Atherosclerotic cardiosclerosis: clinical picture, classification, symptoms and treatment. Atherosclerotic cardiosclerosis: causes, symptoms, diagnosis and treatment of IHD

Acquired coronary arteriovenous fistula

Excludes: congenital coronary (arteries) aneurysm (Q24.5)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

IHD and atherosclerotic cardiosclerosis ICD code 10: what is it?

Cardiosclerosis is a pathological change in the structure of the heart muscle and its replacement with connective tissue, occurs after inflammatory diseases - myocarditis, infective endocarditis, after myocardial infarction. Atherosclerosis also leads to the occurrence of cardiosclerosis, pathological changes occur due to tissue ischemia and impaired blood flow. This condition occurs most often in adults or the elderly, with comorbidities such as angina pectoris and hypertension.

Atherosclerotic cardiosclerosis develops as a result of a combination of several factors, such as dietary disorders - the predominance of foods rich in fats and cholesterol and a decrease in vegetables and fruits in the diet, reduced physical activity and sedentary work, smoking and alcohol abuse, regular stress, family tendency to cardiovascular disease. systems.

Men are more prone to developing atherosclerosis, since female sex hormones, such as estrogen, have a protective effect on the walls of blood vessels and prevent the formation of plaques. Women have coronary heart disease and hyperlipidemia, but after 45 - 50 years after menopause. These factors lead to spasm and narrowing of the lumen of the coronary vessels, ischemia and hypoxia of myocytes, their degeneration and atrophy.

Against the background of a lack of oxygen, fibroblasts are activated, forming collagen and elastic fibers instead of destroyed heart muscle cells. Gradually altered muscle cells are replaced by connective tissue, which does not perform contractile and conductive functions. As the disease progresses, more and more muscle fibers atrophy and deform, leading to the development of compensatory left ventricular hypertrophy, life-threatening arrhythmias such as ventricular fibrillation, chronic cardiovascular failure, and circulatory failure.

Classification of atherosclerosis and ischemic heart disease according to ICD 10

Atherosclerotic cardiosclerosis in ICD 10 is not an independent nosology, but one of the forms of coronary heart disease.

To facilitate the diagnosis in the international format, it is customary to consider all diseases according to the ICD 10 classification.

It is arranged as a reference book with alphabetic and numerical categorization, where each group of diseases is assigned its own unique code.

Diseases of the cardiovascular system are indicated by codes from I00 to I90.

Chronic ischemic heart disease, according to ICD 10, has the following forms:

1. I125.1 - Atherosclerotic disease of the coronary arteries
2. I125.2 - Past myocardial infarction, diagnosed by clinical symptoms and additional studies - enzymes (ALT, AST, LDH), troponin test, ECG.
3. I125.3 Aneurysm of the heart or aorta - ventricular or wall
4. I125.4 - Coronary artery aneurysm and dissection, acquired coronary arteriovenous fistula
5. I125.5 - Ischemic cardiomyopathy
6. I125.6 - Asymptomatic myocardial ischemia
7. I125.8 - Other forms of ischemic heart disease
8. I125.9 - Chronic ischemic heart disease, unspecified

For the localization and prevalence of the process, diffuse cardiosclerosis is also isolated - the connective tissue is located evenly in the myocardium, and cicatricial or focal - sclerotic areas are denser and located in large areas.

The first type occurs after infectious processes or due to chronic ischemia, the second - after myocardial infarction at the site of necrosis of the muscle cells of the heart.

Both of these types of damage can occur simultaneously.

Clinical manifestations of the disease

Symptoms of the disease appear only with significant obliteration of the lumen of the vessels and myocardial ischemia, depending on the spread and localization of the pathological process.

The first manifestations of the disease are short pains behind the sternum or a feeling of discomfort in this area after physical or emotional stress, hypothermia. The pain is squeezing, aching or stabbing in nature, accompanied by general weakness, dizziness, cold sweat can be observed.

Sometimes the patient's pain radiates to other areas - to the left shoulder blade or arm, shoulder. The duration of pain in coronary heart disease is from 2-3 minutes to half an hour, it subsides or stops after rest, taking Nitroglycerin.

With the progression of the disease, symptoms of heart failure are added - shortness of breath, swelling of the legs, cyanosis of the skin, cough in acute left ventricular failure, enlarged liver and spleen, tachycardia or bradycardia.

Shortness of breath often occurs after physical and emotional stress, in a supine position, decreases at rest, sitting. With the development of acute left ventricular failure, shortness of breath increases, a dry, painful cough joins it.

Edema is a symptom of decompensation of heart failure, occurs when the venous vessels of the legs are overfilled with blood and a decrease in the pumping function of the heart. At the beginning of the disease, edema is observed only in the feet and legs, with progression they spread higher, and can even be localized on the face and in the chest, pericardial, and abdominal cavities.

There are also symptoms of ischemia and hypoxia of the brain - headaches, dizziness, tinnitus, fainting. With a significant replacement of the myocytes of the conduction system of the heart with connective tissue, conduction disturbances can occur - blockade, arrhythmias.

Subjectively, arrhythmias can be manifested by sensations of interruptions in the work of the heart, premature or late contractions, and a feeling of palpitations. Against the background of cardiosclerosis, conditions such as tachycardia or bradycardia, blockades, atrial fibrillation, extrasystoles of atrial or ventricular localization, and ventricular fibrillation may occur.

Cardiosclerosis of atherosclerotic genesis is a slowly progressive disease that can occur with exacerbations and remissions.

Methods for diagnosing cardiosclerosis

Diagnosis of the disease consists of anamnestic data - the time of onset of the disease, the first symptoms, their nature, duration, diagnostics and treatment. Also, for making a diagnosis, it is important to find out the patient's history of life - past illnesses, operations and injuries, family susceptibility to illness, the presence of bad habits, lifestyle, professional factors.

Clinical symptoms are the main ones in the diagnosis of atherosclerotic cardiosclerosis, it is important to clarify the prevailing symptoms, the conditions for their occurrence, and the dynamics throughout the disease. Supplement the information obtained with laboratory and instrumental research methods.

Use additional methods:

• General analysis of blood and urine - with a mild course of the disease, these tests will not be changed. In severe chronic hypoxia, a decrease in hemoglobin and erythrocytes, an increase in COE are observed in the blood test.
• A blood test for glucose, a test for glucose tolerance - there are deviations only with concomitant diabetes mellitus and impaired glucose tolerance.
• Biochemical blood test - determine the lipid profile, with atherosclerosis, total cholesterol, low and very low density lipoproteins, triglycerides will be elevated, high density lipoproteins will be reduced.

This test also determines liver and kidney tests, which may indicate damage to these organs during prolonged ischemia.

Additional instrumental methods

X-ray of the chest organs - makes it possible to determine cardiomegaly, deformity of the aorta, aneurysms of the heart and blood vessels, congestion in the lungs, their edema. development of collaterals. Dopplerography of blood vessels, or triplex scanning, is performed using ultrasonic waves, which allows you to determine the nature of blood flow and the degree of obstruction.

Be sure to carry out electrocardiography - it determines the presence of arrhythmias, hypertrophy of the left or right ventricle, systolic overload of the heart, the onset of myocardial infarction. Ischemic changes are visualized on the electrocardiogram by a decrease in the voltage (size) of all teeth, depression (decrease) of the ST segment below the isoline, negative T wave.

Complements the ECG echocardiographic study, or ultrasound of the heart - determines the size and shape, myocardial contractility, the presence of immovable areas, calcifications, the functioning of the valve system, inflammatory or metabolic changes.

The most informative method for diagnosing any pathological processes is scintigraphy - a graphic image of the accumulation of contrasts or labeled isotopes by the myocardium. Normally, the distribution of the substance is uniform, without areas of increased or decreased density. Connective tissue has a reduced ability to capture contrast, and sclerosing areas are not visualized on the image.

Magnetic resonance scanning and multislice computed tomography remain the methods of choice for diagnosing vascular lesions in any area. Their advantage lies in their great clinical significance, the ability to display the exact localization of the obstruction.

In some cases, for a more accurate diagnosis, hormonal tests are performed, for example, to determine hypothyroidism or Itsenko-Cushing's syndrome.

Treatment of coronary heart disease and cardiosclerosis

Treatment and prevention of coronary artery disease begins with lifestyle changes - adherence to a hypocaloric balanced diet, giving up bad habits, physical education or exercise therapy.

The diet for atherosclerosis is based on a dairy-vegetarian diet, with a complete rejection of fast food, fatty and fried foods, semi-finished products, fatty meats and fish, confectionery, chocolate.

Mostly consumed products are sources of fiber (vegetables and fruits, cereals and legumes), healthy unsaturated fats (vegetable oils, fish, nuts), cooking methods - boiling, baking, stewing.

Drugs used for high cholesterol and coronary artery disease - nitrates to relieve angina attacks (Nitroglycerin, Nitro-long), antiplatelet agents for the prevention of thrombosis (Aspirin, Thrombo Ass), anticoagulants in the presence of hypercoagulation (Heparin, Enoxiparin), ACE inhibitors for hypertension (Enalapril , Ramipril), diuretics (Furosemide, Veroshpiron) - to relieve swelling.

Statins (Atorvastatin, Lovastatin) or fibrates, nicotinic acid are also used to prevent hypercholesterolemia and progression of the disease.

For arrhythmias, antiarrhythmic drugs (Verapamil, Amiodarone), beta-blockers (Metoprolol, Atenolol) are prescribed, for the treatment of chronic heart failure - cardiac glycosides (Digoxin).

About cardiosclerosis is described in the video in this article.

Atherosclerotic cardiosclerosis: clinic, treatment and coding in ICD-10

Cardiosclerosis is a pathological process associated with the formation of fibrous tissue in the heart muscle. This is facilitated by myocardial infarction, acute infectious and inflammatory diseases, atherosclerosis of the coronary arteries.

Cardiosclerosis of atherosclerotic genesis is caused by a violation of lipid metabolism with the deposition of cholesterol plaques on the intima of elastic-type vessels. In the continuation of the article, the causes, symptoms, treatment of atherosclerotic cardiosclerosis and its classification according to ICD-10 will be considered.

Classification Criteria

At the same time, it is customary to consider all nosologies according to the international classification of diseases of the tenth revision (ICD-10). This directory is divided into headings, where each pathology is assigned a numerical and letter designation. The grading of the diagnosis is as follows:

• I00-I90 - diseases of the circulatory system.
• I20-I25 - ischemic heart disease.
• I25 - chronic ischemic heart disease.
• I25.1 Atherosclerotic heart disease

Etiology

As mentioned above, the main cause of the pathology is a violation of fat metabolism.

Due to atherosclerosis of the coronary arteries, the lumen of the latter narrows, and signs of atrophy of myocardial fibers appear in the myocardium with further necrotic changes and the formation of scar tissue.

This is also accompanied by the death of receptors, which increases myocardial oxygen demand.

Such changes contribute to the progression of coronary disease.

It is customary to single out the factors leading to impaired cholesterol metabolism, which are:

1. Psycho-emotional overload.
2. Sedentary lifestyle.
3. Smoking.
4. Increased blood pressure.
5. Irrational nutrition.
6. Overweight.

Clinical picture

Clinical manifestations of atherosclerotic cardiosclerosis are characterized by the following symptoms:

1. Violation of the coronary blood flow.
2. Heart rhythm disorder.
3. Chronic circulatory failure.

Violation of coronary blood flow is manifested by myocardial ischemia. Patients feel pain behind the sternum of a aching or pulling nature with irradiation to the left arm, shoulder, lower jaw. Less commonly, pain sensations are localized in the interscapular region or radiate to the right upper limb. Anginal attack is provoked by physical activity, psycho-emotional reaction, and as the disease progresses, it also occurs at rest.

You can stop the pain with the help of nitroglycerin preparations. In the heart there is a conducting system, thanks to which a constant and rhythmic contractility of the myocardium is ensured.

The electrical impulse moves along a certain path, gradually covering all departments. Sclerotic and cicatricial changes are an obstacle to the propagation of the wave of excitation.

As a result, the direction of movement of the impulse changes and the contractile activity of the myocardium is disturbed.

Patients with atherosclerotic atherosclerosis are concerned about such types of arrhythmia as extrasystole, atrial fibrillation, blockade.

IHD and its nosological form Atherosclerotic cardiosclerosis has a slowly progressive course, and patients may not feel any symptoms for many years.

However, all this time irreversible changes occur in the myocardium, which ultimately leads to chronic heart failure.

In case of stagnation in the pulmonary circulation, shortness of breath, cough, orthopnea are noted. With stagnation in the systemic circulation, nocturia, hepatomegaly, and swelling of the legs are characteristic.

Therapy

Treatment of atherosclerotic cardiosclerosis involves lifestyle changes and the use of medications. In the first case, it is necessary to focus on activities aimed at eliminating risk factors. To this end, it is necessary to normalize the mode of work and rest, reduce weight in case of obesity, do not avoid dosed physical activity, and follow a hypocholesterol diet.

In case of ineffectiveness of the above measures, drugs are prescribed that contribute to the normalization of lipid metabolism. Several groups of drugs have been developed for this purpose, but statins are more popular.

The mechanism of their action is based on the inhibition of enzymes involved in the synthesis of cholesterol. The latest generation of drugs also contribute to an increase in the level of high-density lipoproteins, or, more simply, “good” cholesterol.

Another important property of statins is that they improve the rheological composition of the blood. This prevents the formation of blood clots and avoids acute vascular accidents.

Morbidity and mortality from cardiovascular pathology is growing every year, and any person should have an idea about such a nosology and the correct methods of correction.

What is atherosclerotic cardiosclerosis - causes, symptoms and treatment

The disease atherosclerotic cardiosclerosis is a serious disorder that is associated with changes in the muscle tissue of the myocardium. The disease is characterized by the formation of cholesterol plaques on the walls of veins and arteries, which increase in size and, in severe cases, begin to interfere with normal blood circulation in the organs. Often other diseases of the cardiovascular system become the cause of atherosclerotic cardiosclerosis.

