Functional classes of angina pectoris table

With this form
angina pectoris also recommended
the appointment of statins and antiplatelet agents.
For the prevention of pain syndromes
First of all, BBs are assigned, and when
insufficient efficiency use
calcium antagonists and long-acting nitrates
actions. In cases of persistent
angina pectoris prescribed ACE inhibitors
and nicorandil. There is evidence of effectiveness
ivabradine and ranolazine.

Sick stable
angina pectoris I-II FC without violation
heart rate and conduction may
sent as to local cardiological
sanatoriums as well as distant balneological
and climatic resorts. With angina pectoris
III — IV FC sanatorium treatment
contraindicated.

From this article you will learn: what is angina pectoris, the causes of its development. What are its types (functional classes – abbreviated as FC), symptoms and treatment of the disease.

Nivelichuk Taras, Head of the Department of Anesthesiology and Intensive Care, work experience 8 years. Higher education in the specialty “General Medicine”.

Angina of exertion is a chronic heart disease caused by a decrease in blood circulation in the coronary (cardiac) vessels and manifested by pain in the chest behind the sternum – in response to physical or psychoemotional stress (that is, with “stress”). There is still angina pectoris, when the same symptoms occur without load.

With this disease, the arteries of the heart at rest bring a sufficient amount of blood to the heart muscle (myocardium), and when loaded, it is not enough to provide increased myocardial needs. This is accompanied by a complex of characteristic symptoms, pain and structural changes in the heart.

Pathology is very common: at the age of 45–65 years, about 1–2% of women and 3-5% of men are sick, after 65 years, 10–15% of women and 12–20% of men. It can bother patients to varying degrees. The division of the disease into functional classes (FC) depends on how severe the symptoms are, all four of them.

In the initial stages (FC 1), performance is only slightly affected, patients are forced to abandon active physical activity as they provoke pain in the heart.

Severe forms of angina pectoris (FC 3 or 4) make a person disabled, since without pain he cannot even take a few steps.

Over time, the walls of the heart thicken, it increases in size and is not able to pump blood.

Angina pectoris can be cured in 2-3 months only at an early stage. All other forms require constant compliance with the restrictions of the motor regime, diet, medication. The treatment is carried out by cardiologists, therapists, cardiac surgeons.

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The essence of pathology

According to the international classification of diseases, angina pectoris is one of the chronic variants of coronary heart disease. With this pathology, the heart experiences ischemia (oxygen starvation) due to insufficient blood flow through the coronary arteries. The main causative mechanism of angina pectoris is narrowing of the lumen of the coronary (main) arteries of the heart by more than 50%.

The term angina pectoris itself is translated as pressing chest pain. The name of angina pectoris is due to the fact that it occurs only with physical or psychoemotional stress of the body, as they are accompanied by increased heart function.

In a calm state, the needs of the myocardium correspond to the volume of blood brought by the vessels, so pain does not occur.

With angina pectoris, circulatory disorders in the vascular system of the heart are not critical. They do not cause necrosis of myocardial cells (heart attack). But a constant oxygen deficiency changes its structure: there is a thickening of the walls, an increase in cavities, expansion of the volume, the replacement of normal tissue with an inferior scar.

All this further narrows the coronary arteries and reduces blood flow. There is a vicious circle, the outcome of which is either heart failure or a heart attack (necrosis of the heart muscle).

Cause narrowing of the coronary vessels and the associated angina pectoris can:

  • Atherosclerosis (deposition of cholesterol in the form of tubercles and plaques inside the artery) is the main cause (85–90%).
  • Spasm (contraction of the circular muscle layer of the vascular wall).
  • Compression by hypertrophic (thickened) or scar-modified myocardium (for example, after a heart attack).
  • Congenital features and abnormalities of the structure of the coronary arteries.
  • Inflammation of the wall and the formation of blood clots in the vessels of the heart (for example, with vasculitis, systemic lupus erythematosus, blood clotting).

Persons with an increased likelihood of angina pectoris are a risk group. These are the people:

  • after the age of 45 years;
  • male;
  • suffering from hypertension;
  • suffering from diabetes;
  • obese;
  • with a quick temper (choleric);
  • suffering from diseases, accompanied by thickening (hypertrophy) of the myocardium;
  • leading a sedentary lifestyle;
  • smokers
  • abusing strong coffee.

