test, VEM, CPES - allow you to actively identify IMIM and characterize its relationship with blood pressure, heart rate, physical activity. Simultaneous perfusion myocardial scintigraphy and echocardiography can reveal concomitant hypoperfusion and impaired myocardial contractile function.

ECG monitoring allows you to determine the total number and duration of episodes of MIMS, as well as to identify MIMS at night and without regard to exercise.

Painless type II ischemia is much more common than type I MI. Even in individuals with typical angina, about 50% of ischemic episodes are asymptomatic. With concomitant diabetes mellitus, this figure is slightly higher. It should be remembered that MIMI, as well as oligosymptomatic and asymptomatic MI, are often found in people with diabetes mellitus, sometimes being the only indication for coronary artery disease. In this disease, neuropathy with a violation of superficial and deep sensitivity is very common.

Forecast

The damaging effect of ischemia on the myocardium is determined not by the presence of pain, but by the severity and duration of hypoperfusion. Therefore, painless myocardial ischemia of both types is a poor prognostic sign. The number, severity and duration of episodes of myocardial ischemia, regardless of whether they are painful or painless, have an unfavorable prognostic value. Individuals with type 1 MIMI identified during exercise testing have a 4- to 5-fold higher risk of cardiovascular death than healthy individuals. Identification of episodes of MIMD during daily ECG monitoring is also an unfavorable predictor. Concomitant MIMD cardiovascular risk factors (diabetes mellitus, history of myocardial infarction, smoking) further worsen the prognosis.

2.5.3. Vasospastic angina

It was described in 1959 as a type (variant) of a pain attack in the chest caused by myocardial ischemia at rest, without regard to physical and emotional stress, accompanied by ST segment elevations on the ECG. Often such angina is called variant.

Vasospastic angina can be accompanied by threatening arrhythmias (ventricular tachycardia, ventricular fibrillation), occasionally leading to the development of MI and even sudden death.

It has been proven that this type of angina pectoris is caused by spasm of the coronary arteries. With “typical” vasospastic angina, ischemia occurs due to a significant decrease in the diameter of the lumen of the coronary arteries and a decrease in blood flow distal to the site of spasm, but not as a result of an increase in myocardial oxygen demand.

As a rule, spasm develops locally, in one of the large coronary arteries, which may be intact or contain atherosclerotic plaques.

The reasons for the increased sensitivity of local areas of the coronary arteries to vasoconstrictor stimuli are unclear. Among the main promising areas of research are endothelial dysfunction, damage to the vascular wall during the early formation of atheroma, and hyperinsulinemia.

Among the established risk factors for vasospastic angina are cold, smoking, severe electrolyte disturbances, the use of cocaine, ergot alkaloids, autoimmune diseases.

It is possible that vasospastic angina pectoris is associated with precursors of aspirin bronchial asthma, as well as other vasospastic disorders - Raynaud's syndrome and migraine.

Symptoms

Vasospastic angina usually occurs at a younger age than exertional angina due to coronary artery atherosclerosis. It is not uncommon for patients with vasospastic angina to fail to identify many of the typical risk factors for atherosclerosis (with the exception of smoking).

The pain attack in vasospastic angina is usually very strong, localized in a "typical" place - in the sternum. In cases where the attack is accompanied by syncope, concomitant ventricular arrhythmias should be suspected. Often such attacks occur at night and early in the morning.

Unlike unstable angina and exertional angina, the intensity of attacks of vasospastic angina does not increase over time, and exercise tolerance in patients is preserved. At the same time, it should be remembered that in some patients, vasospastic angina pectoris develops against the background of atherosclerosis of the coronary arteries, so they may have positive exercise tests with ST segment depression during or after exercise, as well as ST segment elevations during spontaneous coronary artery spasms outside physical activity. loads.

Differential diagnosis between exertional angina and vasospastic angina based on the description of a painful attack is not easy. Physical examination is most often nonspecific.

The basis of non-invasive diagnosis of vasospastic angina is the ECG changes recorded during an attack. Vasospastic angina is accompanied by marked ST segment elevations. Simultaneous inversion of the T waves and an increase in the amplitude of the R waves may be harbingers of threatening ventricular arrhythmias. Simultaneous detection of ST segment elevations in many leads (extensive ischemic zone) is an unfavorable predictor of sudden death. Along with ST-segment elevations detected against the background of pain, 24-hour ECG monitoring often reveals similar pain-free changes. Sometimes vasospastic angina is accompanied by transient disturbances of intracardiac conduction. Ventricular extrasystole usually occurs against the background of prolonged ischemia. Ventricular arrhythmias in vasospastic angina can be caused by both hypoperfusion against the background of vasospasm and subsequent reperfusion after its disappearance. Sometimes the consequence of prolonged spasm of the coronary arteries may be an increase in the activity of cardiospecific plasma enzymes. Cases of the development of transmural MI after severe spasms of the coronary arteries are described.

Stress testing of individuals with vasospastic angina is not very informative. In the course of stress tests, the following are detected in approximately equal amounts: 1) ST segment depression (against the background of concomitant coronary artery atherosclerosis), 2) ST segment elevation, 3) absence of diagnostic ECG changes.

On echocardiography during an attack of vasospastic angina pectoris, a violation of local myocardial contractility in the ischemic zone is noted.

The main diagnostic criterion for vasospastic angina is considered to be coronary artery spasm verified in CAG - spontaneous, or during a pharmacological test.

Most patients with vasospastic angina pectoris in CAH have hemodynamically significant stenosis in at least one major coronary artery. In this case, the site of spasm development is usually within 1 cm of the stenosis. Sometimes spasms develop in several parts of the coronary bed at once. Angina pectoris in such patients is associated with physical activity, while ECG changes are recorded more often in precordial leads (V1-V6).

In some individuals with CAG, completely intact coronary arteries are detected. In such cases of vasospastic angina, ST-segment elevation is noted in leads II, III, aVF and is not related to exercise in any way.

Diagnostic tests for vasospastic angina

They are used to call a typical pain attack for the patient. They are unsafe, so they are carried out in the conditions of the ward (department) of intensive observation or angiographic laboratory through a central venous or intracoronary catheter. Considering that a prolonged spasm of damaged coronary arteries can cause MI, provocative tests are usually carried out in persons with intact or slightly changed coronary arteries based on the results of a previous angiographic study.

The main tests for detecting vasospastic angina pectoris are a cold test, intracoronary administration of acetylcholine, methacholine, histamine, dopamine.

Forecast

Mortality from cardiovascular complications in vasospastic angina in the absence of angiographic signs of stenosing coronary atherosclerosis is about 0.5% per year. However, when a spasm of the coronary arteries is combined with atherosclerotic stenosis, the prognosis is worse.

2.5.4. Microvascular angina

Synonymous with this type of angina is the term "coronary syndrome X". It is characterized by a combination of 3 features:

Typical or atypical angina pectoris;
Identification of signs of myocardial ischemia based on the results of stress ECG tests (treadmill, VEM, PEES) and imaging studies ((in most cases - myocardial scintigraphy; or - stress echocardiography). The most sensitive method for diagnosing myocardial ischemia in these patients is the use of pharmacological tests ( with ATP / adenosine / dipyridamole / dobutamine) or VEM test in combination with single photon emission computed tomography of the myocardium with the introduction of 99mTc-MIBI (analogue of Thallium-201);
Detection of normal or slightly changed large and medium coronary arteries in CAG, and normal function of the left ventricle in ventriculography.

The cause of microvascular angina is considered to be dysfunction of small coronary arteries with a diameter of 100-200 microns in the pre-arteriolar segment of the coronary bed. The CAG method does not allow to detect damage to arteries, the diameter of which is less than 400 microns. Dysfunction of these arteries is characterized by excessive vasoconstriction (microvascular spasm) and an inappropriate vasodilation response (decreased coronary reserve) in response to exercise. Ischemic ECG changes and defects in myocardial capture of the radiopharmaceutical during stress tests are identical in patients with microvascular angina (MVS) and obstructive atherosclerosis of the epicardial coronary arteries, but differ in the absence of hypokinesis zones in microvascular angina, which is due to small volumes of ischemia foci, their frequent localization in the subendocardial zone.

