The definition and classification of coronary heart disease

In 1979 the World Health Organization is the definition of coronary heart disease: As the coronary functional change or organic diseases caused by coronary blood flow and myocardial demand caused by an imbalance between myocardial damage, including chronic and acute temporary situation. Ischemic heart disease, the breakdown is as follows: (1) of primary cardiac arrest: Primary cardiac arrest is a sudden incident, it is envisaged due to instability caused by ECG no other diagnosis can be made the basis. If not for recovery or recovery failure, primary cardiac arrest attributed to sudden death. Previous evidence of ischemic heart disease dispensable, if the death occurred when nobody to see, the diagnosis is conjectural in nature. (2) angina: ① exertion angina: exertion angina is characterized by the movement or other increased myocardial oxygen demand in the short-term induced by the onset of chest pain, rest or sublingual nitroglycerin, pain often can vanish quickly. Exertion angina can be divided into three categories: a beginning of the exertion angina: exertion angina course within one month. B-exertion of stable angina: exertion angina course stability one month or more. C deterioration of exertion angina: the same degree of fatigue induced by the onset of chest pain frequency, severity and duration gradually worsened. ② spontaneous angina: spontaneous angina is characterized by chest pain onset and the increase in myocardial oxygen demand no obvious relationship. Compared with the exertion angina, this pain generally longer duration, extent heavier, and are not easily nitroglycerin is easing. No enzyme changes. ECG often have certain temporary ST-segment depression or T wave changes. Angina may occur spontaneously alone, or combined with the exertion angina exist. Spontaneous pain in patients with angina attack frequency, duration and degree of pain may have different clinical manifestations. Sometimes, patients may have a longer duration of chest pain attacks, similar to myocardial infarction, but no ECG and the characteristics of the enzyme changes. Some spontaneous angina patients, in the attack at a temporary ST-segment elevation, often called variant angina. But in early myocardial infarction map ECG recording of this type, can not use this name. (3) myocardial infarction: ① acute myocardial infarction: The clinical diagnosis of acute myocardial infarction in accordance with regular history, ECG and serum enzyme changes to take place. History: typical history is a serious and long-lasting chest pain. Sometimes, history is not typical, and the pain can be mild or not, other symptoms can be mainly. ECG: the certainty of change in ECG is abnormal, lasting Q-wave and continuous wave or QS day above current evolution of the injury. When there are certainly ECG changes, ECG alone can make the diagnosis. Some other cases, there are uncertainties electrocardiogram showed changes, including: a static injury current; b T-wave inversion symmetry; c single ECG records of a pathological Q wave; d conduction hampered. Serum enzyme: a positive change in serum enzyme concentrations, including changes in the sequence, and then began to increase or lower. Such changes must be specific enzymes and blood samples taken symptom onset and the time lag associated. Cardiac-specific isozyme also increased certainty of change. B not sure at the beginning of change for the concentration increased, but not with the subsequent reduction in activity can not curve. Judge: a definite acute myocardial infarction: if there is certainty of ECG changes and / or changes in affirmative enzyme can be diagnosed as acute myocardial infarction clear. History may be typical or non-typical. B possible acute myocardial infarction: When sequence, electrocardiogram changes uncertainty continued over 24 hours and above, with or without the uncertainty of change, may be diagnosed as acute myocardial infarction. History may be typical or non-typical. In acute myocardial infarction recovery, some patients may show spontaneous chest pain, sometimes accompanied by ECG changes, but no new enzyme changes, some of these cases can be diagnosed as post-infarction Dressler's syndrome, as some spontaneous angina patients, while others relapse of acute myocardial infarction may be extended . Other diagnostic measures may contribute to the establishment of the exact diagnosis. ② old myocardial infarction: old myocardial infarction often under affirmative electrocardiogram changes, and no history of acute myocardial infarction to make changes in the diagnosis. If there is no legacy electrocardiogram changes, according to earlier typical ECG changes or based on past positive changes in serum enzyme diagnosis. (4) ischemic heart disease in heart failure: Ischemic heart disease may occur due to various reasons heart failure, it can be acute myocardial infarction or previous myocardial infarction complications, or may be angina attack or arrhythmia induced by. In the absence of ischemic heart disease before clinical evidence of heart failure or electrocardiogram (rule out other reasons), the diagnosis of ischemic heart disease is still speculative. (5) arrhythmia: Arrhythmia is ischemic heart disease can be the only symptom. In such circumstances, unless proven coronary obstructive coronary angiography, or the diagnosis of ischemic heart disease is still conjectural nature. "Infarction angina before" and "intermediate coronary syndrome" This does not include the name of this report. According to the group, the diagnosis is reminiscent of the former diagnosis, only in a few cases been confirmed. Then a diagnosis of all cases can be attributed to this report describes ischemic heart disease in a classification.