Angina pectoris can occur in different ways, but always in the form of seizures. Depending on how often seizures occur and how they are provoked, the disease is classified into types and functional classes.

Angina pectoris is of two types:

  1. Stable – these are seizures of the same type in severity and provoking factors that have been observed for more than a month.
  2. Unstable – attacks of a different nature or of the same type for less than a month.

Functional classes are provided only for stable angina pectoris. They reflect how much the heart is capable of performing loads. The higher the functional class of angina pectoris, the lesser the load can provoke a pain attack, and therefore the worse the condition of the heart.

Functional classes (FC) Features of provoking factorsStress Walking
FC 1 (first)Strong, heavyMore than 1 km, runningAbove 5-7 floors or weight transfer
FC 2 (second)Habitual, moderate500 m to 1 kmUp to 2-3 floors
FC 3 (third)LungsLess than 400-500 mTo the first floor
FC 4 (fourth)The minimumAny exertion (eating, talking), pain at rest

Angina pectoris may be the first to occur – when the pain first appeared in life. And it can be progressive – in this case, attacks are stronger, more frequent and longer, or arise from lesser loads than before.

Angina pectoris has only one symptom – heart pain, provoked by stress and stress on the heart. There are also additional manifestations, but the characteristics of the pain syndrome are so specific that only it is enough to make the correct diagnosis.

What a classic attack of angina pectoris looks like is described in the table.

Characteristics of pain
LocalizationIn the middle of the chest, clearly behind the sternum
CharacterCompressive, crushing, can be burning
SeverityMild to moderate, but should not be strong
DurationAbout 10-15 minutes, but not more than half an hour
Irradiation (where it gives)To the left shoulder blade, shoulder joint, neck, possibly to the entire area of ​​the heart
What goes fromCessation of loading, administration of nitroglycerin
What is accompanied byShortness of breath, palpitations
What else could be hidden behind this painHeart attack (then the pain is more than 30 minutes, very strong, does not go away after nitroglycerin).
Intercostal neuralgia (aggravated by movements of the chest, spreads along the ribs on the left)

Modern treatment

The treatment of angina pectoris is carried out by a cardiologist or therapist, if necessary, surgery – a cardiac surgeon. The medication scheme that is used to treat angina pectoris, generally accepted by the European and American Associations of Cardiology, is the so-called ABCDE algorithm. Each of its components, as well as the names of the drugs are described in the table.

Scheme ABCDE Purpose and direction of treatment Names of drugs, treatment features
ABlood thinningAspirin Cardio, Lospirin, Cardiomagnyl, Clopidogrel
BCoronary Artery DilationNitrate group: Isoket, Nitroglycerin, Cardicet Beta-blocker group: Metoprolol, Bisoprolol Nebivolol, Propranolol
CAtherosclerosis ControlStatins: Simvastatin, Atorvastatin, Atoris, Lovastatin
DDiet, proper nutrition – lowering cholesterolExclusion of products: animal fats, strong coffee, alcohol, salt, smoking cessation
Enrichment of the diet with useful omega 3 fatty acids (vegetable oils, red fish, nuts)
ERestoring myocardial structure, improving nutritionVitamin E, Preductal, Triduatan, Mildronate, Riboxin.
In small doses, drugs for lowering blood pressure are indicated: Berlipril, Enap, Lisinopril, Perindopril

Drugs for the treatment of angina pectoris

The duration of conservative therapy and the possibility of a complete cure for angina pectoris depends on the functional class, the causes and structural changes of the heart:

  • With FC 1, the disease is curable in 75–85%. Enough course administration of a complex of drugs for 2-3 months. Compliance with diet, limiting stress for life. 15–20% of patients undergo life-long repeated courses of treatment from 1 time in 2-3 years to 1-2 times a year.
  • With FC 2-3 it is not possible to completely recover. Complex therapy courses for 2-3 months, 2 times a year, lifelong intake of acetylsalicylic acid preparations, diet, load restriction, nitroglycerin for pain reduce the number of attacks and improve tolerance to loads.
  • With FC 4, the disease is incurable. A lifelong intake of drugs is required (aspirin constantly at night, nitroglycerin during seizures), all other drugs in courses of 2-3 months 3-4 times a year.
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Operative therapy

An operation for exertional angina is indicated if its cause is atherosclerosis of a limited area (about 1-2 cm) of the coronary artery, causing a narrowing of the lumen by more than 50%.

