Prevention and treatment of coronary heart disease;
Prevention of coronary heart disease should start with people's living habits, diet, exercise and other aspects, and drug prevention is also very important. Exercise prescription depends on the patient's personal situation. Proper exercise or exercise can improve the blood perfusion of the heart, increase the collateral circulation of coronary artery, and play a role in protecting and improving the heart function. Maintain a balanced diet. Eating more marine fish, vegetables, fruits, beans and olive oil can effectively prevent coronary heart disease.
Among the drugs for treating and preventing coronary heart disease, compound Danshen dripping pills, a modern Chinese medicine, not only has the effect of anti-platelet aggregation, but also has the effect of lowering cholesterol and triglyceride. Reduce blood viscosity; Improve systemic and cardiac microcirculation; Antioxidant free radicals; Multi-level, multi-target and multi-system effects such as protecting myocardial cells. All the action points are in the key parts of coronary heart disease. Therefore, insisting on taking compound Danshen dripping pills has a good effect on preventing and treating coronary heart disease.
Four countermeasures to prevent coronary heart disease;
Four lines of defense against cardiovascular diseases and preventive countermeasures
According to the report of the World Health Organization in 2000,170,000 people worldwide died of cardiovascular diseases, and one in every three people died of cardiovascular diseases. This figure is expected to increase by 50% by 2020, and 80% of the deaths are distributed in low-and middle-income countries. From 2000 to 2020, myocardial infarction will rise from the fifth place to the first place among various causes of death, and stroke will rise from the sixth place to the fourth place.
"The occurrence and development of cardiovascular diseases has a systematic process. People's recent attention to smoking, hypertension, dyslipidemia, obesity, metabolic syndrome and other risk factors can be regarded as the upstream of the disease, and sometimes multiple risk factors can be concentrated on one person. With the change of lifestyle, these risk factors are becoming more and more common among people and developing towards teenagers. It takes decades for cardiovascular diseases to develop from risk factors to clinical symptoms. But unfortunately, there are quite a few patients who have never had symptoms or premonitions, sudden myocardial infarction, stroke or even accidental death. Even if it can be successfully treated, patients with myocardial infarction will eventually develop chronic heart failure during the development of chronic diseases. Chronic heart failure has now become a new challenge faced by both developing and developed countries. "
In view of the occurrence and development of atherosclerotic diseases, Professor Hu Dayi from the Department of Cardiology of Peking University People's Hospital and Cardiovascular Center of Beijing Tongren Hospital of Capital Medical University called for strengthening the prevention of cardiovascular diseases and building defense lines from different levels to block the occurrence and development of diseases. He put forward the need to establish four lines of defense:
The first line of defense is disease prevention, that is, primary prevention. Its core content is the comprehensive control of various risk factors. First of all, we should change the traditional medical practice and mode. At present, it is very necessary for us to use too much force to target the downstream of the disease, such as interventional therapy, bypass, etc., but it can only be targeted at the advanced stage or the serious consequences. We should put more energy into the upstream of diseases and emphasize prevention. "Second, it is necessary to change from the traditional empirical model to the evidence-based medicine model, that is, all interventions must have research evidence. Third, form a multidisciplinary alliance. In the past, the Hypertension Society only cared about hypertension, while the Diabetes Society only cared about diabetes and so on. This situation is no longer suitable for a person with multiple risk factors. Only by learning more about joint action and grasping and managing multiple risk factors on the same platform can we get twice the result with half the effort. It is necessary not only to prevent risk factors, but also to predict the risk of morbidity and mortality of patients in the next 10 and 20 years, and then divide different groups according to different risk levels, and put forward different intervention measures for different groups. Fourth, change the situation that specialists and community doctors are out of touch. Only by transforming the great achievements of clinical research into the standardized medical behavior of doctors, including community doctors, can the social benefits of reducing diseases be realized. For example, statins can reduce the incidence of cardiovascular diseases by 65,438+0/3, but the use time of these drugs is too late, too little, too short, and many doctors start taking drugs after 3-6 months of myocardial infarction. Interventional therapy is indeed beneficial to relieve the symptoms of patients, but unfortunately, it has not improved the prognosis of patients. Interventional therapy can fundamentally improve the prognosis of patients only by holding hands with statins.