What is atherosclerotic cardiosclerosis

The medical term "cardiosclerosis" refers to a severe disease of the heart muscle associated with the process of diffuse or focal proliferation of connective tissue in the muscle fibers of the myocardium. There are varieties of the disease at the place of formation of disorders - aortocardiosclerosis and coronary cardiosclerosis. The disease is characterized by a slow spread with a long course.

Atherosclerosis of the coronary arteries, or stenosing coronary sclerosis, causes serious metabolic changes in the myocardium and ischemia. Over time, muscle fibers atrophy and die, coronary heart disease worsens due to a decrease in excitation of impulses and rhythm disturbances. Cardiosclerosis often affects older or middle-aged men.

Note!

Fungus won't bother you anymore! Elena Malysheva tells in detail.

Elena Malysheva - How to lose weight without doing anything!

ICD-10 code

According to the tenth International Classification of Diseases (ICD 10), which helps to identify the diagnosis in the medical history and choose the treatment, there is no exact code for atherosclerotic cardiosclerosis. Doctors use the code I 25.1, meaning atherosclerotic heart disease. In some cases, the designation 125.5 - ischemic cardiomyopathy or I20-I25 - ischemic heart disease is used.

Symptoms

For a long time, atherosclerotic cardiosclerosis may not be detected. Symptoms in the form of discomfort are often mistaken for a simple malaise. If the signs of cardiosclerosis begin to bother you regularly, you should consult a doctor. The following symptoms serve as the reason for the appeal:

• weakness, decreased performance;
• shortness of breath that occurs during rest;
• pain in the epigastrium;
• cough without signs of a cold, accompanied by pulmonary edema;
• arrhythmia, tachycardia;
• acute pain in the sternum, radiating to the left forearm, arm or shoulder blade;
• increased anxiety.

A rare sign of atherosclerotic cardiosclerosis is a slight enlargement of the liver. The clinical picture of the disease is difficult to determine, guided only by the patient's feelings, they are similar to the symptoms of other diseases. The difference lies in the fact that over time, the progression of seizures develops, they begin to appear more often, be of a regular nature. In patients with atherosclerotic plaques in the post-infarction state, the likelihood of recurrent complications is high.

Causes of atherosclerotic cardiosclerosis

The main cause of atherosclerotic cardiosclerosis is the appearance of scars, a violation of the full blood flow to the heart. Atherosclerotic, or fatty plaques increase in size, block sections of blood vessels and pose a serious threat to the patient. Due to insufficient intake of nutrients, increased blood lipids, proliferation of pathological connective tissue, the size of the heart increases, a person begins to feel the growing symptoms of the disease.

This change is influenced by internal factors caused by other diseases in the body, and external factors due to the wrong way of life of a person. The list of possible reasons includes:

• bad habits - smoking, drinking alcohol, drugs;
• wrong daily routine;
• various diseases of the cardiovascular system;
• increased physical activity;
• eating fatty foods containing cholesterol;
• sedentary lifestyle;
• excess weight;
• hypercholesterolemia;
• arterial hypertension;
• hereditary factors.

It was noted that in women before the onset of menopause, atherosclerotic cardiosclerosis occurs less frequently than in men. After reaching the age, the chances of hearing from the doctor the diagnosis of "atherosclerotic cardiosclerosis" are equalized. People with heart disease are at higher risk. These diseases are called both the cause and the consequence of cardiosclerosis. With the appearance of plaques in the vessels that cause oxygen starvation, the likelihood of complications increases, which can lead to the death of the patient.

Diagnostics

In order to make a diagnosis, the doctor is guided by the data of the anamnesis - the presence or absence of past heart disease and the patient's complaints. Analyzes that are prescribed to clarify the clinical picture include:

• a biochemical blood test - is needed to identify the level of cholesterol and ESR;
• urinalysis - determines the level of leukocytes;
• bicycle ergometry allows you to clarify the stage of myocardial impairment;
• ECG helps to establish the pathology of intracardiac conduction and rhythm, the presence of coronary insufficiency, left ventricular hypertrophy.

As an additional examination for atherosclerotic cardiosclerosis, daily monitoring is prescribed using echocardiography, coronary angiography, and rhythmography. At the discretion of the doctor, MRI of the heart and blood vessels, chest X-ray, ultrasound examination of the pleural and abdominal cavities is performed. A complete diagnosis contributes to the rapid choice of the right treatment.

Treatment

Methods of therapy for atherosclerotic cardiosclerosis are aimed at restoring coronary circulation, eliminating cholesterol plaques in arteries and blood vessels, as well as treating certain diseases - atrioventricular blockade, arrhythmia, heart failure, coronary artery disease, angina pectoris. For this purpose, the doctor prescribes medicines:

• acetylsalicylic acid;
• diuretics;
• statins;
• antiarrhythmic drugs;
• peripheral vasodilators;
• sedative drugs;
• nitrates.

For people who are overweight, it is obligatory to select a special diet with the replacement of fatty foods, change the daily routine, get rid of physical exertion during treatment. With the formation of an aneurysmal defect of the heart, surgical actions are indicated to remove the aneurysm. The introduction of a pacemaker will help solve the problem with rhythm disturbance.

Forecast and prevention

When compiling a further prognosis, the doctor is guided by the clinical data of the diagnostic study. In most cases, if the patient has successfully completed the treatment and follows the recommendations, then he can return to a normal life. However, among people who neglect the advice of a doctor, the mortality rate is high. After completing the course of therapy, the patient should be observed by a specialist for a long time, report any ailment.

Prevention of atherosclerotic cardiosclerosis is recommended to start at a young age if there is a genetic predisposition to the disease. Good nutrition, timely treatment of colds, the correct daily routine, the rejection of bad habits will not allow atherosclerotic changes to form in the vessels of the heart. People with a tendency to heart disease are shown to engage in physical exercises that increase endurance.

Video: atherosclerotic cardiosclerosis

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Atherosclerotic cardiosclerosis: treatment, causes, prevention

Atherosclerotic cardiosclerosis is a type of coronary heart disease, which is characterized by impaired blood supply. It develops against the background of progressive atherosclerosis in the coronary arteries of the myocardium. There is an opinion that this diagnosis is made to all persons over the age of 55 who have at least once encountered pain in the region of the heart.

What is atherosclerotic cardiosclerosis?

As such a diagnosis of "atherosclerotic cardiosclerosis" does not exist for a long time and you will not hear it from an experienced specialist. This term is usually called the consequences of coronary heart disease, in order to clarify pathological changes in the myocardium.

The disease is manifested by a significant increase in the heart, in particular, its left ventricle, and rhythm disturbances. Symptoms of the disease are similar to those of heart failure.

Before atherosclerotic cardiosclerosis develops, the patient may suffer from angina pectoris for a long time.

The disease is based on the replacement of healthy tissues in the myocardium with scar tissue, as a result of atherosclerosis of the coronary vessels. This happens due to a violation of the coronary circulation and insufficient blood supply to the myocardium - an ischemic manifestation. As a result, in the future, many foci are formed in the heart muscle, in which the necrotic process has begun.

Atherosclerotic cardiosclerosis often "coexists" with chronic high blood pressure, as well as with sclerotic damage to the aorta. Often the patient has atrial fibrillation and atherosclerosis of cerebral vessels.

How is pathology formed?

When a small cut appears on the body, we do our best to make it less noticeable after healing, but the skin will still no longer have elastic fibers in this place - scar tissue is formed. A similar situation occurs with the heart.

A scar on the heart can appear for the following reasons:

1. After suffering an inflammatory process (myocarditis). In childhood, the reason for this is past diseases, such as measles, rubella, scarlet fever. In adults - syphilis, tuberculosis. During treatment, the inflammatory process subsides and does not spread. But sometimes a scar remains after it, i.e. muscle tissue is replaced by scar tissue and is no longer able to contract. This condition is called myocardial cardiosclerosis.
2. Be sure to scar tissue will remain after surgery performed on the heart.
3. Postponed acute myocardial infarction - a form of coronary heart disease. The resulting area of ​​necrosis is very prone to rupture, so it is very important to form a fairly dense scar with the help of treatment.
4. Atherosclerosis of blood vessels causes their narrowing, due to the formation of cholesterol plaques inside. Insufficient oxygen supply of muscle fibers leads to the gradual replacement of healthy tissues with scar tissue. This anatomical manifestation of chronic ischemic disease can be found in almost all older people.

Causes

The main reason for the development of pathology is the formation of cholesterol plaques inside the vessels. Over time, they increase in size and interfere with the normal movement of blood, nutrients and oxygen.

When the lumen becomes very small, heart problems begin. It is in a constant state of hypoxia, as a result, coronary heart disease develops, and then atherosclerotic cardiosclerosis.

Being in this state for a long time, muscle tissue cells are replaced by connective tissue, and the heart stops beating properly.

Risk factors that provoke the development of the disease:

• genetic predisposition;
• Gender identity. Men are more susceptible to the disease than women;
• age criterion. The disease develops more often after the age of 50 years. The older the person, the higher the formation of cholesterol plaques and, as a result, coronary disease;
• The presence of bad habits;
• Lack of physical activity;
• Improper nutrition;
• Overweight;
• The presence of concomitant diseases, as a rule, is diabetes mellitus, renal failure, hypertension.

There are two forms of atherosclerotic cardiosclerosis:

• Diffuse small focal;
• Diffuse macrofocal.

In this case, the disease is divided into 3 types:

• Ischemic - occurs as a consequence of prolonged fasting due to lack of blood flow;
• Post-infarction - occurs at the site of tissue affected by necrosis;
• Mixed - for this type, the two previous signs are characteristic.

Symptoms

Atherosclerotic cardiosclerosis is a disease that has a long course, but without proper treatment is steadily progressing. In the early stages, the patient may not feel any symptoms, so you can only notice abnormalities in the work of the heart on the ECG.

With age, the risk of vascular atherosclerosis is very high, therefore, even without a previous myocardial infarction, one can assume the presence of many small scars in the heart.

• First, the patient notes the appearance of shortness of breath, which appears during exercise. With the development of the disease, it begins to disturb a person even while walking slowly. The person begins to experience increased fatigue, weakness and is unable to quickly perform any actions.
• There are pains in the region of the heart, which intensify at night. Typical attacks of angina pectoris are not excluded. Pain radiates to the left collarbone, shoulder blade or arm.
• Headaches, congestion and tinnitus indicate that the brain is experiencing oxygen starvation.
• Disturbed heart rhythm. Tachycardia and atrial fibrillation are possible.

Diagnostic methods

The diagnosis of atherosclerotic cardiosclerosis is made on the basis of the collected anamnesis (earlier myocardial infarction, the presence of coronary heart disease, arrhythmia), the symptoms and data obtained using laboratory tests.

1. The patient undergoes an ECG, where signs of coronary insufficiency, the presence of scar tissue, heart rhythm disturbance, left ventricular hypertrophy can be determined.
2. A biochemical blood test is performed, which reveals hypercholesterolemia.
3. Echocardiography data indicate violations of myocardial contractility.
4. Bicycle ergometry shows the degree of myocardial dysfunction.

For a more accurate diagnosis of atherosclerotic cardiosclerosis, the following studies can be performed: daily ECG monitoring, MRI of the heart, ventriculography, ultrasound of the pleural cavities, ultrasound of the abdominal cavity, chest x-ray, rhythmocardiography.

Treatment

There is no such treatment for atherosclerotic cardiosclerosis, because damaged tissue cannot be restored. All therapy is aimed at relieving symptoms and exacerbations.

Some drugs are prescribed to the patient for life. Be sure to prescribe drugs that can strengthen and expand the walls of blood vessels. If there are indications, an operation can be performed, during which large plaques on the vascular walls will be eliminated. The basis of treatment is proper nutrition and moderate exercise.

Disease prevention

In order to prevent the development of the disease, it is very important to start monitoring your health on time, especially if there have already been cases of atherosclerotic cardiosclerosis in the family history.

Primary prevention is proper nutrition and prevention of overweight. It is very important to exercise daily, not lead a sedentary lifestyle, visit a doctor regularly and monitor blood cholesterol levels.

Secondary prevention is the treatment of diseases that can provoke atherosclerotic cardiosclerosis. In the case of diagnosing the disease at the initial stages of development and subject to the implementation of all the doctor's recommendations, cardiosclerosis may not progress and will allow a person to lead a full life.

PROFILE COMMISSION FOR THE SPECIALTY "PATHOLOGICAL ANATOMY" OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

RUSSIAN SOCIETY OF PATHOLOGISTS

FSBI "RESEARCH INSTITUTE OF HUMAN MORPHOLOGY"

SBEE DPO "RUSSIAN MEDICAL ACADEMY OF POSTGRADUATE EDUCATION" MINISTRY OF HEALTH OF RUSSIA

Moscow State Medical and Dental University named after A.I. EVDOKIMOVA» MINISTRY OF HEALTH OF RUSSIA

SBEE HPE "Russian National Research Medical University named after N.I. Pirogov" MINISTRY OF HEALTH OF RUSSIA

SBEE HPE "FIRST ST PETERSBURG STATE MEDICAL UNIVERSITY NAMED AFTER ACADEMICIAN I.P. PAVLOV» MINISTRY OF HEALTH OF RUSSIA

Wording
pathological diagnosis
with ischemic heart disease
(class IX "diseases of the circulatory system" ICD-10)

Moscow - 2015

Compiled by:

Frank G.A., Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy of the State Budgetary Educational Institution of Higher Professional Education of the Russian Medical Academy of Postgraduate Education of the Ministry of Health of Russia, Chief Freelance Pathologist of the Ministry of Health of Russia, First Vice President of the Russian Society of Pathologists;

Zayratyants O.V., Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy, Moscow State Medical University named after A.I. A.I. Evdokimov of the Ministry of Health of Russia, Vice-President of the Russian and Chairman of the Moscow Society of Pathologists;

Shpektor A.V., Doctor of Medical Sciences, Professor, Head of the Department of Cardiology, FPDO, Moscow State Medical University named after A.I. A.I. Evdokimova of the Ministry of Health of Russia, chief freelance cardiologist of the Department of Health of the city of Moscow;

Kaktursky L.V., Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Central Clinical Laboratory of the Research Institute of Human Morphology, Chief Freelance Pathologist of Roszdravnadzor, President of the Russian Society of Pathologists;

Mishnev O.D., Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy and Clinical Pathological Anatomy, SBEI HPE Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia, Vice-President of the Russian Society of Pathologists;

Rybakova M.G., Doctor of Medical Sciences, Professor, Head of the Department of Pathological Anatomy, State Budgetary Educational Institution of Higher Professional Education First St. Petersburg State Medical University. acad. I.P. Pavlov of the Ministry of Health of Russia, chief freelance pathologist of the Committee on Healthcare of St. Petersburg;

Chernyaev A.L., Doctor of Medical Sciences, Professor, Head of the Pathology Department of the Federal State Budgetary Institution Research Institute of Pulmonology of the Federal Medical and Biological Agency of Russia;

Orekhov O.O., Candidate of Medical Sciences, Head of the Pathological Anatomical Department of City Clinical Hospital No. 67, Chief Freelance Pathologist of the Moscow City Health Department;

Losev A.V., Candidate of Medical Sciences, Head of the Pathological Anatomical Department of the Regional Clinical Hospital of the Ministry of Health of the Tula Region, Chief Freelance Pathologist of the Ministry of Health of the Tula Region and the Ministry of Health of Russia in the Central Federal District of the Russian Federation.