1. Endovascular – insertion of a thin probe through an artery in the inguinal region. Under x-ray control, the probe is carried up the aorta into the coronary vessels.

Having determined the place of narrowing, you can perform:

  • balloon angioplasty – expand the vessel by inflating the balloon at the end of the probe with air;
  • stenting – the installation of a stent (a small metal spring), which will not only temporarily expand the artery, but will also keep the walls from re-narrowing.

Stable angina pectoris in women and men: symptoms, drugs, causes, diagnosis

Angina pectoris is a common disease that is often diagnosed by patients in the initial stages. And absolutely in vain, because some of its forms can lead to sad consequences. Does stable angina pectoris belong to such forms?

Features of the disease

Stable angina pectoris is a syndrome characterized by pain in the sternum, arising from attacks in response to physical or emotional stress. In men and women, it manifests itself identically, however, statistics say that the disease most often occurs in men over 50 years of age.

Since stable angina is a subtype of other forms, according to the ICD code, it fits several positions at once:

  • I20. Angina pectoris, common point
    • I20.1. A documented spasm form.
    • I20.8. Other types.
    • I20.9. Unspecified type.

Unlike unstable, stable angina pectoris occurs under certain conditions. That is, patients with a stable form know their limit of physical effort and can partly control negative symptoms. Patients with unstable angina pectoris suffer from seizures under various circumstances, for example, with effort and at rest, and nitroglycerin is not always able to eliminate this condition.

Next, we will consider the classification of stable angina pectoris and functional classes that are characteristic of angina pectoris.

In medical practice, there are 4 functional classes of angina pectoris:

  • First. Pain attacks are rare, disappear after a decrease in load. Strong pain can provoke pain and everyday activities, such as walking, are well tolerated.
  • Second. Angina attacks occur with fast or long walking, and nitroglycerin is needed to stop them. Most often, the pain appears in cold weather, in the morning, after eating or stress. Speed ​​up to 4 km / h is well tolerated by the patient.
  • Third. It manifests itself in painful attacks when performing daily tasks, for example, when climbing to the first floor. Speed ​​limited to 3 km / h.
  • Fourth. The patient can not perform even minimal work, pain attacks can occur even at rest.

A stable course of angina is characterized by a chronic course, however, it can be acute, occurring suddenly.

About the first signs of stable angina in women and men, read below.

The main cause of angina pectoris is atherosclerosis, which affects the blood vessels of the heart with plaques. A spasm of a long course can also lead to a decrease in myocardial blood supply, which is associated with hypersensitivity of vascular wall cells to fluctuations in the tone of the autonomic nervous system.

There are also certain risk factors that can lead to atherosclerosis and angina pectoris, respectively. The most significant factors are obesity and smoking addiction, which cause vasoconstriction. Risk factors also include menopause, oral contraceptive use, diabetes mellitus, physical inactivity and a genetic predisposition.

Stable angina pectoris in women and men: symptoms, drugs, causes, diagnosis

Epidemiology,
risk factors, incidence

Cardiovascular
diseases and, in the first place, ischemic heart disease, –
root cause of disability and death
in men and women over 60 years old.
Atherosclerosis of coronary arteries in
women, on average, develops for 5-10 years
later than men. Perhaps the reason is
that at a young and middle age in
women in the lipid profile noted more
higher than men, the level of HsLVP.

postpartum development
period of diabetes, the onset of premature
menopause (natural or after
surgical procedures) with obesity,
the development of hypertension and a violation of carbohydrate
exchange, as well as hormonal intake
reproductive drugs in reproductive
age. Hormone replacement
therapy is currently not recommended
as a means of primary and secondary
prevention of coronary heart disease, and among older women
able to even increase incidence
CHD.

