ICD-10 code for acute coronary syndrome - I20.0 (unstable angina). These symbols describe such a state of a person when the blood supply to the heart muscle suddenly weakens. Pathology is extremely dangerous. Statistics say that the probability of death in the first quarter of an hour, especially without qualified assistance, reaches 40%. The smartest way to minimize risk is to know what ACS is, why the condition appears, and how to prevent it.
General view
In the ICD-10 code of acute coronary syndrome I20.0, a disease is recorded in which fatty accumulations form on the arterial walls. Normally, these vessels feed the heart muscle - with blood, an influx of nutrients and oxygen is provided here. Normally, the human heart can work strictly in the presence of a constant,stable blood flow, rich in essential substances. Acute coronary syndrome occurs when an artery becomes blocked. In the predominant percentage of cases, the cause is a thrombus. The supply of oxygen to the myocardium barely decreases, the cells begin to die, lacking the most important chemical compound for life.
In medicine, a violation of the supply of full-fledged blood to organic tissues is called ischemia. With ACS, this process causes premature death of large volumes of muscle fibers that form the heart - a heart attack occurs, a heart attack.
Acute coronary syndrome is possible, in which mass death of muscle cells does not occur, but the myocardium is still significantly harmed. This condition can be one-time or chronic. If ACS does not cause ischemia, the characteristic of the patient's condition is unstable angina.
How to notice?
Coded with symbols I20.0 in the ICD, acute coronary syndrome is not just a dangerous disease, but also a condition that comes suddenly. In the predominant percentage of cases, the attack begins unpredictable for the patient. Main manifestations of ACS:
- unpleasant, painful sensations in the chest, upper limbs, jaw, back, abdomen;
- dizzy, headache;
- sick and vomit;
- hard to breathe;
- sweat production is activated;
- dyspepsia.
The most striking sign of ACS is chest pain. In each case, the set of manifestations of acute coronary syndrome is determinedindividual characteristics of the patient. The age of the patient, gender, general condition of the body, the presence of concomitant he alth disorders play a role.
Risk group
From statistics it is known that acute coronary syndrome often develops in people who are characterized by the following features, disorders:
- diabetes mellitus;
- genetic predisposition;
- middle and older;
- presence of bad habits;
- high blood pressure;
- high cholesterol in the circulatory system;
- sedentary lifestyle;
- extra pounds;
- malnutrition.
Of the bad habits with the greatest risk of ACS, smoking is associated. Age groups and the likelihood of developing acute coronary syndrome correlate as follows: for men, the probability is higher over the age of 45, for the fair sex - after crossing the 55-year milestone.
We'll check everything
To verify the correctness of the proposed diagnosis and the I20.0 code used according to the ICD, acute coronary syndrome is clarified with the help of special studies. If the doctor has prescribed such measures, it is important to go through all the required procedures - this will help to identify in a timely manner how great the risk of ischemia is, and therefore, take measures to ensure a long and he althy life.
If ACS is suspected, the risk of the condition is assessed as high, the patient must be sent for an electrocardiogram. InDuring the examination, they check how actively the heart is working. Special electrodes are used, fixing them on strictly specified areas of the body. If the study shows abnormal impulses or lack of regularity, the organ is likely to work poorly, with malfunctions. When diagnosing an acute coronary syndrome, sometimes the information obtained through an ECG is enough to localize the location of a blood clot.
Clarification of the patient's condition is possible with the help of blood tests. If the cells die, damage is done to the heart muscle, usually in samples taken from the circulatory system, traces, enzymes, characteristic of this condition can be seen. If the result is positive, enzymes are detected, we can confidently talk about a heart attack, acute coronary syndrome. The ICD code for this condition is I20.0.
Suspicion of ACS is a reason to do a cardiac scintigraphy. The study evaluates how much blood flows to the main organ of the body. Physicians can understand how extensive muscle damage is due to acute coronary syndrome with or without ST elevation.
Sometimes a Holter monitoring is recommended. This is a long-term study - with devices that record the specifics of the work of the heart muscle, you will have to walk for 24 hours. A special mechanism records the activity of the organ, and the doctor deciphers the data. With the help of monitoring, you can understand what are the heart rhythm disturbances, at what moments the heart does not receive the necessary volume of blood. A certain number of cases are known when timely medical care for acutecoronary syndrome was not provided due to the absence of symptoms of this serious condition. Daily monitoring using the Holter method eliminates this situation.
What to do?