Microvascular angina may coexist with classic angina in patients with atherosclerotic stenosis (more than 70% of cases).

In some patients with angina pectoris syndrome with "normal" large and medium coronary arteries, myocardial hypertrophy is often detected against the background of arterial hypertension. The "hypertensive heart" syndrome is characterized by endothelial dysfunction of the coronary arteries, changes in the ultrastructure of the myocardium and the coronary bed with a simultaneous decrease in the coronary reserve.

Diagnostic tests for microvascular angina pectoris

Exercise echocardiography with exercise or intravenous dobutamine to detect segmental disorders of myocardial contractility.

Prognosis for microvascular angina

As recent studies have shown, the long-term prognosis is unfavorable: according to long-term observations, cardiovascular events develop in 5-15% of patients.

2.6. General non-invasive diagnostics

When examining all patients with suspected CAD, as well as before changing the treatment of patients with proven CAD, the doctor conducts a general health assessment (Table 3).

Table 3. "Diagnostic measures for suspected chronic ischemic heart disease and for optimizing treatment in people with proven chronic ischemic heart disease"

Collection of anamnesis, analysis of documentation, assessment of quality of life

Physical examination

Registration of a 12-lead ECG at rest

Registration of a 12-lead ECG during or immediately after an attack of chest pain

Chest x-ray for suspected circulatory failure

Chest x-ray for atypical symptoms and suspected lung disease

Echocardiography transthoracic 1) to exclude non-coronary causes; 2) to assess local myocardial contractility; 3) to assess the LVEF for the purpose of risk stratification; 4) to assess LV diastolic function

Ambulatory ECG monitoring for suspected concomitant paroxysmal arrhythmia

Ambulatory ECG monitoring for suspected vasospastic angina

Ultrasonography of the carotid arteries to detect extracardiac atherosclerosis (wall thickening, atherosclerotic plaques) in individuals with suspected CAD

Clinical blood test with determination of hemoglobin level and leukocyte formula

Screening for T2DM: fasting blood glucose and HbA1C. If uninformative - glucose tolerance test

Plasma creatinine level to calculate creatinine clearance to assess renal function

Fasting blood lipid spectrum (levels of total cholesterol, LDL-C, HDL-C, TG)

If thyroid disease is suspected, laboratory testing of thyroid function

In people who have recently started taking statins, a study of liver function

In persons who complain of symptoms of myopathy while taking statins, the activity of blood creatine phosphokinase

If heart failure is suspected, blood BNP/proBNP levels

Notes: T2DM, type 2 diabetes mellitus; HbA1C. - glycosylated hemoglobin; THC - total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; BNP/proBNP – brain natriuretic peptide

2.6.1 Physical examination

In most cases, physical examination in chronic coronary artery disease is of little specificity. Signs of risk factors and symptoms of coronary heart disease complications can be identified. The symptoms of heart failure (shortness of breath, wheezing in the lungs, cardiomegaly, gallop rhythm, swelling of the neck veins, hepatomegaly, swelling of the legs), atherosclerosis of peripheral arteries (intermittent claudication, weakening of the pulsation of the arteries and atrophy of the muscles of the lower extremities), arterial hypertension, arrhythmia, noise over the carotid arteries.

In addition, attention should be paid to overweight and external symptoms of anemia, diabetes mellitus (scratching, dryness and flabbiness of the skin, decreased skin sensitivity, skin trophic disorders). In patients with familial forms of hypercholesterolemia, a careful examination can reveal xanthomas on the hands, elbows, buttocks, knees and tendons, as well as xanthelasmas on the eyelids.

Be sure to calculate the body mass index, waist circumference, determine the heart rate, measure blood pressure (BP) on both arms. All patients should conduct palpation of the peripheral pulse, auscultation of the carotid, subclavian and femoral arteries. If intermittent claudication is suspected, the ankle-brachial systolic BP index should be calculated. In atypical angina pectoris, pain points of the parasternal region and intercostal spaces are palpated.

2.6.2. EKG at rest

Recording a 12-lead ECG at rest is mandatory for all patients.

In uncomplicated chronic coronary artery disease outside the load, specific ECG signs of myocardial ischemia are usually absent. The only specific sign of IHD on the resting ECG is large-focal cicatricial changes in the myocardium after myocardial infarction. Isolated changes in the T wave, as a rule, are not very specific and require comparison with the clinic of the disease and data from other studies.

Registration of an ECG during a pain attack in the chest is of much greater importance. If there are no ECG changes during pain, the probability of coronary artery disease in such patients is low, although it is not completely excluded. The appearance of any ECG changes during a pain attack or immediately after it significantly increases the likelihood of coronary artery disease. Ischemic ECG changes in several leads at once are an unfavorable prognostic sign.

In patients with initially altered ECG due to postinfarction cardiosclerosis during an attack, even typical angina pectoris, ECG changes may be absent, be of little specificity or false positive (decrease in amplitude and reversion of initially negative T waves). It should be remembered that against the background of intraventricular blockades, ECG registration during a pain attack is uninformative. In this case, the doctor decides on the nature of the attack and the tactics of treatment according to the accompanying clinical symptoms.

2.6.3. ECG monitoring

ECG monitoring is indicated for all patients with CIHD if concomitant arrhythmias are suspected, as well as when it is impossible to perform a stress test due to concomitant diseases (diseases of the musculoskeletal system, intermittent claudication, a tendency to a pronounced increase in blood pressure during dynamic physical exertion, detraining, respiratory failure) .

Allows you to determine the incidence of pain and painless myocardial ischemia, as well as to conduct a differential diagnosis with vasospastic angina.

The sensitivity of ECG monitoring in the diagnosis of coronary artery disease is 44-81%, the specificity is 61-85%. This diagnostic method is less informative for detecting transient myocardial ischemia than exercise tests.

Prognostically unfavorable findings during daily ECG monitoring:

Large total duration of myocardial ischemia;
Episodes of ventricular arrhythmias during myocardial ischemia;
Myocardial ischemia with low heart rate (<70 уд./мин).

The detection of a total duration of myocardial ischemia of >60 min per day during ECG monitoring serves as a good reason for referring the patient to CAG and subsequent myocardial revascularization, since it indicates severe damage to the coronary arteries.

2.6.4. Ultrasound examination of the carotid arteries

The study is carried out in patients with a diagnosis of coronary artery disease and a moderate risk of severe complications to assess the severity and prevalence of atherosclerosis. The detection of multiple hemodynamically significant stenoses in the carotid arteries forces us to reclassify the risk of complications as high, even with moderate clinical symptoms. In addition, ultrasound of the carotid arteries is performed in all patients with coronary artery disease who are scheduled for surgical myocardial revascularization.

2.6.5. X-ray examination in chronic ischemic heart disease

X-ray examination of the chest is performed in all patients with coronary artery disease. However, this study is most valuable in patients with postinfarction cardiosclerosis, heart defects, pericarditis and other causes of concomitant heart failure, as well as in cases of suspected aneurysm of the ascending aortic arch. In such patients, on radiographs, it is possible to assess the increase in the heart and aortic arch, the presence and severity of intrapulmonary hemodynamic disorders (venous congestion, pulmonary arterial hypertension).

2.6.6. Echocardiographic study

The study is carried out in all patients with a suspected and proven diagnosis of chronic coronary artery disease. The main purpose of echocardiography (EchoCG) at rest is the differential diagnosis of angina pectoris with non-coronary chest pain in aortic valve defects, pericarditis, ascending aortic aneurysms, hypertrophic cardiomyopathy, mitral valve prolapse and other diseases. In addition, echocardiography is the main way to detect and stratify myocardial hypertrophy and left ventricular dysfunction.