Abbreviations

• CABG - coronary artery bypass grafting
• IHD - ischemic heart disease
• MI - myocardial infarction
• ICD-10 - International Statistical Classification of Diseases and Related Health Problems, Tenth Revision
• MNB - international nomenclature of diseases
• ACS - acute coronary syndrome
• CVD - cardiovascular diseases
• PCI - percutaneous coronary intervention

Methodology

Methods used to collect/select evidence:

Search in electronic databases.

Description of the methods used to collect/select evidence:

Methods used to assess the quality and strength of evidence:

• - expert consensus
• - development of ICD-10
• - study of the MNB.

Methods used to formulate recommendations:

Expert Consensus

Consultations and expert assessment:

The preliminary version was discussed at a meeting of the specialized commission on the specialty "pathological anatomy" of the Ministry of Health of Russia on February 19, 2015, at a meeting of the Moscow Society of Pathologists on April 21, 2015, after which it was posted on the website of the Russian Society of Pathologists (www.patolog.ru) for a wide discussion, so that specialists who did not take part in the profile commission and the preparation of recommendations have the opportunity to familiarize themselves with them and discuss them. The final approval of the recommendations was carried out at the VIII Plenum of the Russian Society of Pathologists (May 22-23, 2015, Petrozavodsk).

Working group:

For the final revision and quality control of the recommendations, they were re-analyzed by the members of the working group, who came to the conclusion that all the comments and comments of the experts were taken into account, the risk of systematic errors in the development of recommendations was minimized.

Method formula:

The rules for formulating the final clinical, pathoanatomical and forensic diagnoses, filling in a statistical accounting document - a medical death certificate for coronary heart disease in accordance with the requirements of the current legislation of the Russian Federation and ICD-10 are given. The domestic rules for the formulation of the diagnosis and diagnostic terminology were adapted to the requirements and codes of the ICD-10.

Indications for use:

Unified rules for formulating the final clinical, pathoanatomical and forensic diagnosis, issuing a medical certificate of death in coronary heart disease in accordance with the requirements of the current legislation of the Russian Federation and ICD-10 throughout the country are necessary to ensure interregional and international comparability of statistical data on incidence and causes death of the population.

Logistics:

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) with additions for 1996-2015.

"" - approved by order of the Ministry of Health of the Russian Federation No. 241 of 08/07/1998

annotation

Clinical recommendations are intended for pathologists, forensic experts, cardiologists and doctors of other specialties, as well as for teachers of clinical departments, graduate students, residents and senior students of medical universities.

The recommendations are the result of a consensus between clinicians, pathologists and forensic experts and are aimed at improving the quality of diagnosis of nosological units included in the group concept of "coronary heart disease" (CHD) and their statistical accounting among the causes of death in the population. The purpose of the recommendations is to introduce into practice unified rules for formulating a pathoanatomical diagnosis and issuing medical certificates of death in coronary artery disease in accordance with the provisions of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” and the requirements of the International Statistical Classification diseases and health problems of the 10th revision (ICD-10). The rules apply to final clinical and forensic diagnoses in connection with the underlying general requirements for the formulation and the need for their comparison (comparison) in the course of clinical and expert work. Examples of the construction (formulation) of pathoanatomical diagnoses and the execution of medical death certificates are given.

Clinical recommendations are based on a summary of literature data and the authors' own experience. The authors are aware that the construction and formulation of diagnoses may change in the future as new scientific knowledge is accumulated. Therefore, despite the need to unify the formulation of the pathoanatomical diagnosis, some proposals may give rise to discussion. In this regard, any other opinions, comments and wishes of specialists will be accepted by the authors with gratitude.

Introduction

Diagnosis is one of the most important objects of standardization in healthcare, the basis for quality management of medical services, documentary evidence of a doctor's professional qualifications. The reliability of data provided by health authorities on morbidity and mortality of the population depends on the unification and strict adherence to the rules for formulating diagnoses and issuing medical death certificates. The responsibility assigned to pathologists and forensic experts is especially high.

The recommendations are the result of a consensus between clinicians, pathologists and forensic experts and are aimed at improving the quality of diagnosis of nosological units included in the group concept of "coronary heart disease" (CHD) and their statistical accounting among the causes of death in the population.

Their need is due to:

• - statistical data on the multiple and disproportionate excess of mortality rates from cardiovascular diseases (CVD), coronary artery disease and myocardial infarction (MI) in Russia compared with the EU and the USA, which may indicate different approaches to their diagnosis and accounting. Thus, diseases of the CHD group in Russia are selected as the initial cause of death 3 times more often than in Europe. As a result of overdiagnosis of chronic forms of coronary artery disease, cardiosclerosis variants make up the vast majority (up to 20%) of all nosological units - the initial causes of death. Their proportion among deaths in the IHD group reaches 90%, many times higher than the mortality rates from these diseases in the EU and the USA. The mortality rate is artificially inflated both from coronary artery disease in general, reaching 30%, and from CVD, exceeding 60% among all causes of death, which is 3 times higher than in the EU and the USA.
• - introduction of new definitions and classifications of acute coronary syndrome (ACS) and MI into international clinical practice in recent years.
• - introduction of more than 160 changes and updates in the ICD-10 by WHO experts over the past decades.
• - publication of the Central Research Institute of Health Organization and Informatization of the Ministry of Health of the Russian Federation and the Ministry of Health of Russia of new recommendations for coding according to ICD-10 for class IX diseases “Diseases of the circulatory system”.

Coronary artery disease

IHD (or coronary heart disease) - a group (generic) concept that includes pathological processes (nosological forms) arising from acute or chronic myocardial ischemia (inconsistency in the level of supply of oxygenated blood to the level of demand for it in the heart muscle) caused by spasm, narrowing or obstruction of the coronary arteries during their atherosclerosis.

IHD in ICD-10 is included in class IX "Diseases of the circulatory system", which combines a large number of group (generic) concepts and nosological units, identified both on the basis of their etiology and pathogenesis, and on the basis of medical and social criteria (many pathogenetically represent complications of atherosclerosis, arterial hypertension, diabetes mellitus). In particular, such the group concept is IBS. It includes a number of nosological forms, namely, types of angina pectoris, MI, cardiosclerosis, etc. In ICD-10, even such nosological units as acute and repeated MI are divided into separate forms according to the localization of the pathological process and some other criteria, which is necessary take into account when coding.

As independent nosological forms, hypertension and secondary arterial hypertension with the diseases that caused them cannot be diagnosed in the diagnosis if nosological units from the IHD group are diagnosed (as well as from the groups of cerebrovascular diseases, ischemic lesions of the intestines, limbs and other main arteries).

Class IX includes a number of terms, such as “hypertensive disease”, “atherosclerotic heart disease”, “past myocardial infarction”, etc. There are domestic analogues for them: “hypertensive disease” or “arterial hypertension”, “atherosclerotic cardiosclerosis” or "diffuse small-focal cardiosclerosis", "post-infarction cardiosclerosis", or "large-focal cardiosclerosis". When formulating a diagnosis, it is permissible to use the terms accepted in domestic classifications, and for issuing a medical death certificate, their analogues from ICD-10 with the corresponding codes.

Not used in diagnoses, as they represent group and / or unspecified pathological conditions in IHD (given in ICD-10 not for their use in a detailed diagnosis): acute coronary heart disease, unspecified (I24.9), atherosclerotic cardiovascular disease, so described (I25 .0), chronic ischemic heart disease, unspecified (I25.9) .

Cannot appear as underlying disease pathological processes that are complications or manifestations of IHD and some other nosological forms (syndromes, symptoms): current complications of acute myocardial infarction (I23.0-I23.8), heart failure (I50), arrhythmia variants (I44-I49), in addition to congenital arrhythmias and conduction disorders leading to fatal asystole, most of the pathological processes from the group "complications and ill-defined heart diseases" (I51), acute (but not chronic) aneurysm of the heart, pulmonary embolism (pulmonary embolism, except for obstetric practice for which in ICD-10 there is a special class XV "Pregnancy, childbirth and the puerperium" and the corresponding codes), cor pulmonale (acute or chronic), pulmonary hypertension (except for primary, idiopathic, which is a nosological form), phlebothrombosis (but not thrombophlebitis) and etc. .

As a nosological unit - the main disease in fatal outcomes (the original cause of death) are not used the following pathological processes present in the IHD group in ICD-10 class IX: coronary thrombosis not leading to myocardial infarction (I24.0), disorders of the circulatory system after medical procedures, not elsewhere classified (I97).

With any mention in the headings of the clinical diagnosis of atherosclerosis of the coronary arteries, it is advisable (if appropriate vascular studies have been performed, for example, angiography), and in pathoanatomical or forensic diagnoses, it is necessary to indicate:

• - localization and degree of maximum stenosis of specific arteries (in %),
• - localization and features (variant of complication) of unstable ("easily injured") atherosclerotic plaques.

Additionally, it is also advisable to indicate the stage of atherosclerosis and its degree (the area of ​​the lesion). There are 4 stages of atherosclerosis: I - lipid spots, II - lipid spots and fibrous plaques, III - lipid spots, fibrous plaques and "complicated lesions" (hemorrhages in fibrous plaques, atheromatosis, their ulceration, thrombotic complications), IV - the presence of atherocalcinosis along with with previous changes. There are 3 degrees of severity of atherosclerosis of the aorta and arteries: moderate, damage to 25% of the area of ​​the intima, pronounced, the area of ​​the lesion is from 25% to 50%, pronounced, the area of ​​the lesion is more than 50%.

It is unacceptable to replace the term "atherosclerosis" with the terms "calcification" or "sclerosis" of the artery, since such lesions can be caused not only by atherosclerosis, but also by vasculitis or hereditary diseases.

Nosological units from the CHD group are excluded if the detected myocardial damage (angina pectoris syndrome, MI, cardiosclerosis) is caused not by atherosclerosis of the coronary arteries, but by other causes (coronary and non-coronary necrosis and their outcomes). In such cases, myocardial damage is indicated in the diagnosis under the heading "Complications of the underlying disease", or, when the logic of the diagnosis dictates, as part of the manifestations of the underlying disease.

When formulating a diagnosis, one of the nosological forms that make up the IHD should be selected. It is unacceptable to simultaneously indicate several such units in different sections of the diagnosis, for example, MI under the heading "Main disease", and post-infarction cardiosclerosis - "Concomitant disease", or post-infarction and atherosclerotic cardiosclerosis even in one heading.

The modern clinical classification of IHD does not fully correspond to the morphological and ICD-10:

1. Acute forms of IHD:

1.1. Acute (sudden) coronary death;

1.2. Acute coronary syndrome:

1.2.1. Unstable angina;

1.2.2. MI without ST segment elevation (non-ST-elevation myocardial infarction - NSTEMI);

1.2.3. MI with ST segment elevation (ST-elevation myocardial infarction - STEMI).

2. Chronic forms of IHD:

2.1. Angina pectoris (except unstable),

2.2. Atherosclerotic (diffuse small focal) cardiosclerosis;

2.3. Ischemic cardiomyopathy;

2.4. Large-focal (post-infarction) cardiosclerosis;

2.5. Chronic aneurysm of the heart.

2.6. Other rare forms (painless myocardial ischemia, etc.).

Excluded from use and absent in the classifications and ICD-10 the term "focal myocardial dystrophy"(“acute focal ischemic myocardial dystrophy”), proposed by A.L. Myasnikov (1965). In the diagnosis, instead of this term, MI (as its ischemic stage) should be indicated, and not always as part of IHD.

Angina pectoris is a group of clinically distinguished nosological units included in the ICD-10 (I20.0-I20.9). Its morphological substrate can be a variety of acute and chronic changes in the myocardium. In the final clinical, pathoanatomical and forensic diagnoses, it is not used.

Ischemic cardiomyopathy(code I25.5) - an extreme manifestation of prolonged chronic myocardial ischemia with its diffuse lesion (severe diffuse atherosclerotic cardiosclerosis, similar to dilated cardiomyopathy). The diagnosis of ischemic cardiomyopathy is established with severe dilatation of the left ventricular cavity with impaired systolic function (ejection fraction of 35% or less). The use of this diagnosis is advisable only in specialized cardiological medical institutions.

Diagnosis "chronic aneurysm of the heart"(in ICD-10 - "heart aneurysm" with code I25.3) does not require additional indication of the presence of postinfarction cardiosclerosis if it is limited to the walls of the aneurysm. Diagnosis post-infarction (large-focal) cardiosclerosis does not require additional indication of the presence of atherosclerotic (diffuse small-focal) cardiosclerosis.

Painless myocardial ischemia(asymptomatic ischemia, code I25.6) is diagnosed in a patient when episodes of myocardial ischemia are detected on the ECG, but in the absence of angina attacks. Like angina pectoris, silent myocardial ischemia does not may appear in the final clinical, pathological or forensic diagnosis.

