The basic etiology of 1
With the development of society and the continuous improvement of living standards, people consume too much animal fat and foods with high cholesterol, such as animal viscera, various meats, egg yolks, etc., which increases the cholesterol content in the human body.
With the development of modern market economy, people's competition for employment and technology is increasing day by day, which makes some people unable to adapt to this changing reality, leading to mental stress, insomnia and fatigue. Because of mental stress and endocrine dysfunction, the levels of catecholamine and adrenal glucocorticoids in the blood increase, leading to hypertension and fat metabolism disorder. The periodic increase of hypertension and high cholesterol levels will further affect the coagulation mechanism and increase platelet aggregation. Under the influence of these factors, with the increase of age and the change of air pollution, the toxic substance PAF in human blood vessels increases significantly, which in turn causes the damage of coronary artery wall and atherosclerosis after fat accumulation. At the same time, PAF continues to absorb platelets with enhanced cohesion, resulting in coronary artery stenosis, intima thickening and hardening, and insufficient blood supply to the heart.
The increasing competition in modern market, employment and technology makes some people unable to adapt to this changing reality, leading to nervousness, insomnia and fatigue. Because of mental stress and endocrine dysfunction, the levels of catecholamine and adrenal glucocorticoids in the blood increase, which leads to hypertension and fat metabolism disorder in the body. The periodic increase of hypertension and cholesterol levels will further affect the coagulation mechanism and increase platelet aggregation. Under the influence of these factors, with the increase of age and the deterioration of air pollution environment, the toxic substance PAF in human blood vessels increases significantly, which in turn causes the damage of coronary artery wall and atherosclerosis after fat accumulation. At the same time, PAF is constantly adsorbed, and the platelet with enhanced aggregation causes coronary artery lumen stenosis, intima thickening and hardening, which makes the heart blood supply insufficient.
2 General preventive and therapeutic measures
2. 1 Adjust the dietary structure. The intake of high-fat and high-cholesterol foods should be controlled below 30% of total calories, the intake of animal protein should be controlled below 20% ~ 50%, and plant protein should be increased. Soy protein is recommended because stigmasterol can lower cholesterol. WHO surveys in more than 30 countries have found that the incidence of coronary heart disease is significantly reduced in areas where soybeans and other plant proteins are consumed.
2.2 carbohydrate intake accounts for 60% ~ 70% of the total calories, especially for obese people and those with high triglycerides, the proportion of carbohydrates should be increased, such as rice and potatoes.
2.3 Fruits and vegetables are rich in dietary fiber, which can promote gastrointestinal peristalsis, lower cholesterol and prevent constipation. Such as auricularia auricula, onion, garlic, mushrooms, ginger, laver and so on. All of them have different degrees of lipid-lowering effect, which can dilate coronary artery, lower blood pressure, induce diuresis, calm down and help prevent coronary heart disease.
2.4 Water and minerals Appropriate increase in the proportion of beneficial inorganic salts and trace elements, such as magnesium, calcium, manganese, copper and zinc, can reduce the incidence of coronary heart disease.
2.5 The intake of seasoning salt and soy sauce is directly proportional to hypertension. It is recommended to eat 3 ~ 5g of salt every day, and don't eat too much soy sauce. MSG contains high sodium content, so patients with hypertension should eat less. Tea has the function of lowering cholesterol, which is beneficial to prevent atherosclerosis.
2.6 Take necessary physical exercise, establish a correct outlook on life, world outlook and values, control anger, avoid worries, get rid of worries, be optimistic and happy, and combine work and rest, which is conducive to preventing coronary heart disease.
3 prevention of general drugs
3. 1 Vitamins such as vitamin B 1, B6, C, PP, E and A have certain effects on improving fat metabolism and preventing atherosclerosis and myocardial infarction.
3.2 Compound Danshen tablets, Xuezhikang tablets, aspirin enteric-coated tablets, sodium alginate tablets, Gynostemma pentaphyllum tablets, Luoxintong tablets, etc. All of them have the functions of dilating cardiovascular and cerebrovascular diseases, dredging and softening blood vessels, reducing blood lipid and blood viscosity, clearing PAF, cleaning blood and atherosclerotic plaque thrombosis, effectively preventing the occurrence of coronary heart disease, hypertension and hyperlipidemia, and reducing the incidence.