Marked in
recent years in many countries
tendency to decrease mortality from coronary heart disease
did not affect the subpopulation of women
young age with this diagnosis:
among them, mortality has not changed.

Symptoms
diseases and diagnostic studies

As compared with
men, IHD in women less likely to debut
like acute MI and sudden death. First
a sign of coronary heart disease in women is more often
stable angina pectoris. However themselves
symptoms of angina pectoris in women and men
may differ and are different
interpreted by doctors. As such
chest pain in women have
less diagnostic significance
regarding ischemic heart disease, especially in young and
middle age.

As compared with
men, women with true stable
angina exertion angina
seizures more often occur outside the active
physical activity – during sleep,
after eating, during stress. because of
low clinical alertness
doctors more often regard chest pains in
women as extracardiac and therefore less common
direct them to additional
research (stress tests with
visualization and CAG) than men.

Among
higher prevalence of women
“Functional” myocardial diseases
(vasospastic and microvascular
angina pectoris), the symptoms of which are often
unlike “typical” angina pectoris and
new to doctors. ECG in women
“masking” signs are more common
myocardial ischemia: for example, early
ventricular repolarization, negative
T waves and other non-specific
changes in the end of the ventricular
complex.

Diagnostic significance
the usual stress ECG in women is less
than in men (60-70% against almost 80%) –
due to higher frequency
false positives due to
detraining as well as more frequent
baseline ECG changes in the background
dishormonal changes in the period
postmenopausal women. To overcome these
diagnostic limitations should
actively target women with suspicion
on coronary heart disease for such additional non-invasive
research like spect pharmacological
and echocardiographic exercise
tests for MRI of the myocardium and
MSCT of the coronary arteries.

Doctors are less likely to direct
women on the CAG compared to men
preferring to appoint women
conservative treatment – even with
men-comparable risk levels
severe complications. CAG procedure
women suffer slightly worse
men – mainly due to non-fatal
vascular and renal complications.

“Benign” such syndromes
now revised: proved that
cardiovascular mortality
complications among these patients are all
same as in the general population. Besides
addition, the addition of the usual KAG method
Injection examination revealed a significant revaluation
opportunities of traditional CAG in
elimination of coronary atherosclerosis
arteries.

Therefore, in women with
typical angina pectoris and identified
with CAG intact or slightly modified
coronary arteries should be actively
conduct angiographic pharmacological
tests with adenosine and acetylcholine for
detect vasospastic reactions
coronary arteries. In doubtful
cases may be useful.

Principles
drug treatment of coronary heart disease in men
and women are the same.

Revascularization
myocardium: balloon angioplasty with
stenting and coronary artery bypass grafting

From patients
directed to PCI, women most often
older than men, they have more severe
angina pectoris (III-IV FC). Moreover, in women
concomitant diseases are more often detected
(Hypertension, heart failure, diabetes,
hypercholesterolemia, etc.). Coronary
anatomy does not affect success
angiographic manipulations among
men and women.

In the early postoperative
period in women is somewhat more likely to occur
thrombosis with stent occlusion, including
with a fatal outcome. However, the frequency of myocardial infarction
and the need for emergency CABG early
period after BCA in women and men
are the same. In the long term after PCI
in women, it is somewhat more often resumed
angina pectoris, and more often in men
IM, there is a need for KS, and
sudden death occurs.

In women, more often
operational complications happen
(bleeding, heart failure,
IM), they rarely manage to completely
carry out the planned revascularization
myocardium.

By analogy with the Cheka,
women sent for planned
CABG surgery, on average older than men, and
suffer a large number of related
diseases. Postoperative
mortality in women is higher than in men.
Possible reasons: related
diseases, smaller diameter coronary
arteries, as well as more frequent conduction
KS for women on urgent and emergency
indications.

In the long term
after CABG, women are slightly more likely
angina recurs, women
working age less likely to return
to active labor than men. However
survival rate, myocardial infarction, need
in repeated CABG among men and women
are the same.