Syndrome X in the clinical diagnosis, a patient is established who, in the presence of angina attacks, does not show coronary artery lesions (angiographically, etc.), there are no signs of vasospasm, and other causes of angina pectoris syndrome that are not included in the IHD group are excluded. "Stunned" (stunned) myocardium- dysfunction of the left ventricle of the heart after episodes of acute ischemia without myocardial necrosis (including after myocardial revascularization). "Hibernating", "asleep" (hibernating) myocardium- the result of a long-term decrease in coronary perfusion while maintaining the viability of the myocardium (but with its pronounced dysfunction). In the diagnosis, the terms "syndrome X", "stunned" and "hibernating" myocardium are not used, there are no ICD-10 codes for them.

In foreign literature, instead of terms "atherosclerotic cardiosclerosis" and "diffuse small-focal cardiosclerosis" use essentially the same concepts: "diffuse or small-focal atrophy of cardiomyocytes with interstitial myocardial fibrosis" or "atherosclerotic heart disease". Last term included in ICD‑10 (code I25.1) .

Unjustified overdiagnosis of atherosclerotic (diffuse small-focal) or post-infarction (large-focal) cardiosclerosis as the main or competing, or combined disease should be avoided. So, often this diagnosis is erroneously established with an insufficiently professionally performed autopsy and a superficial analysis of thanatogenesis, especially in observations of acute death, when acute (sudden) coronary death is the true primary cause of death. It is also important to differentiate brown myocardial atrophy (with severe perivascular sclerosis and myofibrosis) in various severe diseases and in the dead of old age, and diffuse small-focal cardiosclerosis as a form of coronary artery disease. Often, nosological units from the group of chronic coronary artery disease, which do not play a significant role in thanatogenesis, are incorrectly recorded as competing or combined diseases. They should be listed under the heading "Concomitant diseases" (examples 1 - 5).

• Main disease: Bilateral focal confluent pneumonia in the VI-X lung segments with abscess formation (bacteriologically - S. pneumoniae, date) J13.
• Background disease: Chronic alcohol intoxication with multiple organ damage: …. (F10.1)
• Complications of the underlying disease: Acute general venous plethora. Cerebral edema.
• Accompanying illnesses: Diffuse small focal cardiosclerosis. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis mainly of the branches of the left artery up to 50%). Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Cerebral edema.

b) Pneumococcal bilateral pneumonia (J 13)

II. Chronic alcohol intoxication (F10.1).

• Main disease: Atherosclerotic (dyscirculatory) encephalopathy. Stenosing atherosclerosis of the arteries of the brain (2nd degree, II stage, stenosis of predominantly internal carotid arteries up to 50%) (I67.8).
• Background disease: Hypertension: arteriolosclerotic nephrosclerosis (I10).
• Cachexia: brown myocardial atrophy, liver, skeletal muscle.
• Accompanying illnesses: Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Cachexia

b) Atherosclerotic (dyscirculatory) encephalopathy (I67.8).

• Main disease: Intracerebral non-traumatic hematoma in the subcortical nuclei of the right hemisphere of the brain (hematoma volume). Atherosclerosis of the arteries of the brain (2nd degree, II stage, stenosis predominantly of the left middle cerebral artery up to 30%) (I61.0).
• Background disease: Hypertension: concentric myocardial hypertrophy (heart weight 430 g, wall thickness of the left ventricle 1.8 cm, right - 0.3 cm), arteriolosclerotic nephrosclerosis (I10).
• Complications of the underlying disease: Breakthrough of blood in the cavity of the right lateral and third ventricles of the brain. Edema of the brain with the dislocation of its trunk.
• Accompanying illnesses: Large focal cardiosclerosis posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis mainly of the branches of the left artery up to 50%). Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

b) A breakthrough of blood into the ventricles of the brain.

c) Intracerebral hematoma (I61.0).

II. Hypertension (I10).

• Main disease: Ischemic cerebral infarction (atherothrombotic) in the frontal, parietal lobes and subcortical nuclei of the left hemisphere (the size of the focus of necrosis). Stenosing atherosclerosis of the arteries of the brain (3rd degree, III stage, stenosis of predominantly anterior and middle left cerebral artery up to 30%, red obstructive thrombus 2 cm long and unstable atherosclerotic plaque of the left middle cerebral artery) (I63.3).
• Complications of the underlying disease: Edema of the brain with the dislocation of its trunk.
• Accompanying illnesses: Diffuse small-focal cardiosclerosis. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the right artery up to 50%). Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Edema of the brain with dislocation of its trunk.

• Main disease: Residual effects after an intracerebral hemorrhage (date - according to the medical history): a brown cyst in the region of the subcortical nuclei of the right hemisphere of the brain. Stenosing atherosclerosis of the arteries of the brain (2nd degree, II stage, stenosis predominantly of the right posterior, middle and basilar cerebral arteries up to 30%) (I69.1).
• Background disease: Hypertension: concentric myocardial hypertrophy (heart weight 390 g, wall thickness of the left ventricle 1.7 cm, right 0.2 cm), arteriolosclerotic nephrosclerosis (I10).
• Complications of the underlying disease: Bilateral total focal confluent pneumonia (etiology).
• Accompanying illnesses: Large focal cardiosclerosis posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the left circumflex artery up to 50%). Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Focal confluent pneumonia.

b) Residual effects after intracerebral hemorrhage (I69.1).

II. Hypertension (I10).

Acute coronary syndrome

The term "acute coronary syndrome" (ACS) was proposed by V. Fuster et al. (1985), but its definition has undergone a number of changes in recent years. Currently ACS is a group clinical concept within IHD, which combines various manifestations of acute myocardial ischemia due tocomplicated by unstable atherosclerotic plaque of the coronary artery of the heart. The introduction of the concept of ACS into practice led to the exclusion of the term "acute coronary insufficiency", which still appears in the ICD-10 in the group "other acute forms of coronary artery disease" with the general code I24.8. Terms such as "preinfarction condition" and "acute coronary insufficiency" are not used in the diagnosis.

The ACS includes the following nosological forms:

Unstable angina;

MI without ST segment elevation (non-ST-elevation myocardial infarction - NSTEMI);

MI with ST segment elevation (ST-elevation myocardial infarction - STEMI).

They can end in acute (sudden) coronary (cardiac) death, which in some classifications is included in the ACS. However, it should be borne in mind that acute coronary, and, moreover, cardiac death is not limited to ACS, as well as MI. The symptom previously used in the clinic in the form of the appearance of a pathological Q wave on the ECG is no longer a criterion for the diagnosis and classification of ACS. ACS, as a group concept, and absent in the ICD-10, cannot appear in the diagnosis. This is a preliminary diagnosis, a “logistic” concept, indicating the need for certain emergency medical and diagnostic measures. With a fatal outcome, unstable angina pectoris cannot be indicated in the diagnosis. In the final clinical, pathological or forensic diagnosis, either acute (sudden) coronary death (ICD-10 code - I24.8) or MI (ICD-10 codes - I21.-) should be recorded, depending on the specific situation. and I22.-). In pathoanatomical and forensic diagnoses, ST segment changes in MI are indicated only if there are relevant data in the final clinical diagnosis, with reference "according to the card of an inpatient or outpatient", "according to the medical history").

The reason for the development of ACS is an acutely developed partial (with unstable angina and MI without ST segment elevation) or complete occlusion (with MI with ST segment elevation) of the coronary artery of the heart by a thrombus with complicated unstable atherosclerotic plaque. Complications of an unstable atherosclerotic plaque include hemorrhage into the plaque, erosion or rupture, separation of its cover, thrombus, thrombo- or atheroembolism of the distal parts of the same artery. Clinical criteria for diagnosing the causes of ACS in terms of damage to the coronary arteries of the heart are limited by the concepts of "complicated unstable atherosclerotic plaque" or "atherothrombosis", which are often used as synonyms. However, it should be clarified that endothelial damage with the development of coronary artery thrombosis can also be observed in atherosclerotic plaques that do not meet the morphological criteria for their instability. In this regard, from a general pathological position, it is more correct to speak of "complicated atherosclerotic plaque".

Complicated (usually unstable) atherosclerotic plaque of the coronary artery of the heart is a mandatory morphological criterion for the diagnosis of nosological forms included in ACS. It is important to note that stenosis of the coronary arteries by atherosclerotic plaques before the development of their complications in 50% of patients is insignificantly expressed and is less than 40%. Due to autothrombolysis or thrombolytic therapy, autopsy may no longer detect thrombi of the coronary arteries of the heart diagnosed during life (angiographically, etc.). Even without thrombolytic therapy after 24 hours, blood clots persist in only 30% of patients. Therefore, at autopsy, the detection of a complicated unstable atherosclerotic plaque, even without coronary artery thrombosis, is of fundamental importance.

The definitions of the concepts of ACS and type 1 MI (see below) dictate the requirements for the study of the coronary arteries of the heart at autopsy: it is imperative to cut the coronary arteries longitudinally, limiting only transverse sections is unacceptable. It is advisable to use the method of opening the heart according to G. G. Avtandilov. In pathoanatomical and forensic diagnoses, it is mandatory to indicate the location, type (stable, unstable) and nature of complications of atherosclerotic plaques, the degree of stenosis of specific arteries, and a description of the stage and degree (area) of atherosclerotic lesions of the arteries is optional.

So, for example, the entry is unacceptable: “Acute MI (localization, prescription, size). Atherosclerosis of the coronary arteries of the heart (2nd degree, II stage, stenosis up to 30%, thrombosis of the left coronary artery). An example of a recommended entry could be the following wording: “Acute MI (localization, prescription, size). Stenosing atherosclerosis of the coronary arteries of the heart (complicated unstable atherosclerotic plaque with a rupture of the tire, a red obstructive thrombus 1 cm long of the left coronary artery at a distance of 1.5 cm from its mouth; atherosclerotic plaques stenosing the lumen of the predominantly left circumflex artery up to 40%).

Morphological verification of focal myocardial ischemia is necessary for pathoanatomical diagnosis of nosological forms in the composition of ACS. Although irreversible necrotic changes in cardiomyocytes develop already after 20-40 minutes of ischemia, the rate of necrosis development is affected by the state of collaterals and microvasculature, as well as the cardiomyocytes themselves and individual sensitivity to hypoxia. In addition, macro- and microscopic morphological signs of necrosis that do not require the use of special diagnostic methods appear no earlier than 4-6 hours (up to 12 hours).

If myocardial ischemia of any origin is suspected, a macroscopic test is mandatory, for example, with nitrosine tetrazolium or potassium tellurite. Histological diagnosis of myocardial ischemia is less specific and more time-consuming, depending on the correct choice of the myocardial area suspected of ischemia and research methods. More reliable is polarizing microscopy, which can, to a certain extent, replace the macroscopic sample.

It should be borne in mind that positive results of macroscopic tests or relatively specific histological changes appear approximately 30 minutes after the onset of acute myocardial ischemia. They are also not a criterion for qualifying the focus of ischemia or necrosis as a nosological form of myocardial damage from the IHD group.

Acute (sudden) coronary death

Under the term "acute (sudden) coronary death"in the clinic, they mean sudden death within one hour (according to other definitions - from 6 to 12 hours) from the onset of the first symptoms (signs) of myocardial ischemia in IHD. In the ICD-10, it is included in the group "other acute forms of coronary artery disease" (code I24.8). Pathological or forensic diagnosis of acute (sudden) coronary death is established method of excluding other causes of death based on clinical and morphological analysis. It is necessary to exclude focal myocardial ischemia. In cases where there are clinical and laboratory data on ACS or MI, and a complicated atherosclerotic plaque of the coronary arteries and focal myocardial ischemia are detected at autopsy, type I MI, its ischemic stage, is diagnosed. If an autopsy reveals a coronary or non-coronary focal myocardial ischemia not associated with IHD, the diseases that caused it are diagnosed, which become the main disease.

concept"acute (sudden) cardiac death" is defined as sudden "cardiac" death (primary circulatory arrest), unexpected in nature and time of occurrence, even in the case of previously established heart disease, the first manifestation of which is loss of consciousness within one hour (according to other definitions - from 6 to 12 hours.) from the onset of the first symptoms. More often it is caused by lethal arrhythmias (ventricular tachycardia, turning into ventricular fibrillation, primary ventricular fibrillation, bradyarrhythmias with asystole). In the clinic, the terms "acute cardiac death" and "acute coronary death" are often used as synonyms, and acute (sudden) cardiac death is a broader concept, a clinical syndrome for any heart damage. However in ICD-10, the term "acute (sudden) cardiac death" excludes acute coronary death and the presence of coronary artery disease . Diagnosis "acute (sudden) cardiac death" (ICD-10 code - I46.1) - "diagnosis of exclusion", allowed after the absolute exclusion of the violent nature of death, acute coronary death, any heart disease and other nosological forms, when the nature of the pathological process and the corresponding morphological substrate underlying the heart lesion cannot be established (examples 6, 7).

• Main disease: Acute coronary death(Let's say the term "Sudden coronary death"). Foci of uneven myocardial blood filling in the interventricular septum. Stenosing atherosclerosis of the coronary arteries of the heart (3rd degree, stage II, stenosis of up to 50% of the branches of the left and right arteries) (I24.8).
• Complications of the underlying disease: Ventricular fibrillation (according to clinical data). Acute general venous plethora. Liquid blood in the cavities of the heart and the lumen of the aorta. Edema of lungs and brain. Small punctate hemorrhages under the epicardium and pleura.
• Accompanying illnesses: Chronic calculous cholecystitis, stage of remission.

Medical death certificate

I. a) Acute coronary death (let's say the term "sudden coronary death") (I24.8).

• Main disease: Sudden cardiac death. Ventricular fibrillation (according to clinical data) (I46.1).
• Complications of the underlying disease: Acute general venous plethora. Liquid blood in the cavities of the heart and great vessels. Edema of lungs and brain.
• Accompanying illnesses: Chronical bronchitis

Medical death certificate

I. a) Sudden cardiac death (I46.1).

myocardial infarction

MI is coronarogenic (ischemic) necrosis of the myocardium, which can be both a nosological form as part of IHD, and a manifestation or complication of various diseases or injuries accompanied by impaired coronary perfusion (coronaritis, thrombosis and thromboembolism of the coronary arteries, their developmental anomalies, etc. .) .