The second line of defense is to prevent accidents. That is, the patient who has already developed the disease, can he be stable for a long time without myocardial infarction? Among them, stabilizing plaque and antithrombotic therapy are the key to prevent incidents, and there will be no incidents without thrombosis. Early use of statins can not only reduce blood lipid, but also stabilize plaque, improve endothelial cells and resist inflammation. Combined use of antithrombotic drugs with different mechanisms is not only a new research direction, but also a new medical practice. The second part of antithrombotic is antithrombotic mildew. The great progress in anticoagulation is the successful development of low molecular weight heparin, which is equivalent to or even better than intravenous heparin and will replace ordinary heparin in many fields. Pentose is superior to low molecular weight heparin. A major feature of this medicine is that it is given at a fixed dose of 2.5 mg once a day regardless of gender, age, weight and operation time, and there is no difference in dosage, which is convenient for patients and ensures the safety of medication.
The third line of defense is to prevent consequences. If there are serious consequences such as myocardial infarction and stroke, we should consider how to treat patients as soon as possible and scientifically. The hospital set up a chest pain center and opened a green channel. Family members should send patients to the hospital in time to save lives. Both thrombolysis and interventional therapy should emphasize time. Time is the heart muscle, and time is life. As a patient, as long as it is chest pain, he should go to the hospital for a chance to rescue him. Different and timely antithrombotic drugs should be used in combination for low-risk patients, and early intervention and statins should be used for high-risk patients.
The fourth line of defense is to prevent recurrence. "It's not too late to mend." After successfully rescuing patients, secondary prevention should be done to prevent reinfarction, accidental death and slow down or prevent the occurrence of heart failure. First of all, we should pay attention to the change of lifestyle. Patients with myocardial infarction must quit smoking and use preventive drugs, such as aspirin, beta blockers, statins and angiotensin converting enzyme inhibitors. Select effective drugs to achieve effective dosage. At present, there is a lot of waste of health resources in our country, either the variety is wrong or the dosage is wrong, so that patients can not get the protection they deserve. We can't calculate the price of a flat plate unilaterally, but we should calculate the health cost from a macro perspective. This is the biggest savings by preventing and reducing accidents and hospitalization.
"Doctors should adhere to the patient-centered, and doctors are the healers of patients' pain. What doctors do is one thing, but the first consideration is what patients need most, not what we can do with patients. Everyone is busy, busy intervening, busy bridging. This is necessary, but not enough. " Professor Hu said. The focus of future work is to prevent cardiovascular diseases, so doctors should adhere to the preventive countermeasures of "ABCDE". A: aspirin, angiotensin converting enzyme inhibitor (ACEI); B: beta blockers, blood pressure control; C: lowering cholesterol and quitting smoking; D: diabetes control and reasonable diet; Physical education, patient education and community work.
-Abstract of Professor Hu Dayi's speech.
Self-protection of heart failure
Self-protection of patients with heart failure through scientific means is the key link to delay the progress of the disease and prevent its deterioration. Patients should strive to do the following:
Control diseases that cause heart failure: For example, for heart failure caused by hypertension, controlling systolic and diastolic blood pressure within the normal range through long-term treatment can reduce the risk of heart failure.
In order to prevent factors that can promote heart failure, specific measures include the following aspects:
● Prevention of respiratory tract infection
If a person with heart failure but stable condition has respiratory infection, it is very easy to make the condition deteriorate sharply. Therefore, in the case of cold season or sudden climate change, patients should go out less, wear masks and add clothes when going out, and patients should also go to crowded places less.
● Grasp the activity.
Do some physical activities as much as you can, but don't do too much, and you can't take part in more intense activities to avoid sudden aggravation of heart failure.
● Choose a light and low-salt diet.
Eat less greasy food and more fruits and vegetables. For patients with heart failure, salt intake must be controlled. Excessive salt intake will aggravate fluid retention and edema, but it is not necessary to completely avoid salt.
● Maintain a healthy lifestyle.
Be sure to quit smoking and drinking, keep a balanced mind, don't be too excited and fluctuating, and ensure adequate sleep.