2.6.7. Laboratory research

Few laboratory studies have independent prognostic value in chronic CAD. The most important parameter is the lipid spectrum. Other laboratory tests of blood and urine reveal previously hidden concomitant diseases and syndromes (DM, heart failure, anemia, erythremia, and other blood diseases), which worsen the prognosis of coronary artery disease and require consideration in the possible referral of the patient for surgical treatment.

Lipid spectrum of blood

Dyslipoproteinemia, a violation of the ratio of the main classes of lipids in plasma, is a leading risk factor for atherosclerosis. With a very high cholesterol content, coronary artery disease develops even in young people. Hypertriglyceridemia is also a significant predictor of atherosclerosis complications.

IHD and exertional angina in the ICD-10 have their place. There are diseases that are based on violations in the process of blood flow to the heart muscle. Such diseases are called coronary heart disease. A separate place in this group is occupied by angina pectoris, as it signals that the patient's condition is dangerous. The disease itself is not fatal, but it is a precursor to ailments that are fatal.

Accepted international classification

In international documentation, IHD occupies categories from I20 to I25. I20 is angina pectoris, which is also called angina pectoris. If it is not stable, then the number 20.0 is indicated. In this case, it can be increasing, as well as angina pectoris, both for the first time and in a progressive stage. For a disease that is also characterized by spasms, the number 20.1 is set. In this case, the disease can be angiospastic, variant, spasmodic, or Prinzmetal's syndrome. The remaining varieties of the disease are indicated under the number 20.8, and if the pathology has not been clarified, then the code 20.9 is used.

If the patient has an acute stage of myocardial infarction, then this is section I21. This includes a specified acute ailment or established within a month (but no more). Some side effects after a heart attack are excluded, as well as a past illness, chronic, lasting more than a month, and also subsequent. In addition, this section does not include postinfarction syndromes.

If the patient has a recurrent myocardial infarction, then this is section I22. This code is used for all types of myocardial infarction, which is localized anywhere, but occurs within 28 days from the moment of the first attack. This includes the relapsing, repetitive, and growing species. But a chronic condition is ruled out. For some current complications of acute myocardial infarction, section I23 is used.

The classification includes other forms of acute ischemic heart disease. All information about this is contained in section I24. If the patient has a coronary type thrombosis that does not lead to myocardial infarction, then the number 24.0 is written. But at the same time, thrombosis in a chronic form or lasting more than 28 days is excluded. For Dressler's syndrome, the number 24.1 is used. The remaining forms of acute ischemic heart disease are written under the number 24.8, and if the disease is not fully specified, then the code 24.9 is used.

For the chronic form of ischemic disease, code I25 is used. If the patient has an atherosclerotic disease of the heart and blood vessels, then the number 25.0 is written. If only atherosclerosis of the heart, then 25.1. If myocardial infarction was transferred in the past, then the number 25.2 is written. For a cardiac aneurysm, code 25.3 is used. If the patient has an aneurysm of a coronary artery, then the number 25.4 is indicated. However, the congenital form of this disease is excluded. If the patient has cardiomyopathy of the ischemic type, then the number 25.5 is used. When ischemia occurs without visible symptoms, a diagnosis is made with code 25.6. The remaining forms of coronary heart disease with a chronic course are signed by the number 25.8, and if the patient's condition is not specified, then the code 25.9 is used.

Existing varieties of the disease

Angina pectoris is a type of heart disease. This ailment is considered specific, so that it can be determined by some features. Pathology develops due to the fact that the blood flow to the heart decreases, as the coronary arteries narrow. Depending on how this process is disturbed, various forms of the disease are distinguished.

If the patient's heart muscle tissue is gradually destroyed, then this is necrosis. In this case, there may be a widespread, transmural or superficial infarction. If the myocardium is not destroyed, then this condition is called ischemia. Here allocate angina pectoris of tension and rest. The first form is characterized by the occurrence of heavy physical exertion. This includes unstable and stable forms of angina pectoris. As for angina at rest, it occurs even without physical exertion. There are 2 main subspecies - vasospastic angina and Prinzmetal angina.

Angina itself happens:

1. Voltages. It is characterized by the appearance of pains of a pressing nature in the retrosternal region, when a person has intense physical activity. The pain may radiate to the left side of the chest, left arm, scapular region, neck. As soon as such unpleasant sensations appear, it is necessary to stop any load. After a while, the pain syndrome will go away on its own. Additionally, you can take nitrates. If the pathological condition does not go away, then exertional angina is stable.
2. Peace. Pain behind the sternum appears when a person is at rest. This happens in two cases. Firstly, if a coronary-type vessel spasms reflexively. This is the cause of ischemic disease. Secondly, Prinzmetal's angina must be considered. This is a special variety that occurs abruptly due to the fact that the lumens of the coronary arteries overlap. For example, this happens because of detached plaques.
3. Unstable. This term refers to either exertional angina, which gradually progresses, or rest angina, which is variable. If the pain syndrome cannot be stopped by taking nitrates, then the pathological process can no longer be controlled, and this is very dangerous.

Causes and treatment of pathology

These pathologies are characterized by the following common symptoms:

feeling of constriction behind the sternum and in the left side of the chest;
the course of the disease is manifested by seizures;
unpleasant symptoms occur abruptly, and not only during physical exertion, but also at rest;
the attack usually lasts for half an hour, and if more, then this is already a heart attack;
eliminates the symptoms of an attack Nitroglycerin or other similar drugs based on nitrates.

A key moment in the development of ischemic heart disease is the narrowing of the lumens in the coronary type arteries.

ICD code 10 IHD means a classification of symptoms associated with coronary heart disease. The abbreviation ICD stands for "International Classification of Diseases" and represents the entire list of currently recognized diseases and pathologies of human development.

The number 10 indicates the number of revisions of the list - ICD 10 is the result of the tenth worldwide revision. Codes are assistants in the search for the necessary symptoms and disorders of the body.

Of course, a person's bad habits can contribute to heart failure. In her opinion, heart failure is often the result of risk factors for cardiovascular disease. The most common patients with heart failure with atherosclerosis, arterial hypertension, coronary heart disease, heart valve disorder; Rare causes are gene mutations in infectious diseases that damage the heart muscle.

According to the cardiologist, often the disease is aggravated by malnutrition and misuse of drugs, then there is nothing but patients who will be hospitalized. Around the world, more and more dedicated heart failure caregivers are involved in the management of what the European Heart Failure Association recommends should have a population of one hundred thousand.

IHD, or "coronal disease" is a disease associated with insufficient oxygen enrichment of the muscle tissue of the heart - myocardium. The most common cause of coronary artery disease is atherosclerosis, a dysfunction characterized by the deposition of plaques on the walls of the arteries.

There are a number of complications and concomitant coronary heart disease syndromes. They are described in the ICD code from I20 to I25 number.

However, if the delay is too long, according to Prof. Ausra Kavolinene, Cardiology Clinic of the Lithuanian University of Health Sciences, the ticket remains only one way, i.e. mirian. To make this ticket unnecessary for anyone suffering from coronary heart disease, you must know your heart rate while resting. Those who want to check the heart rate at home should be in a quiet place for 5-10 minutes and feel the pulse in the wrist area. You must count the number of seconds up to 30 seconds and multiply the number obtained by two.

MBK codes

Number I20 is angina pectoris. The classification of diseases divides it into: unstable and other types of angina. Unstable angina pectoris is an intermediate period in the development of coronary disease, between a stable course of dysfunction and a complication. During this period, the likelihood of a heart attack of the middle muscle layer of the heart is especially high.

Studies have shown that heart failure in patients with heart failure should not exceed 60 times at rest. Research has also shown that a higher heart rate increases the risk of death. Some time ago, Australian researchers found that patients with recurrent diabetes were more likely to develop cardiac autonomic neuropathy, which is a dysregulation of the heart's rhythm that leads to a recurrence of myocardial infarction. This only illustrates why it is extremely important to kill the heart rate.

Number I21 is acute myocardial infarction, which can be caused by unstable angina. Myocardial infarction is an acute form of ischemic disease, and occurs when the blood supply to the organ is interrupted.