Modern definition, criteria for clinical diagnosis and classification of MI, called "Third universal definition of myocardial infarction" were the result of the 3rd international consensus reached in 2012 between the European Society of Cardiology, the American College of Cardiology Foundation, the American Heart Association and the World Heart Federation (Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction) . They are based on revised provisions first set out in the materials of the 2nd international consensus in 2007 (Joint ESC/ACCF/AHA/WHF Task for the Redefinition of Myocardial Infarction, 2007) . Some of the definitions presented in ICD-10 have been retained.

MI is considered acute 28 days old. and less.

Recurrent should be called MI with a recurrence of an ischemic attack more than 3 days later. and less than 28 days. after the previous one.

Repeated MI is recognized when it develops after 28 days. after primary. Both recurrent and repeated MI in ICD-10 have a common code (I22), the fourth character of which depends on the localization of the focus of necrosis.

In accordance with the "Third Universal Definition", "The term acute MI should be used when there is evidence of myocardial necrosis resulting from prolonged acute ischemia." The classification of IM includes 5 types. It is advisable to indicate the types of MI in the diagnosis, although they do not have special codes in the ICD-10 .

Spontaneous MI (MI type 1) is caused by rupture, ulceration, or stratification of an unstable atherosclerotic plaque with the development of intracoronary thrombosis in one or more coronary arteries, leading to a decrease in myocardial perfusion with subsequent necrosis of cardiomyocytes. As already mentioned in the section "acute coronary syndrome", due to thrombolysis (spontaneous or induced), an intracoronary thrombus may not be detected at autopsy. On the other hand, coronary artery thrombosis can also develop when a stable atherosclerotic plaque is damaged. In addition, type 1 MI can develop with atherocalcinosis of the coronary arteries of the heart, due to plasmorrhagia and fissuring of petrificates, leading to a rapid increase in the degree of arterial stenosis and / or thrombosis.

Type 1 MI is included in the group concept of ACS and is always a nosological form in the composition of IHD, therefore, the diagnosis is indicated under the heading "Main disease" or a competing or concomitant disease (examples 8 - 11).

• Main disease: Acute transmural myocardial infarction (type 1) anterolateral wall and apex of the left ventricle (about 4 days old, the size of the focus of necrosis). Stenosing atherosclerosis of the coronary arteries of the heart (stenosis up to 50% of the left and unstable, with hemorrhage atherosclerotic plaque of the left descending artery) (I21.0).
• Background disease: Renal arterial hypertension: eccentric myocardial hypertrophy (heart weight 390 g, wall thickness of the left ventricle 2.0 cm, right - 0.3 cm). Chronic bilateral pyelonephritis in remission, pyelonephritic nephrosclerosis (weight of both kidneys - ... g) (I15.1).
• Let's also say: 2. Background disease: Chronic bilateral pyelonephritis in remission, pyelonephritic nephrosclerosis (weight of both kidneys - ... g.). Renal arterial hypertension: eccentric myocardial hypertrophy (heart weight 390 g, wall thickness of the left ventricle 2.0 cm, right - 0.3 cm).
• Complications of the underlying disease: Myomalacia and rupture of the anterior wall of the left ventricle of the heart. Hemotamponade of the pericardium (volume of outflowing blood, ml). Acute general venous plethora. Edema of lungs and brain.
• Accompanying illnesses: Gastric ulcer, stage of remission: chronic callous epithelized ulcer (diameter of the ulcer) of the body of the stomach in the region of its lesser curvature. Chronic indurative pancreatitis in remission.

Medical death certificate

I. a) Hemotamponade of the pericardium.

b) Rupture of the anterior wall of the left ventricle of the heart.

c) Acute anteroapical myocardial infarction (I21.0).

II. Renal arterial hypertension (I15.1).

• Main disease: Recurrent large-focal myocardial infarction (type 1) posterolateral wall of the left ventricle with a transition to the posterior wall of the right ventricle (about 3 days old, the size of the focus of necrosis), macrofocal cardiosclerosis of the lateral wall of the left ventricle (the size of the scar). Eccentric myocardial hypertrophy (heart weight 360 g, wall thickness of the left ventricle 1.7 cm, right - 0.3 cm). Stenosing atherosclerosis of the coronary arteries of the heart (3rd degree, stage II, unstable atherosclerotic plaque with hemorrhage of the descending branch of the left artery, stenosis up to 60% of the mouth of the left artery) (I21.2).
• Background disease: Diabetes mellitus type 2, in the stage of decompensation (blood glucose - ..., date). Diabetic macro- and microangiopathy: atherosclerosis of the aorta (3rd degree, stage III), cerebral arteries (3rd degree, stage II, stenosis of the arteries of the base of the brain up to 25%), diabetic retinopathy (according to the medical history), diabetic nephrosclerosis (arterial hypertension - clinically) (E11.7).
• Complications of the underlying disease: Acute general venous plethora. Pulmonary edema.

Medical death certificate

I. a) Pulmonary edema.

b) Repeated myocardial infarction, posterolateral with the transition to the right ventricle (I21.2).

• Main disease: Recurrent myocardial infarction (type 1): fresh (about 3 days old - or “from ... date”) and organizing foci of necrosis (about 25 days old) in the region of the posterior wall and posterior papillary muscle of the left ventricle and interventricular septum (size of necrosis foci). Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, unstable atherosclerotic plaque with hemorrhage of the left circumflex artery, stenosis of the branches of the left artery up to 60%) (I22.1).
• Background disease: Renovascular hypertension: eccentric myocardial hypertrophy (heart weight 360 g, wall thickness of the left ventricle 1.9 cm, right - 0.2 cm). Stenosing atherosclerosis of the renal arteries (3rd degree, stage III, obturating organized thrombus of the left and stenosis of up to 25% of the right arteries). Primary wrinkled left kidney (weight 25 g), atheroarteriolosclerotic nephrosclerosis of the right kidney (I15.0).
• Let's also say: 2. Background disease: Stenosing atherosclerosis of the renal arteries (3rd degree, stage III, obturating organized thrombus of the left and stenosis of up to 25% of the right arteries). Primarily wrinkled left kidney (weight 25 g), atheroarteriolosclerotic nephrosclerosis of the right kidney. Renovascular hypertension: eccentric myocardial hypertrophy (heart weight 360 g, wall thickness of the left ventricle 1.9 cm, right - 0.2 cm).
• Complications of the underlying disease: Avulsion of the posterior papillary muscle of the left ventricle. Cardiogenic shock (clinically), liquid dark blood in the cavities of the heart and the lumen of large vessels. Spot hemorrhages under the pleura and epicardium. Acute general venous plethora. Respiratory distress syndrome.
• Accompanying illnesses: Atherosclerotic dementia (type, another characteristic - clinically), stenosing atherosclerosis of the arteries of the brain (2nd degree, stage II, stenosis predominantly of the left middle cerebral artery up to 50%), moderately pronounced atrophy of the cerebral hemispheres and internal hydrocephalus. Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Cardiogenic shock.

b) Detachment of the posterior papillary muscle of the left ventricle of the heart

c) Recurrent myocardial infarction of the posterior wall and interventricular septum (I22.1).

II. Renovascular arterial hypertension (I15.0).

• Main disease: Ischemic cerebral infarction (atherothrombotic) in the region of the subcortical nuclei of the right hemisphere of the brain (the size of the focus of necrosis). Stenosing atherosclerosis of the arteries of the brain (3rd degree, III stage, stenosis of predominantly anterior and middle left cerebral arteries up to 30%, red obstructive thrombus and unstable atherosclerotic plaque with hemorrhage of the left middle cerebral artery) (I63.3).
• Competing disease:Acute subendocardial myocardial infarction (type 1) the posterior wall of the left ventricle (about 15 days old, the size of the focus of necrosis). Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, II stage, stenosis up to 50% and unstable, with hemorrhages, atherosclerotic plaques of the circumflex branch of the left coronary artery) (I21.4).
• Background disease: Hypertension: eccentric myocardial hypertrophy (heart weight 430 g, wall thickness of the left ventricle 1.8 cm, right - 0.3 cm), arteriolosclerotic nephrosclerosis (I10).
• Complications of the underlying disease: Bilateral focal pneumonia in the middle and lower lobes of the right lung (etiology). Acute general venous plethora. Edema of lungs and brain.

Medical death certificate

I. a) Focal pneumonia.

b) Ischemic cerebral infarction (I63.3).

II. Acute subendocardial myocardial infarction (I21.4). Hypertension (I10).

MI secondary to ischemic imbalance (MI type 2) develops when a condition other than CAD leads to an imbalance between oxygen demand and/or delivery (endothelial dysfunction, coronary spasm, embolism, tachy/bradyarrhythmias, anemia, respiratory failure, hypotension or hypertension with or without myocardial hypertrophy). Complicated unstable atherosclerotic plaques or atherothrombosis are absent at autopsy.

Type 2 MI in most cases is not a nosological form in the composition of coronary artery disease and in the diagnosis it should be indicated under the heading “Complications of the underlying disease”. The leading role in its pathogenesis (and diagnosis) is comorbidity: the presence, in addition to atherosclerosis of the coronary arteries and coronary artery disease, comorbidities and / or their complications that contribute to the development of ischemic myocardial imbalance. Such combined diseases can be lung diseases, oncological diseases, etc. Even with severe syndrome of chronic cardiovascular insufficiency in a deceased with atherosclerotic or postinfarction cardiosclerosis in IHD, foci of ischemia or myocardial necrosis (in postinfarction cardiosclerosis, usually along the periphery of scars) should be regarded as a complication of the underlying disease, and not repeated MI as part of IHD. Recurrent MI is diagnosed when signs of type 1 MI are detected.

The formulation of the diagnosis is based on the results of clinical and morphological analysis. There are no specific criteria that would allow morphologically to differentiate a small MI in CAD from large focal myocardial necrosis of hypoxic and mixed genesis, which can develop in patients, for example, with severe anemia and the presence of atherosclerosis (but not atherothrombosis, as in type 1 MI) coronary arteries of the heart. In such observations, in the pathoanatomical diagnosis under the heading “Complications of the underlying disease”, it is more appropriate to use the term MI type 2, and not “myocardial necrosis”, although non-coronary hypoxic factor plays an important role in its pathogenesis (examples 12, 13).

• Main disease: COPD: chronic obstructive purulent bronchitis in the acute stage. Focal pneumonia in III-IX segments of both lungs (etiology). Diffuse mesh pneumosclerosis, chronic obstructive pulmonary emphysema. Secondary pulmonary hypertension. Cor pulmonale (wall thickness of the right ventricle of the heart - 0.5 cm, FI - 0.8) (J44.0).
• Combined disease: Large-focal cardiosclerosis of the posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the left circumflex artery up to 40%) (I25.8).
• Background disease: Hypertension: eccentric myocardial hypertrophy (heart weight 390 g, left ventricular wall thickness 1.7 cm), arteriolosclerotic nephrosclerosis (I10).
• Complications of the underlying disease: Acute general venous plethora. Myocardial infarction type 2 in the region of the posterior wall of the left ventricle and the apex of the heart. Brown induration of the lungs, nutmeg liver, cyanotic induration of the kidneys, spleen. Edema of lungs and brain.

Medical death certificate

b) COPD in the acute stage with bronchopneumonia (J44.0).

II. Large focal cardiosclerosis (I25.8)

Hypertension (I10).

• Main disease: Large-focal cardiosclerosis of the posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the left circumflex artery up to 40%) (I25.8).
• Background disease:
• Complications of the underlying disease: Chronic general venous plethora: brown induration of the lungs, nutmeg liver, cyanotic induration of the kidneys, spleen. Subendocardial foci of myocardial necrosis (myocardial infarction type 2) in the posterior wall of the left ventricle. Edema of lungs and brain.

Medical death certificate

I. a) Chronic cardiovascular insufficiency

b) Large focal cardiosclerosis (I25.8)

II. Hypertension (I10).

In rare cases, type 2 MI can be qualified as a form of coronary artery disease and put under the heading "Main disease" in the absence of any diseases and their complications that cause hypoxic or metabolic damage to the myocardium (lack of comorbidity) and the presence of atherosclerosis of the coronary arteries of the heart with stenosis of their clearance by more than 50%. Such an example is a circular subendocardial MI that developed with atherosclerotic lesions of 2 or 3 coronary arteries of the heart without complicated plaque or atherothrombosis (Example 14).

• Main disease: Acute myocardial infarction (type 2) posterolateral wall of the left ventricle with a transition to the posterior wall of the right ventricle (about 2 days old, the size of the focus of necrosis), Stenosing atherosclerosis of the coronary arteries of the heart (3rd degree, stage III, stenosis predominantly of the left circumflex artery up to 70%) (I21. 2).
• Background disease: Hypertension: eccentric myocardial hypertrophy (heart weight 390 g, wall thickness of the left ventricle 1.7 cm, right 0.2 cm), arteriolosclerotic nephrosclerosis (I10).
• Complications of the underlying disease: Acute common venous congestion. Edema of lungs and brain.

Medical death certificate

I. a) Acute cardiovascular failure

b) Acute myocardial infarction, posterolateral with transition to the right ventricle (I21.2).

II. Hypertension (I10).

Type 3 MI (MI resulting in death when CV biomarkers are not available) is cardiac death with symptoms suggestive of myocardial ischemia and presumably new ischemic ECG changes or new left bundle branch block, if death occurs before blood sampling or before the level of cardiospecific biomarkers should rise, or in those rare situations where they are not explored.

Type 3 MI is a clinical concept. At autopsy, acute coronary death, type 1 or 2 MI, as well as other coronarogenic or non-coronary myocardial necrosis of various pathogenesis can be diagnosed. Depending on this, this type of myocardial necrosis can appear in various headings of the diagnosis.

Type 4 MI, a is percutaneous coronary intervention (PCI)-associated MI or PCI-associated MI.

Type 4b MI is MI associated with coronary artery stent thrombosis..

Type 5 MI is MI associated with coronary artery bypass surgery (CABG) or CABG-associated MI.