Treatment of acute coronary syndrome is possible only in a hospital setting. The patient needs an ambulance, and only specialists with education and access to the equipment and medicines necessary in this case can provide it. Primary measures are aimed at relieving pain and optimizing blood circulation - this will restore cardiac functionality. After providing emergency care for acute coronary syndrome, a comprehensive treatment program is prescribed. There is a high probability that doctors will recommend going for surgery. You will also have to take medication.
Among the medications for ACS, it is worth noting the following categories:
- beta blockers;
- angiotensin receptor inhibitors;
- ACE inhibitors;
- nitroglycerin;
- corrective clotting, blood viscosity substances;
- statins.
If medical care for acute coronary syndrome does not show the desired result, surgical intervention is recommended - stenting, bypass or angioplasty. If the doctor has referred for surgery, you should not delay: delay can cost the patient's life.
Important recommendations
Acute coronary syndrome requires the patient to radically change lifestyle, daily habits. Because provoke ACSmay have heart and vascular diseases, you will have to start their treatment, as soon as the doctor warned about the risk of such a condition. In the absence of such diseases, it is possible to prevent ACS if you completely abandon bad habits and lead an active lifestyle. The diet should be reviewed, excluding fatty and spicy, s alty and canned foods from it. Instead, you should consume plenty of fruits and vegetables. Whole grain, protein meals are considered he althy foods.
To keep fit, you should constantly give the body physical activity. The optimal mode is up to three hours a week. Keep your heart rate under control and regularly check your blood pressure, take tests to check the amount of cholesterol in the circulatory system, and take measures to prevent being overweight or underweight.
In order not to learn from experience what acute coronary syndrome without ST segment elevation or with such is, people who have already experienced a heart attack will have to regularly use acetylsalicylic acid. This substance prevents the formation of blood clots. Doctors estimated that the risk of a recurrence of a heart attack only thanks to Aspirin is reduced by almost a quarter.
Terms and nuances
Acute coronary syndrome in ICD 10 is coded as I20.0. The peculiarity of this item of the classification system is its name. ACS, known to doctors and patients in our country, is not the terminology that has become widespread internationally, so the world classifier knows only unstable angina. That is the name of the disease, inscribedin ICD-10. However, just the difference in wording (I20.0 also denotes an intermediate coronary syndrome) does not mean that the patient can not be helped or that some other measures are required. With ACS, you need to help exactly as recommended for the diagnosis of ICD I20.0.
The code for acute coronary syndrome (I20.0) should be known to doctors who draw up a patient's medical history, but for the layman these characters are not so important. It is much more important to understand all the dangers associated with a pathological condition, to have an idea of the necessary assistance measures. To be guided in how to alleviate the patient's condition should not only be persons at risk for ACS, but also their relatives, relatives and colleagues. In the event of an attack, it is they who will be responsible for calling an ambulance in a timely manner and providing the patient with conditions in which to wait for the doctor with minimal damage (as far as possible).
Disease: how does it all begin?
Acute coronary syndrome without ST-segment elevation and with such may appear on the background of atherosclerosis. Doctors have established a sequence of events leading to a high degree of ACS. It all starts (in the predominant percentage of cases) with infection. Infection is possible in a variety of ways:
- herpetic viruses;
- cytomegalovirus;
- flu;
- adenoviruses.
A pathological agent provokes inflammatory processes on the internal vascular membranes, which means that the integrity of organic tissues is violated. This leads to the accumulation of low-density lipoproteins,a specific plaque that narrows the vascular lumen and slows down the speed of blood flow. Platelets merge, stick to the vascular walls. These localizations become places of fibrin accumulation, and after a while a dense thrombus appears, preventing blood from reaching a certain area of the heart muscle.
Acute coronary syndrome without ST and with the rise of this segment is possible due to arterial spasm associated with strong feelings or a hypertensive crisis. Blockage of the vessel is possible due to the entry of a formation from another part of the circulatory system into it - a blood clot can appear in any artery, break off and begin its “journey” through the body.
Higher risk of experiencing ST-segment elevation acute coronary syndrome, without it, in individuals who regularly experience increased stress. These conditions give rise to the need for an increased supply of oxygen, and the circulatory system cannot always provide the supply of the necessary chemical components. Increased clotting of the main fluid of the human body - blood - can play its role. Women who take oral hormonal contraceptives are thought to be at risk for ACS.
Chemistry and medicine
ST-elevation acute coronary syndrome is triggered by the formation of blood clots. This also explains the ACS without lifting this segment. A feature of the process is the release of active components during thrombosis. Histamine, serotonin, and some other substances that have a local effect onVessels: gaps decrease, which means that the blood flow becomes even weaker, the supply of fluid to the organs and tissues that need them decreases.