In the event that normal blood flow does not return, the part of the heart deprived of blood dies without the possibility of resuming its functions.

To illustrate the incidence of heart failure in Lithuania, the doctor asks to imagine a street where only 65-year-old children go. It is likely that one in ten of these people will have heart problems, she said. Therefore, it is obvious that in society this is a very common disease.

Heart failure affects not only the victim, but also members of his family, and when such faces are visible, the state gravitates more and more. The treatment of this disease, especially in hospitals, is one of the most expensive. Therefore, he wants to take on the experience of European countries such as Sweden. In Sweden 80% Hospitals have dedicated heart failure cabinets. Celukkene, Chairman of the Cardiac Heart Failure Working Group. Equivalent to the good Scandinavian experience, it is necessary to strive to implement best practices in the management of heart failure through the organization of specialized care that will allow them to expect better results.

Code I22 indicates a recurrent myocardial infarction. It is divided into infarction of the anterior and inferior wall of the myocardium, other specified localization and unspecified localization. Re-infarction has the risk of death of the patient.

The second time the disease can manifest itself with the same symptoms as the first time - in the sternum, extending into the arm, the space between the shoulder blades, into the neck and jaw. The syndrome can last from 15 minutes to several hours. There may be complications - pulmonary edema, loss of creation, suffocation, an instant decrease in pressure.

One of the most important groups of drugs that reduce heart rate and improve prognosis is beta-blockers. Recently, the possibility of introducing a drug that suppresses the sinus node, ivabradine, has become possible. It not only reduces the heart rate, but also improves the blood circulation of the heart, maintains the strength of the heart contraction. Data from various international clinical trials confirm the effectiveness of this drug in the treatment of chronic heart failure.

By decreasing heart rate, it improves exercise tolerance in patients with heart failure and reduces hospitalizations and deaths. Thus, according to recent studies, the use of ivabradine in the treatment of heart failure gives patients the opportunity to achieve the lowest mortality among patients with this disease.

But a variant of a practically unnoticed heart attack is also possible, when the patient notes only the general weakness of the condition.

For the course of the arrhythmic form, complaints of rapid heartbeat are typical, the abdominal type may be accompanied by abdominal pain, and the asthmatic type may be accompanied by shortness of breath.

By reducing the heart rate, the patient's outlook improves. Doctors agree that heart failure is one of the key drugs, even if beta-blockers cannot be used, J. Chelutkienė concludes. A daily dose of aspirin can reduce a small amount of cancer. Scientists have found that if the drug is used by someone over the age of 50 in the United Kingdom, deaths from bowel or stomach cancer will drop by more than 100,000 people over 20 years. cases.

However, at the same time, they warn that aspirin can cause internal bleeding, so the medicine should only be taken after consulting your doctor. “Although aspirin can cause stomach bleeding, there is no way to change it when treating certain diseases,” said Vilnius University professor Pranas Serpitis. Aspirin is also dangerous, he said, in that once the drug is stopped, it remains effective for several days. According to the professor, even healthy people, however, should not take prophylactic aspirin.

It is impossible to determine exactly which patients will have a second heart attack - sometimes this is not related to lifestyle and habits.

Number I23 lists some current complications of acute myocardial infarction. Among them: hemopericardium, atrial and ventricular septal defect, damage to the heart wall without hemopericardium, chorda tendon and papillary muscle, atrial thrombosis, atrial appendage and ventricular organ, as well as other possible complications.

Aspirin used to be recommended as a good preventative medicine, what has changed? Aspirin has been used in clinical practice for over 100 years. A large number of studies have shown that a dose of aspirin can cause certain side effects of bleeding in the gastrointestinal tract caused by aspirin. Aspirin should not be used in patients who are not developing coronary heart disease or stroke. But, at the risk of these diseases, it is recommended to take aspirin, since there is currently no way to change it.

Code I24 suggests options for other forms of acute coronary heart disease.

Among them: coronary thrombosis, which does not lead to heart muscle infarction, post-infarction syndrome - an autoimmune complication of a heart attack, coronary insufficiency and inferiority, unspecified acute coronary heart disease. The list ends with code listing number I25, with chronic coronary heart disease.

Sometimes a drug is used, but several drugs, the so-called anti-aggressive group. It is necessary to use aspirin if so-called stents are implanted - cardiovascular tubes. He is given another medicine. It will take one month, and the whole year, sometimes all the time.

If aspirin is prescribed by a doctor, is it enough to consult a pharmacist? Pharmacists have a lot of knowledge and can sometimes advise on drug compatibility, but only a family doctor or specialist can tell you about the medicine, what drugs to take and how to use them.

It includes atherosclerotic disease - a syndrome in which the vessels are clogged with atherosclerotic deposits, a previous and cured myocardial infarction that does not show its symptoms at the moment, aneurysm of the heart and coronary artery, cardiomyopathy, myocardial ischemia, and other listed forms of the disease, including and unspecified.

Doctors give aspirin to people after a stroke or heart attack as blood thinners, but to prevent their side effects, bleeding in the stomach. Every medicine we use irritates the walls of the stomach. There are different forms of aspirin that you can choose from. You must decide if you are taking aspirin for protection or for another heart attack.

According to researchers, the side effects of aspirin for the elderly are on the rise. Yes, older people are more likely to experience the side effects of aspirin - moderate bleeding - but unfortunately they are more likely to have coronary heart disease. It was previously thought that aspirin should be used as a preventive measure for such patients. Those who have symptoms of these diseases are now taking aspirin. Older adults are at an increased risk of side effects with all medications.

Each drug should be weighed and adjusted accordingly. How to use aspirin? If the stomach is damaged, bleeding has occurred. Prophylactic, prophylactic drugs are prescribed, but there are situations when it is necessary to give aspirin, otherwise the consequences can be unpleasant. If the blood pressure is normal and there are no signs of disease, aspirin should definitely not be used.

Arterial hypertension is often not considered a serious disease, even it is believed that high blood pressure is inevitable with aging. So many people are convinced that hypertension is normal in older age. However, this attitude of the disease, the unwillingness to notice, see, recognize and ultimately relate to it, can have serious consequences, the most severe of which end in death.

Accepted international classification

What is arterial hypertension - an independent disease or symptoms of another disease? Arterial hypertension is an autonomic disease that increases the risk of other diseases. Arterial hypertension is an independent disease. On the other hand, it may be a sign, expression, and risk factor for other diseases. For example, arterial hypertension is one of the most important risk factors for all diseases of the circulatory system. It is known that with high blood pressure, atherosclerosis progresses faster.

Recall that atherosclerosis is a chronic inflammatory disease in which arterial walls accumulate fat, calcium, form opiate and scaly plaques, clog, constrict blood vessels and disrupt blood circulation. Depending on which blood vessel is damaged, a person can develop various diseases. For example, brain damage can lead to stroke, heart attacks, legs, arterial thrombosis of the legs, late limb gangrene, and so on. volume.

Long-term uncontrolled high blood pressure can lead to changes in the heart muscle, coronary arteries, and conduction heart, which in turn can contribute to coronary heart disease, heart failure, and cardiac arrhythmias.

1. Voltages. It is characterized by the appearance of pains of a pressing nature in the retrosternal region, when a person has intense physical activity. Pain can radiate to the left side of the chest, left arm, scapular region, neck. As soon as such unpleasant sensations appear, it is necessary to stop any load. After a while, the pain syndrome will go away on its own. Additionally, you can take nitrates. If the pathological condition does not go away, then exertional angina is stable.
2. Peace. Pain behind the sternum appears when a person is at rest. This happens in two cases. Firstly, if a coronary-type vessel spasms reflexively. This is the cause of ischemic disease. Secondly, Prinzmetal's angina must be considered. This is a special variety that occurs abruptly due to the fact that the lumens of the coronary arteries overlap. For example, this happens because of detached plaques.
3. Unstable. This term refers to either exertional angina, which gradually progresses, or rest angina, which is variable. If the pain syndrome cannot be stopped by taking nitrates, then the pathological process can no longer be controlled, and this is very dangerous.