MI types 4 a, 4 b and 5 are nosological forms in the composition of IHD, develop as a complication of various types of percutaneous coronary interventions or CABG performed for atherosclerotic lesions of the coronary arteries of the heart in patients with IHD. In the diagnosis, these types of MI are indicated as the underlying disease, and changes in the coronary arteries of the heart and the type of intervention are indicated as its manifestation, if there are no reasons to formulate a diagnosis as in iatrogenic pathology.

Thus, in the final clinical, pathoanatomical or forensic diagnosis, MI can be presented as the main disease (or as a competing or combined disease), only if it is qualified as a nosological form from the CHD group. All other types of myocardial necrosis (including, apparently, the majority of type 2 MI) are a manifestation or complication of various diseases, injuries or pathological conditions.

Myocardial necrosis is a heterogeneous group of focal irreversible myocardial damage in terms of etiology, pathogenesis and morphogenesis, as well as in terms of the extent of the lesion, clinical manifestations and prognosis. From the standpoint of general pathology, myocardial necrosis is usually divided into coronarogenic (ischemic, or MI [the term "MI" is not equivalent to its nosological form in the composition of IHD]) and non-coronary (hypoxic, metabolic, etc.). According to clinical criteria, in accordance with the Third International Consensus, myocardial damage (mainly non-coronary) and MI are distinguished. In connection with the introduction into clinical practice of highly sensitive tests for determining the blood level of cardiospecific biomarkers (especially cardiac troponin I or T), it must be taken into account that they can increase with minimal coronary and non-coronary myocardial damage (Table 1).

Table 1

Myocardial injury accompanied by an increase in cardiac troponin levels

Damage caused by primary myocardial ischemia

Rupture of unstable atherosclerotic plaque of the coronary artery of the heart

Intracoronary thrombosis

Damage secondary to ischemic imbalance in the myocardium

Tachy/bradyarrhythmias

Dissecting aneurysm, ruptured aortic aneurysm, or severe aortic valve disease

Hypertrophic cardiomyopathy

Cardiogenic, hypovolemic, or septic shock

severe respiratory failure

severe anemia

Arterial hypertension with or without myocardial hypertrophy

Spasm of the coronary arteries

Thromboembolism of the coronary arteries of the heart or coronary disease

Endothelial dysfunction with lesions of the coronary arteries of the heart without hemodynamically significant stenosis

Lesions not associated with myocardial ischemia

Myocardial contusion, cardiac surgery, radiofrequency ablation, pacing and defibrillation

Rhabdomyolysis with myocardial involvement

Myocarditis

Effects of cardiotoxic drugs (eg, anthracyclines, herceptin)

Multifactorial or unexplained myocardial injury

Heart failure

Stress cardiomyopathy (takotsubo)

Massive PE or severe pulmonary hypertension

Sepsis and the terminal state of the patient

kidney failure

Severe neurological pathology (stroke, subarachnoid hemorrhage)

Infiltrative diseases (eg, amyloidosis, sarcoidosis)

Physical overvoltage

The pathogenesis of myocardial necrosis is often mixed; therefore, the allocation of their coronarogenic and non-coronary types is often rather conditional. For example, the pathogenesis of myocardial necrosis in diabetes mellitus is associated with both ischemic and microcirculatory disorders, metabolic, hypoxic and neurogenic factors.

Coronary (ischemic) myocardial necrosis develop as a result of impaired blood supply to the myocardium associated with damage to the coronary arteries of the heart. The main reasons for the development of ischemic necrosis, not included in the IHD group, are as follows:

• - (thrombo)vasculitis (coronaritis) and sclerosis of the coronary arteries (rheumatic diseases, systemic vasculitis, infectious and allergic diseases, etc.);
• - vasculopathy - thickening of the intima and media of the coronary arteries with metabolic disorders, proliferation of their intima (homocysteinuria, Hurler syndrome, Fabry disease, amyloidosis, juvenile arterial calcification, etc.);
• - myocarditis of various etiologies;
• - thromboembolism of the coronary arteries (with endocarditis, thrombi of the left heart, paradoxical thromboembolism);
• - traumatic injuries of the heart and its vessels;
• - primary tumor of the heart or metastases of other tumors in the myocardium (tissue embolism);
• - congenital malformations of the heart and coronary arteries of the heart, non-atherosclerotic aneurysms with thrombosis or rupture;
• - systemic diseases with the development of narrowing of the coronary arteries of various origins, but not of an atherosclerotic nature;
• - imbalances between myocardial oxygen demand and its supply (aortic stenosis, aortic insufficiency, thyrotoxicosis, etc.);
• - congenital and acquired coagulopathy with hypercoagulation (thrombosis and thromboembolism: DIC, paraneoplastic syndrome, antiphospholipid syndrome, erythremia, thrombocytosis, blood clotting, etc.);
• - violation of the structural geometry of the heart with a local pronounced decrease in coronary blood flow in cardiomyopathies, myocardial hypertrophy of any origin,
• - drug use (eg cocaine-associated MI, etc.).

In particular, congenital aneurysm of the coronary artery of the heart with rupture (code Q24.5 according to ICD-10) and the development of cardiac hemotamponade should not be attributed to diseases from the group of coronary artery disease. In the diagnosis, both the use of the term "IM", which is more consistent with their general pathological nature, and "myocardial necrosis" are allowed (examples 15, 16).

• Main disease: Ulcerated subtotal gastric cancer with extensive tumor decay (biopsy - moderately differentiated adenocarcinoma, No., date). Cancer metastases to perigastric lymph nodes, liver, lungs (T4N1M1). C16.8
• Complications of the underlying disease: Paraneoplastic syndrome (hypercoagulation syndrome ...). Obturating red thrombus ... of the coronary artery. myocardial infarction anterior wall of the left ventricle.
• Accompanying illnesses: Chronic calculous cholecystitis, stage of remission

Medical death certificate

I. a) Myocardial infarction

b) Paraneoplastic syndrome

c) Subtotal gastric cancer (adenocarcinoma) with metastases, T4N1M1 (C16.8)

• Main disease: Polyarteritis nodosa (periarteritis) with a primary lesion of the coronary arteries of the heart, mesenteric arteries, .... (M.30.0)
• Complications of the underlying disease: myocardial infarction in the region of the posterior and lateral walls of the left ventricle, ....

Medical death certificate

I. a) Myocardial infarction

b) Polyarteritis nodosa (M30.0)

Non-coronary necrosis develop while maintaining coronary blood flow due to:

• - hypoxia (absolute or relative, with increased myocardial oxygen demand), characteristic of many diseases and their complications,
• - exposure to cardiotropic toxic substances, both exogenous, including drugs (cardiac glycosides, tricyclic antidepressants, antibiotics, cytostatics, glycocorticoids, chemotherapy drugs, etc.), and endogenous,
• - a variety of metabolic and electrolyte disorders (with metabolic pathology, organ failure, etc.),
• dishormonal disorders (diabetes mellitus, hypo- and hyperthyroidism, hyperparathyroidism, acromegaly),
• - neurogenic disorders, for example, in cerebrocardial syndrome in patients with severe brain damage (ischemic infarcts, traumatic and non-traumatic hematomas), which are also characterized by impaired blood supply to the myocardium (coronary, ischemic component),
• - infectious-inflammatory and immune (autoimmune, immunocomplex) lesions of the myocardium and often the vessels of the heart, i.e. with a coronary, ischemic component (infectious diseases, sepsis, rheumatic and autoimmune diseases, myocarditis).

Relative hypoxia occurs in various arrhythmias, myocardial hypertrophy, arterial hypo- and hypertension, pulmonary hypertension, heart defects, and many other conditions, including surgery and trauma. Non-coronary myocardial necrosis can be observed in cardiomyopathies, severe diseases with cardiac, renal, hepatic, pulmonary or multiple organ failure, severe anemia, sepsis and shock of any origin, as well as in the postoperative period, terminal state and in intensive care (examples 17-23).

• Main disease: Alcoholic subtotal mixed pancreatic necrosis. Operation of laparotomy, debridement and drainage of the omental sac and abdominal cavity (date) (K85).
• Background disease: Chronic alcohol intoxication with multiple organ manifestations: alcoholic cardiomyopathy, alcoholic encephalopathy, polyneuropathy, fatty hepatosis (F10.2).
• Complications of the underlying disease: Pancreatogenic (enzymatic) shock. Myocardial necrosis in the area of ​​the anterior and lateral walls of the left ventricle. Respiratory distress syndrome. Necrotic nephrosis. Cerebral edema.
• Accompanying illnesses: Large-focal cardiosclerosis of the posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the left circumflex artery up to 40%).

Medical death certificate

I. a) Pancreatogenic shock

b) Alcoholic pancreatic necrosis (K85)

II. Chronic alcohol intoxication (F10.2)

Operation of laparotomy, sanitation and drainage of the omental sac and abdominal cavity (date).

• Main disease: Nodular-branched cancer of the upper lobe bronchus of the left lung with massive tumor decay (... - histologically). Multiple cancer metastases to ... lymph nodes, bones (...), liver, ... (T4N1M1) (C34.1).
• Background disease: COPD in the acute stage: (c) Chronic obstructive purulent bronchitis. Diffuse mesh and peribronchial pneumosclerosis. Chronic obstructive pulmonary emphysema. Focal pneumonia in ... segments of both lungs (etiology). Foci of dysplasia and metaplasia of the bronchial epithelium (histologically) (J44.0).
• Complications of the underlying disease: Secondary pulmonary hypertension, cor pulmonale (heart weight - ... g, right ventricular wall thickness - ... see, ventricular index - ...). Acute general venous plethora. Pleural empyema on the left. Foci of myocardial necrosis in the region of the apex of the heart and the posterior wall of the left ventricle. Pulmonary edema. Cerebral edema.
• Accompanying illnesses:

Medical death certificate

I. a) Foci of myocardial necrosis

b) Pleural empyema

c) Cancer of the left upper lobe bronchus with widespread metastases (T4N1M1) (C34.1).

II. COPD in the acute stage with bronchopneumonia (J44.0).

• Main disease: Cancer of the left breast (... - histologically). Metastases to ... lymph nodes, lungs, liver. Radiation and chemotherapy (….) (T4N1M1) (C50.8).
• Associated disease: Chronic bilateral pyelonephritis in the acute stage .... (N10).
• Background disease: Type 2 diabetes mellitus, decompensated (blood biochemistry - ..., date). Atrophy and lipomatosis of the pancreas. Diabetic macro- and microangiopathy (…).
• Complications of the underlying disease: Acute general venous plethora. Focal confluent pneumonia in ... segments of the left lung (etiology). Foci of myocardial necrosis in the region of the apex of the heart. Pulmonary edema.
• Accompanying illnesses: Large-focal cardiosclerosis of the posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the left circumflex artery up to 50%).

Medical death certificate

I. a) Foci of myocardial necrosis

b) Focal pneumonia

c) Cancer of the left breast with widespread metastases (T4N1M1) (C50.8).

II. Chronic bilateral pyelonephritis in the acute stage (N10)

• Main disease: Hypertension with a primary lesion of the heart and kidneys. Eccentric myocardial hypertrophy (heart weight 510 g, wall thickness of the left ventricle 2.2 cm, right - 0.4 cm) with severe dilatation of the heart cavities. Non-stenosing atherosclerosis of the coronary arteries of the heart (grade 1, stage II). Arteriolosclerotic nephrosclerosis with outcome in primary contracted kidneys (weight of both kidneys 160 g) (I13.1).
• Complications of the underlying disease: CRF, uremia (blood biochemistry -…, date): uremic erosive and ulcerative pangastritis, fibrinous enterocolitis, fibrinous pericarditis, fatty degeneration of the liver. Chronic general venous plethora. Foci of myocardial necrosis in the anterior and posterior walls of the left ventricle (dimensions). Edema of lungs and brain.
• Accompanying illnesses: Atherosclerosis of the aorta, arteries of the brain (2nd degree, II stage).

Medical death certificate

I. a) Uremia.

b) Hypertension with damage to the heart and kidneys (I13.1).

• Main disease: Cancer of the floor of the mouth (... - histologically). Cancer metastases to cervical and submandibular lymph nodes on both sides (T4N1M0) (C04.8).
• Complications of the underlying disease: Metastasis necrosis in the left submandibular lymph node with arrosion ... of the artery. Massive arrosive bleeding. Operation to stop bleeding (date). Hemorrhagic shock (...). Acute posthemorrhagic anemia (data from clinical tests). Acute general anemia of internal organs. Foci of myocardial necrosis in the posterior wall of the left ventricle. Respiratory distress syndrome. Necrotic nephrosis.
• Accompanying illnesses: Diffuse small focal cardiosclerosis. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis mainly of the branches of the left artery up to 50%). Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Hemorrhagic shock

b) Necrosis of metastasis in the lymph node with arterial erosion and

bleeding.

c) Cancer of the floor of the mouth with metastases (T4N1M0) (C04.8).

• Main disease: Phlegmon of the upper and middle third of the thigh (L03.1).
• Background disease: Diabetes mellitus type 2, decompensation stage (blood biochemistry - ..., date). Atrophy, sclerosis and lipomatosis of the pancreas. Diabetic macro- and microangiopathy, retinopathy, polyneuropathy, diabetic nephrosclerosis. E11.7
• Complications of the underlying disease: Sepsis (bacteriologically - ..., date), septicemia, septic shock: systemic inflammatory response syndrome (indicators ...). Hyperplasia of the spleen (mass ...). Syndrome of multiple organ failure (indicators ...). Respiratory distress syndrome. Necrotic nephrosis. DIC syndrome. Myocardial necrosis posterior and lateral walls of the left ventricle.

Medical death certificate

I. a) Sepsis, septic shock

b) Phlegmon of the upper and middle third of the thigh (L03.1)

II. Type 2 diabetes mellitus (E11.7)

• Main disease: Acute phlegmonous perforative calculous cholecystitis. Operation of laparotomy, cholecystectomy, sanitation and drainage of the abdominal cavity (date) (K80.0).
• Complications of the underlying disease: Hepatic and renal insufficiency, electrolyte disturbances (indicators - according to clinical data). Foci of myocardial necrosis in the region of the posterior and lateral walls of the left ventricle.
• Accompanying illnesses: Large-focal cardiosclerosis of the posterior wall of the left ventricle. Stenosing atherosclerosis of the coronary arteries of the heart (2nd degree, stage II, stenosis predominantly of the left circumflex artery up to 40%). Hypertension: concentric myocardial hypertrophy (heart weight 390 g, wall thickness of the left ventricle 1.7 cm, right 0.2 cm), arteriolosclerotic nephrosclerosis (I10). Atherosclerosis of the aorta (3rd degree, stage IV).