Features of the disease

Stable angina pectoris in women and men: symptoms, drugs, causes, diagnosis

Features of the disease

Antiplatelet
(acetylsalicylic acid, clopidogrel);

Blockers
renin-angiotensin-aldosterone
system.

Since the main
the goal of treating chronic ischemic heart disease is
reduction in morbidity and mortality,
then in any drug therapy regimen
in patients with organic damage
coronary arteries and myocardium
drugs with
proven positive effect on
the prognosis for this disease is if
only a specific patient has no direct
contraindications to their reception.

Nitrates and
nitrate-like products (molsidomine);

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Functional classes of angina pectoris: classification of different types of pathology

Angina pectoris is a condition in which the heart muscle lacks oxygen, which is expressed in the appearance of severe pain in the sternum. Pathology is classified based on several factors. They include tolerated physical activity, especially the course of the disease, the causes of pain.

Stable angina pectoris is a clinical syndrome characterized by attacks of compressive pain in the area behind the sternum. The reason for this phenomenon is oxygen deficiency, the amount of which does not ensure the full functioning of the cardiovascular system. Attacks provoke physical or emotional stress.

There are 4 main functional classes of stable angina pectoris:

  1. First. Symptoms of pathology are practically not expressed, which makes timely diagnosis almost impossible. Attacks are rare and only when the physical exertion is too high. Unpleasant sensations go away after the termination of the load. If a person has stable angina pectoris of the first class, he passes any distances without special difficulties, rises up the stairs without feeling short of breath. During the examination, the patient reveals moderate vascular lesions.
  2. Second. Attacks occur when you stay in the fresh air in the cold season, when walking average intensity and running, climbing stairs. They are accompanied by pain in the heart, shortness of breath, discomfort in the sternum, separation of cold sweat, cough. The most pronounced symptoms are observed in the morning, and already in the middle of the day the patient’s condition improves. The attack lasts up to 5 minutes, stops after stopping the load and taking the drug (Nitroglycerin).
  3. Third. The third class of stable angina pectoris is characterized by the manifestation of seizures even with moderate physical activity: the patient cannot climb up the stairs even to the first floor and move at a normal pace. The symptomatology of the pathology manifests itself clearly: the pains are increasing in nature and last up to 15 minutes. The condition is accompanied by excessive sweating, severe shortness of breath, heartburn, nausea. You can eliminate the manifestations of pathology by stopping the load and taking Nitroglycerin.
  4. Fourth. The most severe degree of pathology: the patient does not tolerate physical activity of any level. Even minimal activity (shoes, slow walking) causes an attack. Deterioration of the general condition of the patient can be observed even in a calm state.

The fourth functional class of stable angina pectoris is a dangerous condition that requires urgent medical care.

Domestic scientists have developed a detailed classification of stable angina pectoris, taking as a criterion the cause of its occurrence. They share the following groups:

  • coronary (inflammation of the coronary arteries, atherosclerotic vascular changes);
  • pathology of the peripheral nervous system, angioneurosis;
  • reflex factors (diseases of the gastrointestinal tract and lungs, pathological changes in the spine);
  • metabolic disorders of myocardial cells, which may be associated with impaired thyroid function, neurosis, anemia.

Such an approach will help determine the factors of angina pectoris development and on the basis of this build a course of adequate therapy.

Unstable angina is a sharp exacerbation of the condition of a patient suffering from coronary heart disease. The frequency of seizures, the intensity of which becomes pronounced, increases. An unstable form of angina can develop according to an unpredictable scenario.

The following classes of unstable angina are distinguished:

  1. First. Pain occurs at first with a high load, and subsequently with a slight one. The incidence of seizures is gradually increasing.
  2. Second. Attacks occur on an ongoing basis, even if a person is in a calm position.
  3. Third. This functional class provides for acute angina pectoris at rest, the first episode of which has manifested itself over the past two days.

In addition, unstable angina is classified based on the causes of the development of pathology. Allocate:

  • group A: acute infectious diseases, thyrotoxicosis, anemia;
  • Group B: various heart diseases;
  • Group C: heart attack.

The Rizik classification is a graduation scale, the criteria of which are the data obtained by electrocardiographic examination, as well as the nature of chest pain.