Causes and treatment of pathology

These pathologies are characterized by the following common symptoms:

feeling of constriction behind the sternum and in the left side of the chest;
the course of the disease is manifested by seizures;
unpleasant symptoms occur abruptly, and not only during physical exertion, but also at rest;
the attack usually lasts for half an hour, and if more, then this is already a heart attack;
eliminates the symptoms of an attack Nitroglycerin or other similar drugs based on nitrates.

A key moment in the development of ischemic heart disease is the narrowing of the lumens in the coronary type arteries. This can be caused by such factors:

atherosclerosis of the heart vessels;
rupture of atherosclerotic plaques and the formation of blood clots;
spasm of the arteries, which leads to a decrease in the diameter of the lumen;
frequent stress and constant nervous tension;
excessive physical load;
smoking;
frequent and heavy drinking;
hypertension;
hypertrophic changes in the myocardium;
changes in the elasticity of blood vessels.

postinfarction cardiosclerosis. See also Ibs (river) Ischemic heart disease ICD 10 I20. I25. ICD 9 ... Wikipedia. Cardiosclerosis - damage to the muscle (myocardiosclerosis) and heart valves due to the development in the International Classification of Diseases ICD-10 (diagnosis codes /.) is diffuse small-focal cardiosclerosis, a synonym for which, according to the requirements of the ICD-10, is “atherosclerotic heart disease” with code I25. 1. Replacing a digit with a letter in the ICD-10 code increased the number of three-digit rubrics from 999 to 2600, diseases: Postinfarction cardiosclerosis Hypertensive disease Postinfarction cardiosclerosis H2B (diagnostic protocols) ICD-10 code: I20.8 Other forms of angina pectoris In connection with this made it necessary to develop a unified list of ICD-10 codes for such diagnostic ¦Postinfarction cardiosclerosis¦I25.2¦ During the examination, the patient was diagnosed with coronary heart disease, postinfarction cardiosclerosis (myocardial infarction dated 12.12.94), angina pectoris, the initial cause of death should be considered postinfarction cardiosclerosis , code I25.8; well, probably, the one who sees the difference in ICD 10 between IHD deliveries first postinfarction cardiosclerosis, code I25.8 (ICD-10, vol. 1, part 1, p. 492); - code I25.2 does not apply as the initial cause of death, given by Dressler's Syndrome - code I 24.1 according to ICD-X; postinfarction angina (after 3 to 28 days) - ICD code 20.0 Focal cardiosclerosis (ICD code I 25.1

Postinfarction cardiosclerosis code micb 10

New Articles

Protocol code: 05-053

Profile: therapeutic Stage of treatment: hospital Purpose of the stage:

selection of therapy;

improvement of the general condition of the patient;

decrease in the frequency of seizures;

increased tolerance to physical activity;

reducing signs of circulatory failure.

Duration of treatment: 12 days

ICD10 code: 120.8 Other forms of angina pectoris Definition:

Angina pectoris is a clinical syndrome manifested by a feeling of tightness and pain in the chest of a compressive, pressing nature, which is most often localized behind the sternum and can radiate to the left arm, neck, lower jaw, epigastrium. The pain is provoked by physical activity, exposure to cold, heavy meals, emotional stress, disappears at rest, is eliminated by nitroglycerin within a few seconds or minutes.

Classification: IHD classification (VKNTs AMS USSR 1989)

Sudden coronary death

Angina:

angina pectoris;

first-time angina pectoris (up to 1 month);

stable angina pectoris (indicating the functional class from I to IV);

progressive angina;

rapidly progressive angina;

spontaneous (vasospastic) angina.

primary recurrent, repeated (3.1-3.2)

Focal myocardial dystrophy:

Cardiosclerosis:

postinfarction;

small-focal, diffuse.

Arrhythmic form (indicating the type of heart rhythm disorder)

Heart failure

Painless form

angina pectoris

FC (latent angina): angina attacks occur only during physical exertion of great intensity; the power of the mastered load according to the bicycle ergometric test (VEM) is 125 W, the double product is not less than 278 arb. units; the number of metabolic units is more than 7.

FC (mild angina): angina attacks occur when walking on level ground for a distance of more than 500 m, especially in cold weather, against the wind; climbing stairs more than 1 floor; emotional arousal. The power of the mastered load according to the VEM test is 75-100 W, the double product is 218-277 arb. units, the number of metabolic units 4.9-6.9. Ordinary physical activity requires little restriction.

FC (moderate angina): angina attacks occur when walking at a normal pace on level ground for a distance of 100-500 m, climbing stairs to the 1st floor. There may be rare attacks of angina at rest. The power of the mastered load according to the VEM test is 25-50 W, the double product is 151-217 arb. units; number of metabolic units 2.0-3.9. There is a marked limitation of normal physical activity.

FC (severe form): angina attacks occur with minor physical exertion, walking on level ground at a distance of less than 100 m, at rest, when the patient moves to a horizontal position. The power of the mastered load according to the VEM test is less than 25 W, the double product is less than 150 conventional units; the number of metabolic units is less than 2. Load functional tests, as a rule, are not carried out, patients have a pronounced limitation of normal physical activity.

HF is a pathophysiological syndrome in which, as a result of one or another CVS disease, there is a decrease in the pumping function of the heart, which leads to an imbalance between the hemodynamic demand of the body and the capabilities of the heart.

Risk factors: male gender, advanced age, dyslipoproteinemia, arterial hypertension, smoking, overweight, physical inactivity, diabetes mellitus, alcohol abuse.

Receipt: planned Indications for hospitalization:

decrease in the effect of received outpatient therapy;

decreased tolerance to physical activity;

decompensation.

Necessary volume of examinations before planned hospitalization:

Consultation: cardiologist;

Complete blood count (Eg, Hb, L, leukoformula, ESR, platelets);

General urine analysis;

Definition of AST

Definition of ALT

Determination of urea

Creatinine determination

echocardiography

X-ray of the chest in two projections

Ultrasound of the abdominal organs

List of additional diagnostic measures:

1. 24 hour Holter monitoring

Treatment tactics: appointment of antianginal, antiplatelet, lipid-lowering therapy, improvement of coronary blood flow, prevention of heart failure. Antianginal therapy:

β-blockers - titrate the dose of drugs under the control of heart rate, blood pressure, ECG. Nitrates are given initially by infusion and orally, followed by transition to oral nitrates only. In aerosols and sublingually, nitrates should be used as needed to relieve attacks of anginal pain. If there are contraindications to the appointment of β-blockers, it is possible to prescribe calcium antagonists. The dose is selected individually.

Antiplatelet therapy involves the appointment of aspirin to all patients, to enhance the effect, clopidogrel is prescribed.

In order to combat and prevent the development of heart failure, it is necessary to prescribe an ACE inhibitor. The dose is selected taking into account hemodynamics.

Lipid-lowering therapy (statins) is prescribed to all patients. The dose is selected taking into account the indicators of the lipid spectrum.

Diuretics are prescribed to combat and prevent the development of congestion

Cardiac glycosides - with an inotropic purpose

Antiarrhythmic drugs may be prescribed in case of rhythm disturbances. In order to improve metabolic processes in the myocardium, trimetazidine may be prescribed.

List of essential medicines:

* Heparin, solution for injection 5000IU/ml fl

Fraxiparine, solution for injection 40 - 60 mg

Fraxiparine, solution, 60mg

* Acetylsalicylic acid 100mg tab

* Acetylsalicylic acid 325 mg tab.

Clopidogrel 75 mg tab.

* Isosorbide dinitrate 0.1% 10 ml, amp

* Isosorbide dinitrate 20 mg, tab.

*Enalapril 10 mg tab.

*Amiodarone 200 mg tab.

*Furosemide 40 mg tab.

*Furosemide amp, 40 mg

*Spironolactone 100 mg tab.