At the same time, calcium and adrenaline affect the circulatory system. The work of components that prevent blood clotting is inhibited, and enzymes are released into the liquid that violate the integrity of he althy cells near necrotic areas.
Acute coronary syndrome with or without ST elevation can be prevented by restoring the quality of blood flow. It is categorically difficult to reverse the processes, it requires complex treatment, but even the normalization of blood circulation already makes it possible to slow down the negative progress of the situation. At the same time, doctors pay attention: areas of myocardial necrosis are scarring, in the future they will not participate in contractile muscle movements, and heart failure will gradually increase.
Forms and Features
Aid for acute coronary syndrome is provided based on the characteristics of the patient's condition. It is customary to distinguish three options for the development of the situation:
- unstable angina due to reduced blood supply to muscle tissue;
- heart attack, when dystrophic areas are formed, subject to necrotic changes due to the complete lack of blood supply;
- ventricular fibrillation.
The latter leads to clinical death. It is observed more often against the background of sudden changes, due to a violation of the ability of cells to be excited. The patient is suffering from acutearrhythmias. It is necessary to provide emergency medical care in intensive care.
Features of manifestations
Provision of assistance in acute coronary syndrome is possible after the removal of primary information by ECG. The analysis may indicate acute ischemia (this is expressed by the rise of the interval), there is ACS without rise. The main clinical manifestation is pain; the strength of the syndrome varies greatly. Feelings behind the sternum disturb a third of an hour or longer. Perhaps the spread of pain in the shoulder blades, neck. Nitroglycerin does not show a pronounced effect.
If ACS has developed in an elderly person, the main manifestation is general weakness. The pressure drops, shortness of breath is observed. Sometimes the patient loses consciousness.
Non-classic symptoms recorded relatively rarely:
- abdominal pain;
- vomiting, nausea;
- stabbing pains;
- increased pain on inspiration.
To provide adequate assistance to the patient, the doctor must know whether there have been heart attacks in the past, what are the primary symptoms, what is the nature of the pain, how does it change over time.
Help and do no harm
In acute coronary syndrome, the emergency care algorithm is as follows:
- Give a tablet of acetylsalicylic acid and nitroglycerin.
- Lay the patient down in a comfortable position.
- Reassure the patient.
- Call an ambulance, describing all the symptoms by phone.
As soon as they arrive, doctors will take an ECG, analyze the information received and provide primary measures to support vitalfunctions. It is supposed to use painkillers - narcotic drugs, nitrates, injections of anti-spasm drugs. They give drugs that reduce blood viscosity ("Reopoliglyukin", "Heparin"). Doctors will have everything they need with them in a special kit for primary care "Laying for acute coronary syndrome". Such kits are sold in most pharmacies in our country.
The patient is transferred to a hospital for special care. If the ECG shows normal or close to normal data, choose the methods of assistance based on the characteristics of the symptoms.
Stacking for assistance with acute coronary syndrome is completed taking into account the orders issued at the federal and regional levels. The Ministry of He alth and Social Development is responsible for such instructions.
In case of ACS, the patient is taken to the intensive care unit. If the condition is relatively stable, intensive therapeutic treatment is sufficient. The algorithms for the actions of doctors are described in the official documentation regulating the work of the clinic. Doctors are required to obey the established rules.
Had a heart attack
If a heart attack is diagnosed, give the patient a nitroglycerine tablet under the tongue. An alternative is an aerosol with this substance, applied three times. There are five-minute breaks between procedures. If the pain syndrome persists and the pressure is from 90 units and above, the introduction of nitroglycerin into a vein through a dropper is indicated.
To alleviate the condition a littlepatient, it is allowed to inject morphine sulfate mixed with saline into the vein. To reduce blood viscosity, acetylsalicylic acid, "Clopidogrel" is used.
Beta-blockers can be used if tests confirm the absence of atrioventricular blockade, and there is no mention of asthma, acute heart failure in the medical history. The funds "Egilok", "Propranolol" were widely used.
Clinical guidelines for acute coronary syndrome include situation analysis and identification of factors that stimulate coronary disease. They must be eliminated as soon as possible. In a hypertensive crisis, you should lower the pressure and use drugs to eliminate arrhythmias.
Based on the change in the ECG, decide on the need for thrombolysis.
Thrombolysis: what is it and why is it needed?
The term is used to denote the introduction into the patient's body of a drug capable of dissolving a blood clot. This procedure should be started within the first 120 minutes of the onset of ACS symptoms. Thrombolysis is performed by strictly qualified doctors.