4 discussion
There are many causes of coronary heart disease, but at present, hypertension, hyperlipidemia, hyperglycemia and obesity are considered as the main factors at home and abroad. These reasons are closely related to diet and living environment. Therefore, it is the key to prevent this disease to develop good living habits and adjust the diet structure in daily life. It is good for your health to take necessary physical exercise, insist on exercising or doing exercises for more than 30 minutes every day, improve your self-cultivation, establish a correct outlook on life, and deal with various contradictions according to the law and inevitability of career development. The above method is simple, easy and economical. It is necessary to actively publicize and improve the awareness of group prevention, reduce the incidence of coronary heart disease, and ensure the gradual improvement of the health level of middle-aged and elderly people.
Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease. It is mainly manifested in atherosclerosis, intimal plaque formation, plaque rupture, thrombosis, myocardial ischemia, angina pectoris, arrhythmia and myocardial infarction of blood vessels and coronary arteries that nourish the heart.
In the past 30 years, remarkable achievements have been made in the prevention and treatment of coronary heart disease. The in-hospital mortality rate of acute myocardial infarction has dropped from 30% in the 1970s to 10%- 15%, but coronary heart disease is still the first cause of death for men and women in the United States and the second cause of death in China after cerebrovascular disease. Therefore, in order to further reduce mortality, it is still very important to prevent and treat coronary heart disease.
Primary prevention of coronary heart disease: take a series of preventive measures to eliminate the risk factors of coronary heart disease and reduce the incidence of coronary heart disease before the onset.
The main risk factors of coronary heart disease are obesity, smoking, hypertension, diabetes and hyperlipidemia. The sooner coronary heart disease is prevented, the better. First of all, obesity should be controlled at any age.
Obesity, especially centripetal obesity centered on trunk, is a risk factor for coronary heart disease, hypertension and diabetes. We should carry out health education and prevention among primary and secondary school students through classes, cultivate good living and eating habits from an early age, actively participate in sports activities, enhance physical fitness, and enter middle-aged and elderly people. Especially after obesity, diet should be controlled, advocate staple food 5 yuan every day, breakfast and lunch 2 yuan every day, dinner every day 1 yuan, eat more vegetables and tofu, eat lean meat, milk, eggs and fruits appropriately, and increase physical activity appropriately. This can prevent obesity and reduce the risk of coronary heart disease.
Quitting smoking: The study found that the incidence of myocardial infarction of a large number of smokers is three times that of non-smokers or smokers, and the prevalence and mortality of coronary heart disease of smokers are similar to those of non-smokers. The risk of coronary heart disease is related to the number of cigarettes smoked every day, but not to the length of smoking history. Compared with continuous smokers, the risk of quitting smoking is reduced by half. Therefore, persuading people to quit smoking is an important measure to prevent coronary heart disease.
Hypertension is a serious risk factor of coronary heart disease. 1978, the standard of hypertension in China was above 160/95 mm Hg,1June 999, and it was regarded as the diagnostic standard of hypertension in China according to the standard published by the World Health Organization: ideal blood pressure 120/80 mm Hg; Normal blood pressure is 120- 129/80-84 mm Hg; Normal hypertension is130-139/85-89mmhg, and hypertension is equal to or greater than140/90mmhg. Hypertension is divided into grade one, grade two and grade three. Grade I hypertension is140-159/90-99mmhg, and grade II hypertension is180/165438+100mmhg or more. The standard of lowering hypertension is because medical experts fully realize that the harm of hypertension to human beings has increased with the increase of blood pressure in the past half century. With the control of cardiovascular diseases by blood pressure, the severity of the incidence of coronary heart disease will be reduced. Active treatment of hypertension is an important means to prevent the occurrence and development of coronary heart disease. The blood pressure of adults should be controlled within140/90 mm. In addition to drugs, weight loss and low-salt diet are also important for the treatment of hypertension, and the daily sodium intake should be controlled within 5g.
Patients with coronary heart disease should prevent coronary plaque rupture. The "culprit" of acute ischemic syndrome is plaque rupture, which is common in sudden death. Low density lipoprotein may play a role in the rupture of atherosclerotic plaque, and some external factors, such as vasoconstriction, tachycardia, hypertension, adrenergic stimulation, inflammation and shear stress, also lead to the rupture of plaque. Once the plaque ruptures, platelets aggregate and may form thrombus. If the thrombus blocks the blood vessels, myocardial infarction or sudden death will occur. If the thrombus narrows the blood vessel, acute ischemia will cause angina pectoris. If the thrombus dissolves, contracts and heals, it will return to a stable state clinically and pathologically.