*Hydrolorthiazide 25 mg tab.

Simvastatin 20 mg tab

* Digoxin 62.5 mcg, 250 mcg, tab.

* Diazepam 5 mg tab.

* Diazepam solution for injection in ampoules 10 mg/2 ml

*Cefazolin, por, d/i, 1 g, vial

Fructose diphosphate, fl

Trimetazidine 20 mg tab.

*Amlodipine 10 mg tab.

left ventricular failure;

INFORMATIONAL-METHODOLOGICAL LETTER OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION "USE OF THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND PROBLEMS RELATED TO HEALTH, TENTH REVISION (ICD-10) IN THE PRACTICE OF DOMESTIC MEDICINE"

Focal pneumonia or bronchopneumonia is predominantly a complication of some disease and therefore can only be coded if it is reported as the underlying cause of death. This is more common in pediatric practice.

Croupous pneumonia can be presented in the diagnosis as the underlying disease (initial cause of death). It is coded as J18.1 if no autopsy has been performed. In a pathoanatomical study, it should be coded as bacterial pneumonia according to the results of a bacteriological (bacterioscopic) study, in accordance with the ICD-10 code provided for the identified pathogen.

Chronic obstructive bronchitis complicated by pneumonia is coded to J44.0.

EXAMPLE 13:

Main disease:

Chronic obstructive purulent bronchitis in the acute stage. Diffuse mesh pneumosclerosis. Emphysema of the lungs. Focal pneumonia (localization). Chronic cor pulmonale. Complications: Pulmonary and cerebral edema. Concomitant diseases: Diffuse small-focal cardiosclerosis.

II. Diffuse small focal cardiosclerosis.

Initial cause of death code - J44.0

Lung abscess with pneumonia is coded to J85.1 only if the causative agent is not specified. If the causative agent of pneumonia is specified, use the appropriate one from codes J10-J16.

Maternal death is defined by WHO as the death of a woman during or within 42 days of pregnancy from any cause related to, aggravated by, or managed by the pregnancy, and not from an accident or accidental cause. When coding maternal deaths, class 15 codes are used, subject to the exceptions indicated at the beginning of the class.

EXAMPLE 14:

Main disease: Massive atonic bleeding (blood loss - 2700 ml) in the early postpartum period during childbirth at 38 weeks of gestation: exfoliating hemorrhages of the myometrium, gaping of the uterine - placental arteries.

Operation - Extirpation of the uterus (date).

Background disease: Primary weakness of labor activity. Prolonged childbirth.

Complications: Hemorrhagic shock. DIC-syndrome: massive hematoma in the tissue of the small pelvis. Acute anemia of parenchymal organs.

II. Primary weakness of labor activity. The gestation period is 38 weeks. Childbirth (date). Operation: extirpation of the uterus (date).

It is unacceptable to write down generalizing concepts as the main disease - OPG - preeclampsia (edema, proteinuria, hypertension). The diagnosis should clearly indicate the specific nosological form to be coded.

EXAMPLE 15:

Main disease: Eclampsia in the postpartum period, convulsive form (3 days after the first urgent delivery): multiple necrosis of the liver parenchyma, cortical necrosis of the kidneys. Subarachnoid hemorrhage on the basal and lateral surface of the right hemisphere of the brain. Complications: Edema of the brain with dislocation of its trunk. Bilateral small-focal pneumonia of 7-10 lung segments. Concomitant disease: Bilateral chronic pyelonephritis in remission.

II. The gestation period is 40 weeks. Childbirth (date).

Bilateral chronic pyelonephritis.

EXAMPLE 16:

Main disease: Criminal incomplete abortion at the 18th week of pregnancy, complicated by septicemia (in the blood - Staphylococcus aureus). Complications: Infectious - toxic shock.

II. The gestation period is 18 weeks.

Since the concept of "Maternal death" in addition to deaths directly related to obstetric causes, also includes deaths as a result of a pre-existing disease or a disease that developed during pregnancy, aggravated by the physiological effects of pregnancy, categories O98, O99 are used to code such cases.

EXAMPLE 17:

II. Pregnancy 28 weeks.

Initial cause of death code - O99.8

Cases of maternal death from HIV disease and obstetric tetanus are coded in the 1st class codes: B20-B24 (HIV disease) and A34 (Obstetrical tetanus). Such cases are included in maternal mortality rates. According to WHO, deaths directly attributable to obstetric causes include death not only from obstetric complications of pregnancy, childbirth and the puerperium, but also death from interventions, omissions, maltreatment, or a chain of events arising from any of these reasons. The code O75.4 is used to code the cause of maternal death in case of gross medical errors recorded in the autopsy protocols (transfusion of other group or overheated blood, administration of a drug by mistake, etc.).

EXAMPLE 18:

Main disease: Incompatibility of transfused blood after spontaneous delivery at 39 weeks of gestation. Complications: Post-transfusion toxic shock, anuria. Acute renal failure. Toxic damage to the liver. Concomitant diseases: Anemia of pregnant women.

II. Anemia in pregnancy. Pregnancy 38 weeks. Childbirth (date).

Initial cause of death - O75.4

If the cause of death was injury, poisoning, or some other consequences of external causes, two codes are affixed to the death certificate. The first of these, identifying the circumstances of the occurrence of fatal injury, refers to the codes of the 20th class - (V01-Y89). The second code characterizes the type of damage and refers to class 19.

When more than one type of injury is mentioned in the same area of the body and there is no clear indication of which was the main cause of death, the one that is more severe in nature, complications and more likely to die should be coded, or, in the case of the equivalence of injuries, the one mentioned by the attending physician first.

In cases where injuries involve more than one area of the body, coding should be done under the appropriate rubric of the Injuries affecting multiple areas of the body block (T00-T06). This principle is used both for injuries of the same type, and for various types of injuries in different areas of the body.

EXAMPLE 19:

Primary disease: Fracture of the base of the skull. Hemorrhage in the IV ventricle of the brain. Prolonged coma. Fracture of the diaphysis of the left femur. Multiple bruises of the chest. Circumstances of injury: traffic accident, bus collision with a pedestrian on the highway.

II. Fracture of the diaphysis of the left femur. Multiple bruises of the chest. Both codes are affixed to the death certificate.

3. RULES FOR CODING PERINATAL DEATH

The medical certificate of perinatal death includes 5 sections for recording causes of death, labeled with the letters "a" through "e". In lines "a" and "b" diseases or pathological conditions of the newborn or fetus should be entered, with one, the most important, recorded in line "a", and the rest, if any, in line "b". By "most important" is meant the pathological condition that, in the opinion of the person completing the certificate, made the greatest contribution to the death of the child or fetus. In lines "c" and "d" should be recorded all diseases or conditions of the mother, which, in the opinion of the person filling out the document, had any adverse effect on the newborn or fetus. And in this case, the most important of these states should be written in line "c", and the others, if any, in line "d". Line "e" is provided to record other circumstances that contributed to the death, but which cannot be characterized as an illness or pathological condition of the child or mother, for example, delivery in the absence of the birth attendant.

Each state recorded in lines "a", "b", "c" and "d" should be coded separately.

Conditions of the mother affecting the newborn or fetus recorded in lines "c" and "d" need to be coded as P00-P04 only. It is unacceptable to encode them with headings of the 15th grade.

The fetal or neonatal conditions recorded in (a) may be coded to any category other than P00-P04, but in most cases P05-P96 (Perinatal conditions) or Q00-Q99 (Congenital malformations) should be used.

EXAMPLE 20:

Primigravida 26 years. The pregnancy proceeded with asymptomatic bacteriuria. No other health problems were noted. At the 34th week of pregnancy, fetal growth retardation was diagnosed. A living boy weighing 1600 g was removed by caesarean section. The placenta weighing 300 g was characterized as infarcted. The child was diagnosed with respiratory distress syndrome. Death of the child on the 3rd day. An autopsy revealed extensive pulmonary hyaline membranes and massive intraventricular hemorrhage, which was regarded as non-traumatic.