Streptokinase is used for intravenous administration. If 12 hours or more have passed since the onset of ACS, thrombolysis is absolutely ineffective - the formed thrombus cannot be dissolved by drugs. Medications containing streptokinase must be administered through a dropper into a vein in a hospital setting. The best prognosis in those patients who received the drug drip in the first half hour after admission to the departmentintensive care. It is unacceptable to do the thrombolysis procedure under the following conditions:
- high blood pressure;
- past stroke;
- bleeding;
- cranial injuries received in the last quarter of the year;
- presence of a malignant neoplasm in the brain.
What to do next?
Continuation of therapy is chosen based on the effectiveness of primary measures. If it was possible to stabilize the patient's condition, ease the pain syndrome, while the heart beats rhythmically, at an adequate speed, and the pressure is maintained at an average level, the classical treatment of ischemia is sufficient. It is necessary to constantly take ECG indicators to monitor the patient's condition.
When an attack and arrhythmia recur, in a situation where the ECG shows negative changes in the activity of the heart muscle, the patient should be urgently sent to the intensive care unit for surgical intervention. A shunt or stent may be placed. A specific option is chosen based on the characteristics of the case.
ACS is currently recognized as one of the most dangerous pathological conditions for human life. The patient needs to provide him with emergency care in intensive care. Procrastination, wrong actions - all this can provoke a fatal outcome.
OKS: features
The pathological condition manifests itself as severe, acute pain. Seizures are possible. With angina pectoris, patients describe attacks as short-term, burning, as if squeezing in the chest. heart attackaccompanied by pain shock. Patient needs urgent hospitalization.
OKS shows itself:
- cold sweat;
- excitement;
- panic;
- skin blanching.
With such symptoms, it is important not only to call an ambulance in a timely manner, but also to be with the patient until the doctors arrive. You can not leave the patient alone - this significantly increases the risk of death. You need to be especially attentive to a person who is sick and vomits, as well as prone to loss of consciousness.
If, after assessing the patient's condition, it was decided to resort to surgery, choose the most suitable method for the case. Stenting is an intervention in which they reveal where the artery is narrowed, bring a catheter here using a small balloon, and expand the lumen of the blood vessel. For fixation, a stent is used - a special mesh that is not rejected by the tissues of the human body.
If bypass surgery is indicated, then some of the coronary arteries are removed and implants are placed instead. A timely and correct operation is the best way to prevent a heart attack.
Status has stabilized: what's next?
If a person has survived ACS, he will have to adhere to the restrictions and rules all his life, otherwise the situation is likely to repeat, and the risk of death becomes even higher. General rules of conduct:
- until condition shows steady improvement, stay in bed;
- exclusion from life of stress factors, strongemotions;
- no exercise.
When the condition stabilizes so that the doctors allow physical activity, it is recommended to walk in the fresh air every day. You will have to walk slowly, and the walks themselves should not be long, otherwise they will do more harm than good.
We'll have to reconsider the diet, exclude spicy and s alty, sweets and fat content, any heavy foods. It is strictly forbidden to drink alcohol. The percentage of products of animal origin is minimized, and s alt is used per day in an amount of not more than 6 g. You can not eat richly seasoned food, spicy dishes. You need to follow these rules in the rehabilitation period and after it - in a word, all your life.
If you deviate from the recommendations of the doctor, ACS will cause complications, and relapse is associated with an increased likelihood of death.
Consequences of ACS
Against the background of ACS, the probability is increased:
- faults in the rhythm of the heartbeat in various forms;
- insufficient functioning of the heart muscle in an acute form;
- inflammation of the heart membranes;
- aortic aneurysm;
- fatal.
Even with first aid in the shortest possible time, the risk of relapse is quite high, as is the likelihood of complications. To reduce the dangers to yourself, after ACS you will have to regularly visit a cardiologist for a full systematic examination. It is important to follow the recommendations of the doctor - this will prolong life.
How to warn?
Prevention of ACS involves the rejection of bad habits and the transition to a limited diet with the exception of fatty and s alty, spicy. You should constantly give yourself physical activity, avoid stress and overwork. Persons who are at increased risk of ACS are advised to go for walks on weekends, you can even go on non-sporting trips - such hikes are regularly organized by amateurs in almost any city in our country.
People at risk for ACS should have a tonometer at home and monitor their blood pressure, regularly donate blood to detect cholesterol levels. The therapist at the appointment will tell you which specialized doctors you will have to come for an examination, with what frequency you need to visit doctors. To prevent ACS, you will have to follow the advice. Any identified diseases, especially those affecting blood vessels and the heart, should be treated in a timely manner.