The treatment of acute ischemic syndrome focuses on arterial bypass or remodeling (angioplasty or stent implantation) after stable ruptured plaque, which is not available in most hospitals in China. Conservative treatments such as drug crown enlargement, thrombolysis and arrhythmia have also achieved good results. But the key is prevention, and we should try to stop plaque rupture before it happens. For example, lipid-lowering drugs are used to reduce lipids in plaques, aspirin is used to reduce platelet aggregation, and antioxidants such as vitamin C and vitamin E can also be used. A clinical event occurred in patients with symptomatic coronary heart disease. The standard treatment is taking aspirin, and it is generally recommended that enteric-coated aspirin be 80-120 mg per day; Lipid-lowering drugs generally recommend Shujiangzhi 10-20mg once a night. Vitamin c and vitamin e as antioxidants; Vasodilators advocate the use of Xiao Xin or propranolol, β-blockers, generally betaloc, starting from a small dose, twice a day, gradually increasing the dose, slowing down the heart rate, antihypertensive treatment, etc. The purpose is to prevent the occurrence of the third cardiovascular event, namely angina pectoris, arrhythmia, myocardial infarction and sudden death.
The treatment of modern coronary heart disease can be divided into drug therapy, interventional therapy and surgical methods, all of which have a certain scope of application. Before choosing a treatment, doctors should fully understand and analyze the condition. Besides ECG, ultrasonic ECG and other general examinations, coronary angiography is considered to be the most accurate diagnostic method. Coronary angiography can show the location, scope and degree of coronary artery stenosis.
For mild cases, general treatment and oral drugs can be taken first. The general treatment methods of coronary heart disease include maintaining a good attitude, regular life, proper exercise and paying attention to diet; Eat a low-fat and low-salt diet rich in vitamins and cellulose, and eat as many fresh vegetables and fruits as possible; Also quit smoking and drinking; Treat hypertension, diabetes and hyperlipidemia. Studies have proved that taking statins such as Shujiangzhi and aspirin can reduce the incidence of coronary heart disease by 20-30, and some traditional Chinese medicines such as Danshen dripping pills, nitrates, nitrites and calcium antagonists are also effective. In addition, regular follow-up visits to the hospital can keep many mild patients in a stable state for a long time after the above treatment.
For patients with acute myocardial infarction and other sudden emergencies, thrombolytic therapy has been used since 1980s. Studies have proved that thrombus formed in sudden emergency can be dissolved by fibrinolytic enzyme in blood flow, and the sooner it is dissolved, the more effective it is to rescue patients with myocardial infarction.
Percutaneous transluminal coronary angioplasty and intracoronary stent implantation are commonly used methods for interventional therapy of coronary heart disease. These treatments have the advantages of less injury, higher symptom elimination rate, faster recovery of patients and far better curative effect than drugs, and are suitable for patients at all stages.
The best choice for complex multi-vascular diseases is surgical bypass, also known as bypass grafting. That is, a small section of the patient's own blood vessel (great saphenous vein or internal mammary artery) is used to connect the initiative with the lower part of coronary artery stenosis, and the myocardium can be eliminated quickly after operation, and the symptom elimination rate is 85-95. The 5-year survival rate of this operation is 93, while the 5-year survival rate of drug therapy alone is only 37. However, long-term observation shows that some patients have stenosis again after surgery for a period of time, and surgery is not suitable for all patients, and the same problem will occur in interventional therapy. In recent years, another high technology-laser myocardial revascularization has been introduced. This technique uses laser to make many tiny holes in the myocardium, so that the blood in the ventricular cavity can be directly supplied to the myocardium. The World Health Organization has observed more than 8,000 cases in more than 0/00 countries around the world, which proves that the operation can obviously relieve angina pectoris and can be used as an auxiliary treatment for refractory coronary heart disease. Another new treatment method is to ablate atherosclerotic plaque in coronary artery into fine particles swallowed by cells and eliminated with blood flow by ultrasonic technology, which has been successfully reported in China. The combination of various methods can make most patients with coronary heart disease get satisfactory treatment.