Medical certificate of perinatal death:

a) Intraventricular hemorrhage due to hypoxia of the 2nd degree - P52.1

b) Respiratory distress - syndrome P22.0

c) Placental insufficiency - P02.2

d) Bacteriuria during pregnancy P00.1

e) Delivery by caesarean section at 34 weeks of gestation.

If no cause of death is recorded on either line a or line b, use F95 (Fetal death of unspecified cause) for stillbirths or P96.9 (Perinatal condition, unspecified) for cases of early neonatal death.

If there is no entry in either line "c" or line "d", it is necessary to put down some artificial code (for example, xxx) in line "c" to emphasize the absence of information about the mother's health.

Categories F07.- (Disorders associated with short pregnancy and low birth weight NEC) and F08.- (Disorders associated with long pregnancy and high birth weight) are not used if any other cause of death is reported in the perinatal period.

4. CODING INCIDENCE

Incidence data are increasingly being used in the development of health programs and policies. On their basis, monitoring and evaluation of public health is carried out, epidemiological studies identify population groups at increased risk, and study the frequency and prevalence of individual diseases.

In our country, morbidity statistics in outpatient clinics are based on a record of all diseases that a patient has, so each of them is subject to coding.

The statistics of hospitalized morbidity as opposed to outpatient - polyclinic is based on the analysis of morbidity for a single cause. That is, the main disease state for which treatment or examination was carried out during the corresponding episode of the patient's stay in the hospital is subject to statistical accounting at the state level. The underlying condition is defined as the condition diagnosed at the end of the care episode for which the patient was primarily treated or investigated, and which accounted for the largest share of resources used.

In addition to the underlying condition, the statistical document should list other conditions or problems that occurred during the episode of care. This makes it possible, if necessary, to analyze the incidence of multiple causes. But such an analysis is carried out periodically according to methods comparable in international and domestic practice, with their adaptation to specific working conditions, since there are no general rules for its implementation yet.

Registration in the statistical card of the patient who left the hospital not only the “main condition”, but also concomitant conditions and complications, also helps the person conducting the coding to choose the most appropriate ICD code for the main condition.

Each diagnostic formulation should be as informative as possible. It is unacceptable to formulate a diagnosis in such a way that information is lost that allows you to identify the disease state as accurately as possible.

For example, the formulation of the diagnosis "Allergic reaction to a food product" does not make it possible to use a code that is adequate to the existing condition. Here it is necessary to clarify what exactly this reaction manifested itself in, since codes for its designation can be used even from different classes of diseases:

anaphylactic shock - T78.0

angioedema - T78.3

other manifestation - T78.1

food dermatitis L27.2

allergic contact dermatitis due to contact with food on the skin - L23.6

If the medical visit is related to treatment or examination for the residual effects (consequences) of a disease that is currently absent, it is necessary to describe in detail what this consequence is expressed, while clearly noting that the original disease is currently absent. Although, as mentioned above, the ICD-10 provides for a number of rubrics for coding “consequences. “, in morbidity statistics, in contrast to mortality statistics, the code of the nature of the consequence itself should be used as the code for the “main condition”. For example, left-sided paralysis of the lower limb, as a result of a cerebral infarction suffered a year and a half ago. Code G83.1

Rubrics provided for coding “consequences. » can be used in cases where there are a number of different specific manifestations of the consequences and none of them dominates in severity and in the use of resources for treatment. For example, the diagnosis of "residual effects of a stroke", exposed to the patient in the case when there are multiple residual effects of the disease, and treatment or examinations are not carried out mainly for one of them, is coded under heading I69.4.

If a patient suffering from a chronic disease has an acute exacerbation of the existing condition, which caused his urgent hospitalization, the code of the acute condition of this nosology is selected as the "main" disease, unless the ICD has a special rubric intended for a combination of these conditions.

For example: Acute cholecystitis (requiring surgical intervention) in a patient with chronic cholecystitis.

Code acute cholecystitis K81.0 as "underlying condition".

The code for chronic cholecystitis (K81.1) may be used as an optional additional code.

For example: Exacerbation of chronic obstructive bronchitis.

Code exacerbated chronic obstructive pulmonary disease J44.1 as the "main condition" because the ICD-10 provides the appropriate code for this combination.

The clinical diagnosis established by the patient upon discharge from the hospital, as well as in the case of death, as mentioned above, should be clearly categorized, namely, presented in the form of clear three sections: underlying disease, complications (of the underlying disease), concomitant diseases. By analogy with the sections of clinical diagnosis, the statistical card of the patient who left the hospital is also represented by three cells. However, being a purely statistical document, it is not intended to copy the entire clinical diagnosis into it. That is, the entries in it should be informative, directed in accordance with the objectives of the subsequent development of the primary material.

Because of this, in the column “main disease”, the doctor must indicate the main condition, for which, during this episode of medical care, medical and diagnostic procedures were mainly carried out, i.e. the base state to be encoded. However, in practice this often does not happen, especially when the diagnosis includes not one, but several nosological units that make up a single group concept.

The first word of this diagnosis is coronary artery disease. This is the name of the block of diseases coded by headings I20-I25. When translating the name of the block, a mistake was made and in the English original it is called not coronary heart disease, but coronary heart disease, which is different from ICD-9. Thus, coronary heart disease has already become a group concept, like, for example, cerebrovascular disease, and in accordance with ICD-10, the formulation of the diagnosis should begin with a specific nosological unit. In this case, it is a chronic aneurysm of the heart - I25.3 and this diagnosis should be recorded in the statistical card of the patient who left the hospital as follows:

An entry in the statistical card of a person who left the hospital should not be overloaded with information about diseases that the patient has, but not related to this episode of medical care.

It is unacceptable to fill out a statistical document as shown in example 22.

The statistical card of the departed from the hospital filled in this way should not be accepted for development. The medical statistician, unlike the attending physician, cannot independently determine the underlying disease for which treatment or examination was carried out and which accounted for the largest part of the resources used, that is, select the disease for coding for a single reason.

The statistician can only assign (or recheck) a code that is adequate to the condition, which is determined by the attending physician as the main one. In this case, it is unstable angina pectoris I20.0, and the diagnosis should have been recorded in the card of the patient who left the hospital as follows:

Various types of cardiac arrhythmias are not coded, as they are manifestations of coronary heart disease.

Hypertension in the presence of coronary artery disease mainly acts as a background disease. In the event of death, it must always be indicated only in the II part of the medical certificate of death. In the case of an episode of inpatient treatment, it can be used as the main diagnosis if it was the main reason for hospitalization.

Underlying disease code I13.2.

Acute myocardial infarction lasting 4 weeks (28 days) or less, occurring for the first time in the patient's life, is coded I21.

Repeated acute myocardial infarction in the life of a patient, regardless of the length of the period that has passed since the first disease, is encoded by I22.

The entry of the final diagnosis in the statistical card of the person who left the hospital should not begin with a group concept of the Dorsopathy type, since it is not subject to coding, since it covers a whole block of three-digit headings M40 - M54. For the same reason, it is incorrect to use the group concept of OCG - preeclampsia in statistical accounting documents, since it covers a block of three-digit headings O10-O16. The diagnosis should clearly indicate the specific nosological form to be coded.

The formulation of the final clinical diagnosis with an emphasis on the etiology of the occurrence of the disorder leads to the fact that the statistics of hospitalized morbidity include not specific conditions that were the main reason for inpatient treatment and examination, but the etiological cause of these disorders.

Main disease: Dorsopathy. Osteochondrosis of the lumbar spine L5-S1 with exacerbation of chronic lumbosacral sciatica.

With such an incorrect formulation of the diagnosis in the statistical chart of the person who left the hospital, filled in for a patient who was on inpatient treatment in the neurological department, the code M42.1 may fall into the statistical development, which is not true, since the patient received treatment for exacerbation of chronic lumbar - sacral sciatica.