Medical death certificate

I. a) Foci of myocardial necrosis

b) Hepato-renal insufficiency

c) Acute phlegmonous perforative calculous cholecystitis (K80.0)

II. Operation of laparotomy, cholecystectomy, sanitation and drainage of the abdominal cavity (date)

With the development of myocardial necrosis in the first 4 weeks after surgery and the absence of complicated unstable atherosclerotic plaques in the coronary arteries of the heart (atherothrombosis), they should be regarded as a complication and indicated under the heading “Complications of the underlying disease”. The exception is the detection of morphological signs of type 1 MI.

Thus, the only specific morphological diagnostic criterion for MI as a nosological form in the composition of IHD is a complicated, mainly unstable atherosclerotic plaque of the coronary artery of the heart. In other cases, the qualification of myocardial necrosis should be the result of clinical and morphological analysis.

In the differential diagnosis of coronarogenic and non-coronary necrosis with MI as a nosological form in the composition of IHD, the following clinical and morphological criteria should be taken into account :

• - anamnestic and clinical and laboratory data (if available, and a history of coronary heart disease and / or a slight increase in the level of cardiac troponin cannot be diagnostic criteria for MI from the ischemic heart disease group);
• - the presence of diseases and their complications that may be the cause of the development of certain types of myocardial necrosis (comorbidity is more typical for type 2 MI);
• - changes in the coronary and intramural arteries of the heart (but the presence of stenosing atherosclerosis without complicated atherosclerotic plaque or atherothrombosis cannot be a criterion for diagnosing MI from the IHD group);
• - morphological (macro- and microscopic) features of the heart and its valvular apparatus (changes in the structural geometry of the heart, valve damage, etc.);
• - the number, size, localization and histological features of necrosis foci (non-coronary myocardial necrosis is usually multiple, small in size, located simultaneously in the blood supply pools of different arteries, sometimes with specific changes characteristic of the underlying disease or not corresponding in morphology to the terms of necrosis);
• - morphological features of the myocardium outside the zone of necrosis (changes in cardiomyocytes - fatty degeneration, etc., stroma - inflammatory infiltration, etc., vessels - vasculitis, vasculopathy, etc., often characteristic of the underlying disease).

Literature

1. Oganov R.G. Cardiovascular diseases at the beginning of the XXI century: medical, social, demographic aspects and ways of prevention. http://federalbook.ru/files/FSZ/soderghanie/Tom.2013/IV/. pdf.
2. Samorodskaya I.V. Cardiovascular diseases: principles of statistical accounting in different countries. Healthcare. 2009; 7:49-55. www.zdrav.ru
3. Thygesen K. et al. Joint ESC/ACCF/AHAIWHF Task for the Redefinition of Myocardial Infarction. Eur. Heart J. 2007;28:2525-2538 (JACC. 2007; 50:2173-2195; Circulation. 2007; 116: 2634-2653).
4. Thygesen K., et al. The Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Nat. Rev. cardiol. advance online publication. August 25, 2012; doi:10.1038/nrcardio.2012.122.
5. International Statistical Classification of Diseases and Related Health Problems; 10th revision: Updates 1998-2012. http://www.who.int/classifications/icd/icd10updates/en/index.html.
6. Weissman D.Sh. Guidelines for the use of the International Classification of Diseases in the practice of a doctor: in 2 volumes, volume 1. Moscow: RIO TsNIIOIZ, 2013.
7. On the features of coding some diseases from class IX ICD-10 / Letter of the Ministry of Health of the Russian Federation dated 04/26/2011 No. 14-9 / 10 / 2-4150.
8. The procedure for issuing "Medical death certificates" in cases of death from certain diseases of the circulatory system / Guidelines. - M.: TsNIIOIZ, 2013. - 16 p.
9. Zayratyants O. V., Kaktursky L. V. Formulation and comparison of clinical and pathoanatomical diagnoses: a Handbook. 2nd ed., revised. and add. - M .: MIA, 2011.
10. National Manual of Pathological Anatomy. Ed. M.A. Paltsev, L.V. Kaktursky, O.V. Zayratyants. - M.: GEOTAR-Media, 2011.
11. International Statistical Classification of Diseases and Related Health Problems; 10th revision: In 3 volumes / WHO. – Geneva, 1995.
12. Collection of normative-methodical documents and standards for the pathoanatomical service. The system of voluntary certification of the processes of performing pathoanatomical studies and pathoanatomical services in healthcare. Federal Service for Supervision in Healthcare and Social Development of the Russian Federation. - M., Roszdravnadzor, 2007.
13. Industry standard "Terms and definitions of the standardization system in healthcare", OST TO No. 91500.01.0005-2001, put into effect by order of the Ministry of Health of the Russian Federation dated January 22, 2001 No. 12.
14. Order of the Ministry of Health of the USSR No. 4 of 01/03/1952, Appendix 7.
15. Order of the Ministry of Health of the USSR of 04.04.1983 No. 375 "On the further improvement of the pathoanatomical service in the country."
16. Methodological recommendations of the Ministry of Health of the USSR "Rules for the preparation of medical documentation for PJSC" (sectional section of the work). D.S.Sarkisov, A.V.Smolyannikov, A.M.Vikhert, N.K.Permyakov, V.V.Serov, G.G.Avtandilov et al., 1987
17. Federal State Statistics Service (Rosstat). www.gks.ru
18. WHO/Europe, European mortality database (MDB), April, 2014. http://data.euro.who.int/hfamdb.
19. Shevchenko O.P., Mishnev O.D., Shevchenko A.O., Trusov O.A., Slastnikova I.D. Coronary artery disease. – M.: Reafarm, 2005.
20. Kakorina E.P., Aleksandrova G.A., Frank G.A., Malkov P.G., Zayratyants O.V., Vaisman D.Sh. The order of coding the causes of death in certain diseases of the circulatory system - Archives of Pathology. - 2014. - T.76. - No. 4. - S.45-52.
21. Zairatyants O.V., Mishnev O.D., Kaktursky L.V. Myocardial infarction and acute coronary syndrome: definitions, classification and diagnostic criteria. - Archive of pathology. - 2014. - T.76. - No. 6. - S. 3-11.
22. Scottish Intercollegiate Guideline Network (2007). Acute Coronary Syndromes. SIGN; Edinburgh. http://www.sign.ac.uk/pdf/sign96.pdf. October 2009.
23. Kumar V., Abbas A.K., Astor J.C. Robbins Basic Pathology. 9th Ed. Philadelphia, London, Toronto, Montreal, Sydney, Tokyo: Elsevier Inc., 2013.
24. Avtandilov G.G. Fundamentals of pathoanatomical practice. Guide: 2nd ed. M.: RMAPO, 1998.
25. British Heart Foundation. Factfile: Non-atherosclerotic causes of myocardial infarction (2010). http//bhf.org.uk/factfiles
26. Egred, M., Viswanathan G., Davis G. Myocardial infarction in young adults. Postgraduate med. J. 2005; 81(962):741-755.
27. Kardasz I., De Caterina R., Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J. intern. Med. 2007; 261(4):330-348.

Heart dilemmas cause many difficulties for today's humanity, and not only in a figurative sense. Health complications, which are classified as a branch of cardiology, are considered the most common at the present time and the most dangerous for human life.

In this article, we will talk about one of these problems, which is called atherosclerotic cardiosclerosis, we will study the causes of its onset, symptoms, diagnostic methods, treatment and prevention technology.

Classification of the disease according to ICD-10

Today, it is almost impossible to meet the diagnosis of atherosclerotic cardiosclerosis in health documentation, and this, unfortunately, cannot be explained by a decrease in the incidence of this disease. The fact is that no self-respecting high-class specialist in the field of cardiology will expose his patient, since this term has not been used in the international codification of diseases for a long time.

Atherosclerotic cardiosclerosis, by its origin, is classified as a consequence or continuation of the heart, a specific modification of the disease. In the modern world, any diseases in medicine are classified based on the global nosology, which is provided by the ICD-10 document.

ICD-10 is a reference medical directory, where all diseases are assigned an encoding consisting of letters and numbers, which explains the diagnosis and its strict interpretation. The international classification of the latest modification does not contain a separate code for the disease "atherosclerotic cardiosclerosis", since this concept is considered too broad to clarify health problems. According to ICD-10, the disease is graded into several headings that identify its course, complexity and genesis:

1. Code I1 in the world classification, identifies the disease "atherosclerotic heart disease".
2. Encryption I20-I25 identifies coronary heart disease.
3. IHD of a chronic course is numbered with the code I25.
4. The code I00-I90 in the well-known systematization indicates pathologies in the circulatory system.

The essence of atherosclerotic cardiosclerosis and its systematization

Atherosclerosis is defined in medicine as pathological formations in the heart muscle, due to the replacement of a full-fledged epithelium with connective and scar tissues. Abnormal tissue interchange occurs after heart problems that cause replacement of certain segments of the heart with tissue that is unable to contract. The abnormal process is characterized by prolonged development without any special external symptoms, which makes its diagnosis almost impossible in the early stages of the genesis of the disease. Scar tissue is not able to perform the direct functional tasks of the muscle epithelium, which generates the development of serious heart problems, which are expressed in aneurysms or heart failure.

Specialists from the cardiology industry distinguish two key types of the disease according to its location:

1. Focal or fragmentary cardiosclerosis, characterized by tissue necrosis in a certain region of the main, which can have different scales. The complexity of therapy and the chances of recovery depend on the size of the pathological fragment.
2. The diffuse type of cardiosclerosis is characterized by a uniform distribution of pathological segments throughout the entire region of the organ, including the myocardium.

Additionally, the disease is usually integrated according to the root cause of its inception into the following types:

1. Atherosclerotic cardiosclerosis is a diffuse process that evolves against the background of IHD. Violations of the ischemic category develop mainly on the basis of thrombosis of the coronary vessels of the heart, after which the blood flow worsens, and as a result, the organ ceases to receive the necessary amount of oxygen and useful components for its normal functionality. Due to oxygen starvation, the organ begins to function with an excessive load, which entails its diffuse fouling with connective epithelium. The heart enlarges in volume, its contraction becomes spasmodic, and arrhythmia develops. As a rule, such an anomaly does not develop in one year, the time interval preceding the disease can last for many years. Epicrisis "IHD atherosclerotic cardiosclerosis" is considered the most typical for people of respectable and retirement age.
2. Postinfarction cardiosclerosis is classified as a very serious continuation of the myocardial infarction preceding the disease. Most often, post-infarction cardiosclerosis begins to progress, four months after the experienced heart attack, during the period when the stage of tissue scarring is completed. Since the scar epithelium does not have elasticity and adaptive indicators, unlike full-fledged heart tissues, the organ significantly loses its contractile properties, its muscles locally hypertrophy, and the heart chambers can increase in volume, which will affect the organ's capacity. Postinfarction cardiosclerosis is considered a very dangerous consequence of myocardial infarction and is diagnosed in almost every fourth patient who has survived the precedent. The key ways to prevent the disease are compliance with the recommendations of doctors, the correct regimen of the patient in strict monitoring of blood pressure. Post-infarction cardiosclerosis is often the cause of death for a patient in the first year after a heart attack, so prevention of the disease should be given maximum attention.
3. Postmyocardial cardiosclerosis is a pathology that can have both focal and diffuse localization, develops as a result of myocarditis of an infectious or non-infectious nature experienced by a person. Most often, inflammation of the heart muscle develops after illnesses suffered by the patient, such as tonsillitis, influenza or tonsillitis in a complex form, and are often an aggravation after rheumatism or diphtheria. The epicenters of the disease are formed as a result of destructive transformations in the stem cells of the heart muscle, they are distinguished by a strengthening of the structuring of the myocardium. The consequence of myocardiosclerosis is the formation of lattice seals around the heart, in which the cardiac fibers of the tissues are infringed, which inhibits the possibility of their normal contraction.

Causes and symptoms of the development of the disease

Any of the above modifications of atherosclerotic cardiosclerosis is considered a dangerous cardiological disease, often the cause of human death. In order to identify and prevent the further progression of the disease in time, it is necessary to know the causes of its development, as well as the symptoms that signal the patient about the ontogenesis of the disease.

Experts do not voice unequivocal etiological factors in the formation of the disease, since it can progress due to the presence of many motivators that in total provoke the disease and serious consequences. The underlying factor that leads to atherosclerotic cardiosclerosis is considered to be an excess of cholesterol components in the blood, deposited on the walls of blood vessels and arteries, thereby reducing the quality of blood circulation in the body. Plaques that block blood flow cause proliferation of the connective epithelium in the heart muscles, causing them to increase significantly in size.

Abnormal processes do not develop rapidly, their rate of progression depends on a number of negative indicators:

1. The age indicators of the patient directly affect the dynamics of the formation of atherosclerotic plaques. With age, processes occur in the human body that are characterized by a decrease in metabolism and a deterioration in the elasticity of blood vessels. Accordingly, cholesterol deposits form more rapidly on damaged and less elastic vessel walls than on healthy epithelium.
2. Genetic predisposition to the disease. The chances of getting atherosclerotic cardiosclerosis are higher in those people who have a hereditary predisposition to the disease.
3. Gender affiliation. Women are less likely to develop the disease in periods before menopause. The hormones present in their body help to reduce the risk of the genesis of the disease. After the onset of menopause, the chances of getting cardiosclerosis are equalized.
4. Bad habits. and nicotine is a provocateur of many diseases, including a deterioration in the elasticity of blood vessels and metabolic indicators, increasing the risk of the genesis of the disease.
5. Obesity. A common root cause of the deterioration of metabolism in the body and the provocateur of the accumulation of cholesterol in the blood is overweight, which is considered the result of an inactive lifestyle and poor nutrition of a person.
6. Associated diseases. The presence in the patient's pathogenesis of diabetes mellitus, problems with the heart and vascular systems of the body of complex etiology, liver failure or thyroid anomalies increase the risk of progression of the disease.

