Classification of IBS
Cardiovascular disease is the leading cause of death in the developed world. They are guilty in about 30% of deaths worldwide. Of these, about 44% of deaths are due to coronary heart disease.
Although cardiovascular diseases have traditionally been considered the lot of the developed countries, their distribution is gradually reduced in the improved prevention, diagnosis and treatment, and changes in lifestyle (e.g., reducing Smoking). In developing countries the prevalence of cardiovascular diseases is growing rapidly, this is due to urbanization and adoption of Western culture.
What is coronary heart disease?
Coronary heart disease (CHD) is a group of diseases which are caused by restriction of blood supply to the myocardium. The heart is an aerobic organ that is highly dependent on revenues in its cells of oxygen. Oxygen enters the myocardium from the blood that is delivered to the heart via the coronary arteries.
Atherosclerosis of the coronary arteries reduces the lumen, in connection with which restricted blood flow to the heart. In the initial stages of atherosclerosis the myocardium enough oxygen at rest. During exercise a certain intensity the need of cardiac muscle for oxygen increases and the coronary arteries are unable to deliver its optimal number, causing symptoms of ischemia. The more narrowed the artery is, the less physical activity is needed for the occurrence of the clinical picture.
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Classification of IBS
As mentioned, IBS is a group of diseases that share the same mechanism of development, an insufficient supply of oxygen to the tissues of the heart. Modern medicine divides this group into two parts, chronic and acute coronary artery disease. Chronic ischemic heart disease includes:
- Stable angina – a form of ischemic heart disease, which is manifested by the development of pain or discomfort in your chest during physical activity or emotional stress. In stable angina in humans there is a threshold of intensity beyond which develops the clinical picture of the disease. This threshold allowable load of different people is different, it is usually quite stable. After the cessation of physical activity, the pain usually goes away.
- Silent ischemia – in this form of IBS deterioration of blood supply to the myocardium leads to the development of disease symptoms. Quite often, this syndrome develops in patients with diabetes. Patients with silent ischemia have a worse prognosis compared with those with stable angina.
The acute form of ischemic heart disease called acute coronary syndrome (ACS), which is divided into two types – with ST-segment elevation and without ST-segment elevation on the electrocardiogram. This section has practical importance for choice of tactics of treatment in ACS with ST elevation it is more aggressive and intense.
ACS includes the following diseases:
- Unstable angina. Angina is considered unstable if the clinical picture progresses (for example, symptoms become heavier and appear when the levels of physical exertion that previously well tolerated) if her symptoms first appeared (such angina is considered unstable for months) and when the pain or discomfort develops at rest or during sleep.
- Myocardial infarction is a severe form of IHD, in which due to a sharp deterioration of the blood supply to the heart is dying a certain amount of myocardium. As a rule, it happens suddenly when a coronary artery is completely covered by the thrombus formed on a ruptured atherosclerotic plaque. There are two types of myocardial infarction with pathological Q-wave and without pathological Q wave on the ECG. The presence of pathological Q wave indicates a large size of the hearth of the lost myocardium.
- Sudden coronary death which occurs due to the abrupt cessation of circulation of the heart and it stops. As a rule, at the time of overlapping of the coronary artery occurs a fatal arrhythmia, which leads to death.
The main changes in the classification of IBS recently touched its sharp shape. This is due to the need for quick choice of treatment by a physician. In ACS with ST elevation needs immediate restoration of blood flow in the affected coronary artery, thus preserving viability of at least some of the number of cardiomyocytes. To restore blood flow is possible by introducing special drugs that dissolve the clot (thrombolytics, such as Actilyse, Metaliz, Streptokinase) or surgical interventions. There are two types of surgical interventions for CHD:
- Angioplasty and stenting of the coronary arteries is a minimally invasive procedure in which the lumen of the coronary arteries is recovered by expansion of the affected area with cylinder and (or) stent, wound through the puncture of femoral or radial artery.
- Coronary artery bypass grafting is open heart surgery, for which the necessary incision into the thorax. Surgeons create from another vessel (vein or artery) of a patient’s shunt – a bypass path that bypasses the affected coronary artery.