Lumbar - sacral sciatica on the background of osteochondrosis. Code - M54.1

Main disease: Dorsopathy. Osteochondrosis of the lumbar spine with pain syndrome. Ischialgia. Lumbarization.

Correct wording of the diagnosis:

Lumbago with sciatica on the background of osteochondrosis of the lumbar spine. Lumbarization. Code - M54.4

Thus, the first condition for improving the quality of statistical information is the correct filling of statistical records by doctors. The process of selecting a nosological unit for coding morbidity and mortality requires expert judgment and should be decided jointly with the attending physician.

5. LIST OF CODES FOR DIAGNOSTIC TERMS,

USED IN DOMESTIC PRACTICE AND

NOT REPRESENTED IN ICD-10

Currently, a significant number of diagnostic terms are used in domestic medicine that do not have clear terminological analogues in the ICD-10, which leads to their arbitrary coding in the country. Some of these terms correspond to modern domestic clinical classifications. Others are outdated terms, which, however, are still widely used in our country.

In this regard, it became necessary to develop a unified list of ICD-10 codes for such diagnostic terms in order to exclude their arbitrary coding.

The study of the practice of applying the ICD-10 in certain branches of medicine, the study of requests regarding the selection of codes in the analysis of morbidity and causes of death received from different regions of the country, made it possible to compile a list of nosologies, the coding of which caused the greatest difficulties and to select ICD-10 codes for them.

Right

It includes the right ventricle and the right atrium. This part of the heart is engaged in pumping venous blood, in which the oxygen content is low. Carbon dioxide comes here from all organs and tissues of the body.
There is a tricuspid valve on the right side of the heart that connects the atrium to the ventricle. The latter is also connected to the pulmonary artery by the valve of the same name.

The heart is located in a special bag that performs a shock-absorbing function. It is filled with fluid that lubricates the heart. The volume of the bag is usually 50 ml. Thanks to her, the heart is not subjected to friction with other tissues and works normally.

The heart works in cycles. Before contracting, the organ is relaxed. In this case, passive filling with blood occurs. Both atria then contract, pushing more blood into the ventricles. Then the atria return to a relaxed state.

The ventricles then contract, pushing blood into the aorta and pulmonary artery. After that, the ventricles relax, and the systole phase is replaced by the diastole phase.

The heart has a unique function - automatism. This organ is capable of aggregating nerve impulses without the help of external factors, under the influence of which the contraction of the heart muscle occurs. No other organ of the human body has such a function.

The pacemaker located in the right atrium is responsible for the generation of impulses. It is from there that impulses begin to flow to the myocardium through the conduction system.

The coronary arteries are one of the most important components that ensure the work and vital activity of the heart. It is they who deliver the necessary oxygen and nutrients to all heart cells.

If the coronary arteries have good patency, then the body works in a normal mode, it does not overstrain. If a person has atherosclerosis, then the heart does not work at full strength, it begins to feel a serious lack of oxygen. All this provokes the appearance of biochemical and tissue changes, which subsequently lead to the development of coronary artery disease.

Self-diagnosis

It is very important to know the symptoms of IHD. They usually appear at the age of 50 and older. It is possible to identify the presence of coronary artery disease during physical activity.

Symptoms of this disease include:

angina pectoris (pain in the center of the chest);
lack of air;
heavy breath of oxygen;
very frequent contractions of the heart muscle (over 300 times), leading to a stop in the movement of blood.

Some patients with IHD are asymptomatic. They do not even suspect the presence of an ailment when a myocardial infarction occurs.

To understand what is the likelihood of developing a disease in a patient, he should use a special cardio test “Is your heart healthy?”.

People who want to understand if they have coronary artery disease go to a cardiologist. The doctor conducts a dialogue with the patient, asking questions, the answers to which help to form a complete picture of the patient. So the specialist identifies possible symptoms, studies the risk factors for the disease. The more of these factors, the higher the probability of having coronary artery disease in a patient.

The manifestations of most of the factors can be eliminated. This helps to prevent the disease from developing, while the likelihood of complications is also reduced.

Avoidable risk factors include:

diabetes;
high blood pressure;
smoking;
elevated cholesterol.

The attending physician also examines the patient. Based on the information received, he appoints the passage of examinations. They help to come to the final diagnosis.

The methods used include:

ECG with stress test;
chest x-ray;
a biochemical blood test, including the determination of cholesterol and glucose in the blood.

The doctor, suspecting the patient has a serious lesion of the arteries, which requires urgent surgery, prescribes another type of study - coronary angiography. Next, the type of surgical intervention is determined.

It could be:

angioplasty;
coronary artery bypass grafting.

In less severe cases, medical treatment is used.

It is important that the patient turns to the doctor for help in time. The specialist will do everything so that the patient does not develop any complications.

To avoid the development of the disease, the patient must:

See a cardiologist on time	The doctor carefully monitors all available risk factors, prescribes treatment and makes timely changes if necessary.
Take prescribed medications	It is very important to follow the dosage prescribed by the doctor. In no case should you change or refuse treatment on your own.
Carry nitroglycerin with you if prescribed by your doctor	This drug may be needed at any time. It relieves pain in angina pectoris.
Lead the right lifestyle	The doctor provides details at the appointment.
Keep the attending physician up to date	Be sure to talk about pain behind the sternum and other slightest manifestations of the disease.

Preventive measures

To prevent IHD, you need to follow 3 rules:

No nicotine	Smoking is one of the risk factors for developing coronary artery disease in a patient. Especially when it is accompanied by high blood cholesterol. At the same time, do not forget that because of smoking, life is shortened by about 7 years. Due to the high content of nicotine in the blood, its density increases markedly. Platelets begin to stick together, they become less adapted to life. In the blood of a smoker, the amount of carbon monoxide increases sharply. This automatically reduces the oxygen content, which is necessary for the normal functioning of cells and the body as a whole. Nicotine, getting into the bloodstream, contributes to a spasm of the arteries, which leads to a sharp increase in blood pressure. People who are addicted to cigarettes are 2 times more likely to die from myocardial infarction. At the same time, sudden death occurs 4 times more often than in people leading a healthy lifestyle. So, one pack of cigarettes smoked increases mortality by 2 times, and mortality from coronary artery disease by 3 times. The more a person smokes, the higher the risk of developing coronary artery disease. Even the use of cigarettes with low nicotine and tar content does not reduce the risk of one of the cardiovascular diseases. Passive smokers also have a 25% higher risk of death from coronary artery disease than healthy people.
An active lifestyle is a must	To maintain your health, you need to play sports. It is physical activity that reduces the likelihood of developing coronary artery disease. To maintain the health of the body, you need to play sports at least 3 times a week for 30-45 minutes. In no case should you sharply increase the load, everywhere you need to know when to stop.
Keep your weight in check	One of the most important criteria for health is the ratio of muscle to fat. It largely depends on the metabolic rate. Excess weight always increases the number of heartbeats even at rest. At the same time, the need of muscles for oxygen and nutrients also increases. In people with obesity, lipid metabolism is also often disturbed. This contributes to the development of diseases such as diabetes mellitus, hypertension, which are risk factors for the development of coronary artery disease. If a person's body weight is higher than normal, he should resort to physical activity and proper nutrition. It is best to consult a doctor who will help you make the right diet, tell you which foods will be useful and which will have to be excluded from the diet.

Massage for coronary heart disease

A patient with coronary artery disease can supplement the treatment with aromatherapy massage. In the room where the patient sleeps, you need to put a special lamp. It will fill the air with various aromas of oils. Lavender, mandarin, ylang-ylang, lemon balm are best suited.

Chest massage does not need to be done every day, it should be episodic. Instead of massage oil, you need to use peach, corn or olive oil.

A tablespoon of any of them is mixed with one of the following formulations (1 drop of each ingredient):

oils of geranium, marjoram and frankincense;
neroli, ginger and bergamot oils;
oils of clary sage, bergamot and ylang-ylang.

Massage should be done by first applying the resulting mixture to the left pectoral muscle and on top of it. Movements should be light, smooth, without strong pressure.

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