Symptoms of atherosclerotic cardiosclerosis often at its initial stages of ontogenesis are mild, their intensity increases in proportion to the degree of development of the disease and the volume of the affected segments of the heart vessels. Diffuse cardiosclerosis is very dangerous for health, as it affects the vital organ throughout the volume and is almost asymptomatic, which complicates its diagnosis in the initial stages. Most often, the disease makes itself felt by the appearance of cardiac arrhythmias and heart failure, which signal pathological transformations in the heart muscles and coronary vessels with fatigue, increased sweating, shortness of breath and swelling of the lower extremities.

Pain symptoms in the thoracic region, which have a aching or pulling character, may indicate the development of the disease. Mostly pain in the initial stages are mild in nature, however, over time, their intensity increases. Such symptoms are sometimes perceived by patients as a consequence of increased psychological or physical stress, however, ignoring it can have complex consequences.

Low intensity of manifestation and postmyocardial cardiosclerosis. Its most common symptoms include a decrease in blood pressure, rapid pulse and heart murmurs, which can only be heard by a doctor during an examination.

The signs of post-infarction cardiosclerosis include heart rhythm failures and tachycardia of varying degrees, systematic jumps in blood pressure, fatigue and sweating. Post-infarction cardiosclerosis is often detected in a timely manner, since patients after a heart attack must undergo regular diagnostic tests of the condition of the heart and coronary vessels, and are under the supervision of doctors.

Diagnosis and treatment of the disease

It is almost impossible to determine cardiosclerosis of any etiology solely on the basis of patient complaints, since the manifestations of the disease have symptoms similar to coronary artery disease and other heart pathologies. To make a correct diagnosis to the patient and prescribe a rational course of treatment, it is necessary to conduct a holistic examination of the patient and hardware diagnostics.

To confirm or exclude the diagnosis of "cardiosclerosis", a person needs to donate blood for biochemical microanalysis and urine, as well as undergo an ECG, which determines the presence and degree of pathological currents in the heart. The methods of auxiliary diagnostics of disorders include coronary angiography, rhythmography and echocardiography; MRI of the heart and blood vessels can be prescribed. The choice of the correct method of treatment and its effectiveness depend on the quality of the diagnostics performed.

The methodology for treating the disease varies depending on its typology, the complexity of the course and the degree of damage to the organ, and has several medical directions.

The main component of the treatment of cardiosclerosis is considered to be a change in the patient's lifestyle, which includes the rejection of junk food and addictions that favor an increase in blood cholesterol and the progression of the disease. Patients suffering from obesity are selected a special diet, which, on the one hand, includes a complex of all substances necessary for the life of the body, on the other hand, excludes fatty and flour ingredients that contribute to weight gain and cholesterol levels. A patient with cardiosclerosis should adhere to a rational daily routine with an effective distribution of time for rest and work.

Drug treatment of cardiosclerosis most often includes the following areas:

1. Restoration of blood circulation in the body with the help of drugs to expand the coronary vessels. For this purpose, "Nitroglycerin" or "Atenolol" is predominantly prescribed, as well as "Asparkam" or "Vitrum Cardio" to restore the functionality of the myocardium.
2. Medications from the statin group are prescribed to lower blood cholesterol levels - Rosuvastatin, Torval and others.
3. Blood thinners such as Cardiomagnyl or Aspirin Cardio inhibit the growth of sclerotic plaques in the blood and reduce the risk of vascular thrombosis.
4. Diuretics are prescribed to relieve swelling.
5. Medications "Captopril" or "Lisinopril" are prescribed to normalize blood pressure.
6. Sedative drugs to reduce the risk of emotional overstrain and stress.

Sometimes, in advanced cases, the patient may need surgery to repair defects in the heart. This may be an operation to eliminate an aneurysm, insert a pacemaker, stent or bypass blood vessels.

Medicine also does not exclude the prospects for the treatment of cardiosclerosis with folk remedies in combination with the parallel use of drugs. Infusions and decoctions of hawthorn, lemon balm, rue, cumin, Altai elecampane, rowan bark have an effective effect on the disease. It is also useful for cardiosclerosis to use lemon juice, red currant, a mixture of onion juice and honey. Daily use of homemade cottage cheese has a beneficial effect on the state of blood vessels, reduces the risk of developing cardiosclerosis.

In folk medicine, there are many different recipes for the treatment of cardiosclerosis, however, it is worth using them in integrated therapy only after a full examination and agreement with doctors. Self-medication often not only does not bring health benefits, but also causes significant harm to it.

Summing up

The diagnosis of "atherosclerotic cardiosclerosis" refers to diseases of the cardiological category. Pathologies in the heart and vascular systems of the body in recent years have become the leading cause of death for the current generation of people. Proper attention to one's health is a guarantee of early diagnosis of the disease and effective therapy at the initial stages.

It helps to prevent the disease by high-quality prevention of atherosclerosis from a young age, which consists in easy measures in the form of maintaining a healthy lifestyle.

Atherosclerotic cardiosclerosis is a pathology in which connective tissue grows in the heart due to atherosclerosis of the coronary arteries. Atherosclerotic cardiosclerosis ICD 10 code - I25.1.

Atherosclerosis-cardiosclerosis is one of the manifestations of IHD. Atherosclerotic cardiosclerosis is clinically manifested by heart failure, conduction and heart rhythm disturbances, angina pectoris. Diagnosis of the disease includes a number of laboratory and instrumental studies.

Treatment of this form of cardiosclerosis is conservative. The therapy is aimed at stopping pain in the heart, lowering cholesterol, normalizing conduction and heart rate, and improving blood circulation.

The main cause of the disease is the formation of atherosclerotic plaques at the site of the damaged tissue of the blood vessels. They are formed gradually, as the layering of cholesterol. Over time, the plaques increase in size, and the lumen of the vessel narrows accordingly. The result of this process is a violation of blood circulation, a curvature of the vessel, high blood pressure, and insufficient supply of oxygen to the tissues of the body.

Hypoxia of the heart occurs, which results in the development of coronary artery disease. In ischemic disease, myocardial function is impaired, muscle tissue is replaced by connective tissue, which does not have the necessary elasticity. As a result, pain in the heart appears, and the heart rhythm is disturbed.

Atherosclerotic plaques are formed as a result of exposure to the following causes:

• malnutrition - excess fat in the food consumed leads to the development of obesity and the deposition of cholesterol in the vessels;
• smoking - nicotine increases the level of cholesterol in the body and promotes platelet agglutination, which has a bad effect on blood vessels;
• diabetes;
• hypodynamia - low physical activity leads to the fact that the myocardium is poorly supplied with oxygen, as a result of which stagnant processes occur in it and the growth of connective tissue begins.

Kinds

There are the following forms of atherosclerotic cardiosclerosis (AK):

• diffuse small focal;
• diffuse macrofocal.

By types of AK can be:

• post-infarction - is formed at the site of myocardial tissue death;
• ischemic - develops due to heart failure, progresses slowly;
• transitional (mixed) - as the name implies, it combines the features of the two types of AK listed above.

Symptoms

The main danger of atherosclerotic cardiosclerosis is that at the initial stages of development this disease is asymptomatic.

Since AK is a form of coronary heart disease, doctors usually focus on the clinical signs of this particular disease. However, there are a number of symptoms by which atherosclerotic cardiosclerosis can be diagnosed.

First of all, such symptoms include pain in the heart, which can be aching or sharp. Pain can be observed not only in the region of the heart, but also to give to the left arm or shoulder blade. In addition, with AK, the patient has a feeling of constant fatigue, tinnitus, and headaches.

Another characteristic symptom of the disease is shortness of breath. It occurs gradually, at first after a strong physical overstrain, then during normal walking or even at rest.

With AK, an exacerbation of cardiac asthma occurs, and tachycardia develops (heart rate reaches 150 or more beats per minute in a calm state). One of the most striking symptoms of atherosclerotic cardiosclerosis is swelling of the extremities, which occurs due to problems with the liver.

Diagnostics

In order to make an accurate diagnosis, the doctor interviews the patient and studies his medical history. The specialist is interested in the presence of a history of atherosclerosis, arrhythmias, coronary artery disease and other pathological conditions. During the interview, the doctor finds out what the patient is complaining about and identifies the symptoms of the disease.

After that, a number of laboratory and instrumental studies are assigned to make an accurate diagnosis, the most common of which are:

• ECG - is performed to detect myocardial hypertrophy, detect scar tissue on it, detect heart rhythm disturbances and vascular insufficiency;
• blood test (biochemical and general) - shows a high content of cholesterol and other lipids;
• bicycle ergometry - helps to identify the degree of heart dysfunction and determine the functional reserves of the myocardium;
• echocardiography - allows you to determine the violation of the contractile function of the heart muscle.

Treatment

It is impossible to completely get rid of such a pathology as coronary heart disease atherosclerotic cardiosclerosis. Treatment of this pathology consists in the prevention of exacerbations and relief of symptoms.

First of all, drugs that lower blood cholesterol levels are prescribed. Most often, these are drugs from the group of statins. The duration of the course of treatment and the dose of drugs is determined by the doctor. As a rule, treatment is long-term, and sometimes life-long.

In addition to statins, the appointment of vasodilators or agents that strengthen the walls of blood vessels is indicated.

If the course of atherosclerotic cardiosclerosis is accompanied by angina pectoris or there is a threat of developing a heart attack, then it is possible to perform surgery, during which the largest vascular plaques are removed.

In parallel with the main therapy, the doctor may prescribe tranquilizers or antidepressants.

It should be remembered that self-medication is unacceptable! The attending physician should prescribe certain drugs, determine their dosage and the duration of the course of treatment. Otherwise, the development of a number of serious complications and even death of the patient is possible.

Forecast

In severe cases, the possible outcome of the disease is atherosclerotic cardiosclerosis - death.

The prognosis is affected by the degree of myocardial damage, the presence of concomitant diseases, arrhythmias. In severe cases, signs of ascites and pleurisy are observed, heart failure develops. In the event of an aneurysm rupture, atherosclerotic cardiosclerosis is the cause of the patient's death.

Prevention

It is known that any disease is easier to prevent than to treat it for a long and painful time. This statement also applies to atherosclerotic cardiosclerosis. To prevent the development of this disease, as well as its complications, it is necessary, first of all, to eat right.

Atherosclerotic cardiosclerosis - diet:

• limit or completely eliminate salt from the diet;
• do not eat after six in the evening;
• exclude substances that excite the cardiovascular system and central nervous system (cocoa, tea, coffee, alcohol);
• limit the consumption of cholesterol-containing products (animal entrails, eggs, brains);
• exclude some vegetables from the diet (radish, radish, onion, garlic);
• exclude products that provoke gas formation (cabbage, milk, legumes);
• food must be steamed, without salt, baked and boiled food, fruits and vegetables (except for the above) are also allowed.

In addition to diet, it is necessary to lead a healthy lifestyle and be sure to play sports (swimming, walking, and so on) to strengthen the heart muscle.

It is necessary to undergo preventive examinations at the clinic at least once a year. This makes it possible to detect most CVS diseases at an early stage, which greatly facilitates treatment and makes the prognosis more favorable. If you have the first signs of the disease, you should immediately seek help from a specialist.

Myocardial form of cardiosclerosis develops at the site of the former inflammatory focus in the myocardium. The development of myocardial cardiosclerosis is associated with the processes of exudation and proliferation in the myocardial stroma, as well as the destruction of myocytes. Myocarditis cardiosclerosis is characterized by a history of infectious and allergic diseases, chronic foci of infection, usually by the young age of patients. According to the ECG, diffuse changes are noted, more pronounced in the right ventricle, conduction and rhythm disturbances. The borders of the heart are uniformly enlarged, blood pressure is normal or reduced. Right ventricular chronic circulatory failure often develops. Biochemical parameters of blood are usually not changed. Weakened heart sounds are heard, accent of the III tone in the projection of the apex of the heart.
Atherosclerotic form of cardiosclerosis usually serves as a manifestation of long-term coronary heart disease, characterized by slow development and diffuse nature. Necrotic changes in the myocardium develop as a result of slow dystrophy, atrophy and death of individual fibers caused by hypoxia and metabolic disorders. The death of receptors causes a decrease in the sensitivity of the myocardium to oxygen and the progression of coronary artery disease. Clinical manifestations for a long time may remain scarce. As cardiosclerosis progresses, left ventricular hypertrophy develops, then heart failure occurs: palpitations, shortness of breath, peripheral edema and effusion in the cavities of the heart, lungs, and abdominal cavity.
Sclerotic changes in the sinus node lead to the development of bradycardia, and cicatricial processes in the valves, tendon fibers and papillary muscles can lead to the development of acquired heart defects: mitral or aortic stenosis, valvular insufficiency. During auscultation of the heart, a weakening of the first tone is heard in the projection of the apex, a systolic murmur (with sclerosis of the aortic valve - very rough) in the region of the aorta and the apex of the heart. Develops left ventricular circulatory failure, blood pressure above normal values. In atherosclerotic cardiosclerosis, conduction and rhythm disturbances occur as blockades of varying degrees and sections of the conduction system, atrial fibrillation and extrasystole. The study of biochemical parameters of blood reveals an increase in cholesterol, an increase in the level of β-lipoproteins.
The post-infarction form of cardiosclerosis develops when the site of dead muscle fibers is replaced by scar connective tissue and is of a small or large focal nature. Repeated heart attacks contribute to the formation of scars of various lengths and localizations, isolated or interlocking with each other. Postinfarction cardiosclerosis is characterized by myocardial hypertrophy and expansion of the heart cavities. Cicatricial foci can stretch under the influence of systolic pressure and cause the formation of an aneurysm of the heart. Clinical manifestations of postinfarction cardiosclerosis are similar to the atherosclerotic form.
A rare form of the disease is primary cardiosclerosis, which accompanies the course of collagenosis, congenital fibroelastosis.