The classification of Rizik is as follows:

  1. Class One (A). There is an increase in angina without changes in the ECG.
  2. Class One (B). An increase in angina against a background of ECG changes is characteristic.
  3. Class Two. The first arising angina of tension is manifested.
  4. Class Three. The first-occurring angina pectoris is characteristic.
  5. Fourth grade. We are talking about prolonged angina pectoris with ECG changes.

In accordance with the classification described, the risk of complications in unstable angina (myocardial infarction, death) is directly proportional to the class of pathology noted in the patient.

According to Braunwald, unstable angina is divided into the following functional classes:

  1. First. It implies a form of pathology such as angina pectoris, which is severe or progressive. It is observed in the patient over the past two months. There are no episodes of rest angina pectoris during this period.
  2. Second. This is angina pectoris, or subacute. The state of rest angina pectoris is noted during the last month.
  3. Third. Angina pectoris, acute. This condition has been observed over the past two days.

The higher the class of pathology according to the Braunwald classification, the higher the risk of repeated ischemia and death within six months.

Experts note that although the proposed classification takes into account the causes and severity of pain in the sternum, it ignores such important factors as the patient’s age, the presence of concomitant pathologies, and the nature of the changes on the ECG.

It is a form of angina pectoris, can cause a heart attack and sudden death. Pathology has other names: unstable vasospastic, spontaneous, Prinzmetal angina.

a feature of the pathology is a prolonged and severe pain attack, which can manifest itself even without physical or emotional stress, in a state of complete rest. Most often this happens in the morning.

Variant angina can occur without pain. In this case, two main types (classes) of this form of pathology are distinguished:

  • The first type is different in that there is no pain during the attack. There is only a feeling of compression in the chest. This kind of resting angina pectoris occurs in people with a high pain threshold, as well as in those who suffer from diabetes, since they experience a decrease in sensitivity as a result of polyneuropathy.
  • The second type of Prinzmetal’s angina pectoris is an alternation of attacks without pain and episodes of angina pectoris with severe pain. This type is much more common than the first.

According to the classification of the Canadian Cardiological Society, stable angina is divided into 4 main classes.

  1. The first class of angina pectoris implies the absence of signs of an attack with habitual, everyday physical activity. Symptoms occur with prolonged exercise or too active movements.
  2. The second class provides for an insignificant restriction of physical activity. In this case, prolonged physical activity, climbing the stairs after meals, as well as emotional upheaval, provoke the development of an attack.
  3. The third class is a pronounced limitation of even insignificant physical activity. The patient feels discomfort and pain when walking on foot for more than one or two quarters, cannot climb more than one flight without shortness of breath.
  4. Fourth grade. This is the most severe degree of angina pectoris, in which a person is not able to engage in any kind of physical activity. In addition, symptoms characteristic of an attack can occur even when the patient is at rest. The presence of a fourth type of pathology in the patient requires immediate medical intervention.

Classification is used in assessing the severity of any type of angina pectoris.

Another classification uses the features of the pathology course as a criterion. In this case, the following types of angina are distinguished:

  • First emerged. This form of the disease is indicated if no more than a month has passed since the onset of the first characteristic symptoms. This variety is prone to transition to a stable form, and can also take a progressive direction. With the first occurring form, each attack can lead to a heart attack or death.
  • Progressive angina pectoris. With an increase in episodes of seizures and an increase in their duration, as well as with the appearance of pain, even with minor loads, we are talking about progressive angina pectoris. Attacks can disturb the patient even when he is at rest. The disease often progresses against a background of stable angina pectoris.
  • Stable angina pectoris. The classification and features of this type of pathology were examined in detail in the first paragraph of the article.
  • Spontaneous or variant. This form of the disease is rare. Attacks of angina pectoris develop in a patient either at night or in the early morning. In the intervals between attacks, a person does not complain of poor health. Symptoms of this form are similar to angina pectoris.

Angina pectoris as a form of manifestation of coronary heart disease is divided into functional classes according to many criteria. In their quality are the causes of the development of the disease, especially the course of the pathology, the patient’s ability to endure a certain physical load. Existing classifications allow you to assess the patient’s condition and determine the course of treatment.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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