Specialists note a frightening increase in the number of heart diseases among the population. In addition, the age at which they first manifest has greatly decreased. As a rule, people do not pay attention to the symptoms until trouble happens, but even a slight ailment can be a sign of a serious heart disease. Classification according to the functional classes of angina pectoris shows well the "secrecy" of the disease. Changes happen so gradually that people get used to them and do not consider it necessary to be treated.
Classification of stable angina
There are several varieties of angina pectoris, each of which has both common characteristics for the group and unique symptoms that make it stand out from the rest. Stable angina is a type of exertional angina. It is characterized by the appearance of pain during exercise and the disappearance of discomfort at rest.
The following functional classes of angina pectoris are distinguished:
- First class - pains appear only with excessive loads and quicklypass in peace.
- Second class - chest discomfort when walking more than 300 meters or climbing stairs.
- Third class - pain appears after overcoming a distance of 150 meters or walking up the stairs to one floor.
- Fourth grade - seizures occur with light exertion and at rest.
Unstable angina
Unlike the previous type, unstable angina is manifested by intense pain that is not associated with physical activity. In addition to the functional class, angina pectoris of this type is divided into four forms:
- First time angina pectoris. It is considered as such if the first attack occurred no later than two months ago. It is dangerous because it can be a symptom or a harbinger of myocardial infarction. Able to transform into a stable type of disease.
- Progressive. Attacks become more frequent and stronger, signs of myocardial hypoxia appear on the cardiogram. It is possible to change the functional class to a lower one.
- Early postinfarction. Chest pain persists for two weeks immediately after myocardial infarction.
- Vasospastic. It is also called variant, or Prinzmetal's angina. This form is characterized by nocturnal seizures that are not associated with physical activity.
Braunwald classification
To determine the likelihood of myocardial infarction,use the classification proposed by Braunwald to characterize pain. It does not affect the functional class of angina pectoris in any way, but only expands the diagnostic capabilities of the doctor without the use of instrumental research methods.
First class refers to first-time exertional angina whose symptoms have worsened over the past two months.
Second class is rest angina or its subacute form, but only if it has not appeared less than two days ago.
Third class includes acute angina pectoris and rest angina pectoris that has manifested itself in the last forty-eight hours.
According to provoking factors
There are several more classifications of exertional angina. Functional classes are not the only marker that determines the severity and course of the disease.
According to the factors that can provoke the disease, the following varieties are distinguished:
- A - anemia, hypoxia, infection and other non-coronary causes;
- B - primary angina pectoris of unknown etiology;
- C - postinfarction variant of the disease, formed within two weeks after the acute process.
In the first case (A), the doctor is dealing with secondary angina pectoris and is forced to treat not only it, but also the primary focus. In the other two options (B and C), the situation is different, since the causes of the disease lie directly in the organ itself.
Rizik classification
Functional classes of stable angina pectoris can be supplemented by the Rizik classification, which, in addition to subjective sensations, also takes into account ECG readings.
- First A-class - angina symptoms increase from attack to attack, but there are no changes on the cardiogram.
- First B-class - with increasing pain intensity, objective changes appear on the ECG.
- Second class - the cardiogram reflects changes characteristic of first-time angina pectoris.
- Third grade - ECG shows signs of resting angina.
- Fourth grade - in addition to rest angina, the cardiogram shows a deterioration in the dynamics of the heart and myocardial hypoxia.
Canadian Heart Society Classification
One of the options for classifying angina into functional classes was proposed by Canadian cardiologists in the mid-2000s. It includes five classes:
- Null, when there are no symptoms of the disease, both during exercise and at rest.
- First. Significant physical exertion or emotional stress can provoke an attack of chest pain.
- Second. Slight discomfort behind the sternum appears with intense physical activity.
- Third. Pain and shortness of breath occur regularly during daily activities.
- Fourth. Symptoms can cause even the smallestload.
This classification is used by doctors in the Western Hemisphere, for domestic doctors, the ranking that was given at the very beginning is more familiar, so the diagnosis is written, for example: "CHD: angina pectoris, functional class 2". But this does not mean that our specialists are not familiar with this division of functional classes.
Variant angina
Stable exertional angina, the functional classes of which are described above, also includes a variant type of flow. It has many names, but the essence remains the same: attacks of retrosternal pain appear suddenly, without connection with physical exertion, usually at night or in the morning. Discomfort is caused by spasm of the arteries that feed the heart, but they usually do not reveal any morphological changes that would indicate the presence of atherosclerosis.
Patients who regularly suffer from attacks of variant angina pectoris may not pay attention to the development of such a formidable disease as myocardial infarction, since the symptoms will be similar. Such negligence can cost a person his life if he is not provided with medical assistance. Seizures are corrected with calcium antagonists or nitrates.
Types of angina downstream
Since there are functional classes (FC) of angina pectoris, it means that there are other types of this disease. One of the classifications uses the features of the flow to distinguish fourmanifestation of angina pectoris:
1. For the first time: the pain lasts about a month (but not more than two), they are frequent and intense, directly related to the physical activity of a person. Over time, this species becomes stable. An unfavorable option is when during an attack there is an increase in the ST segment on the cardiogram.
2. Progressive: if the frequency and severity of pain attacks increase even during treatment, this indicates an aggravation of the disease, a decrease in the compensatory abilities of the body and a high risk of heart attack. Patients may experience anxiety and fear of death, asthma attacks.
3. New-onset angina pectoris: If the heart muscle does not receive enough blood due to reduced cardiac output or atherosclerosis of the coronary arteries, then angina attacks may occur at rest. Most often, pain occurs during sleep, since the horizontal position of the body changes the amount of venous blood that returns to the heart, and hence the subsequent cardiac output.
4. Stable angina: the frequency and intensity of attacks do not change over time, the disease is well controlled by drugs and does not threaten critical conditions. But you should not treat this type of disease irresponsibly, because at any time the condition may worsen.