● Rational use of drugs
Some drugs can relieve symptoms quickly, while others need to be taken for a long time to improve heart function and prolong life. Diuretics are the only drugs that can control fluid retention, and cannot be used alone to control heart failure and stabilize the disease. Digitalis preparation (digoxin) can relieve the symptoms of patients by increasing myocardial contractility. Angiotensin converting enzyme inhibitors (such as captopril, mononitrate, etc. ) should be suitable for all patients with heart failure with left ventricular systolic dysfunction, unless patients have contraindications or intolerance to these drugs, but the application of these drugs should be started as early as possible and used for a long time to reduce mortality and prolong life. Beta blockers, all patients with heart failure and left ventricular systolic dysfunction, can be used under the condition of stable condition, but the more drugs, the better, but the less the better, and the rational use of drugs under the guidance of doctors.
Clinical types of coronary heart disease
At present, there are many classifications and types of coronary heart disease, and they are confusing. The accepted clinical classification is based on the classification of the World Health Organization (WHO), namely angina pectoris, myocardial infarction and sudden death. Angina can be divided into fatigue angina and spontaneous angina.
(1) Fatigue angina pectoris can be divided into three categories:
① New angina pectoris refers to fatigue angina pectoris, which occurs within 1 month.
② Stable exertional angina pectoris refers to exertional angina pectoris with stable symptoms 1 ~ 3 months or more.
③ Exacerbating exertional angina pectoris (aggravated angina pectoris, aggravated angina pectoris). The inducement of angina pectoris remains unchanged, but the frequency, degree and duration of pain attack have obviously deteriorated.
(2) Spontaneous angina pectoris refers to angina pectoris at rest. Among them, angina pectoris with ST segment elevation is called variant angina pectoris. New angina pectoris, worsening angina pectoris and spontaneous angina pectoris belong to unstable angina pectoris. Coronary heart disease and heart failure, if the patient has no clinical or ECG evidence of myocardial infarction, this diagnosis can only be speculative.
In addition, arrhythmia may be the only symptom of coronary heart disease. In this case, unless coronary angiography confirms coronary artery disease, it can only be a hypothetical diagnosis.
Dietary principles for preventing and treating coronary heart disease
Because the relationship between nutrition and coronary heart disease is very close, it is very important to formulate reasonable dietary principles for the prevention and treatment of coronary heart disease. Reasonable dietary principles for the prevention and treatment of coronary heart disease are as follows:
1 Reduce the daily cholesterol intake. The intake of cholesterol should not exceed 300 mg/day or be lower than 100 mg/kcal total calories.
The intake of fat should not exceed 30% of total calories, and saturated fatty acids should be controlled within 10% of total calories. Increase polyunsaturated fatty acids so that the ratio of saturated fatty acids to unsaturated fatty acids and polyunsaturated fatty acids should be 7∶ 1∶ 1.
Eat complex carbohydrates and eat little or no simple carbohydrates such as sucrose or glucose.
The total calories should be limited to the standard amount, so that the weight can be maintained at the standard level. If you are overweight (5 kg is normal), you should further limit the total calories or increase physical activity appropriately.
5 advocate eating more fresh fruits and vegetables, bean products and liquid vegetable oil.
6 Try to eat less foods rich in saturated fatty acids or cholesterol, such as fat, animal oil, high-fat milk, egg yolk and animal offal.
7 Don't soften the drinking water.
8 Reduce sodium intake. In terms of sodium chloride, the intake of each person should first strive to reach below 10g/ day, and then it is best to drop below 5g/ day.
9 Drinking: Do not drink or drink less, and the daily amount should not exceed 30g.
Why should patients with coronary heart disease eat less salt?
A large number of studies show that hypertension is one of the risk factors of coronary heart disease. According to the survey data, a considerable proportion of patients with coronary heart disease suffer from hypertension, which can promote the development of coronary heart disease. Therefore, it is of great significance for the prevention and treatment of coronary heart disease to control hypertension and reduce blood pressure level. At the same time, sodium promotes blood circulation, increases cardiac output and directly increases the burden on the heart, which is unfavorable to patients with coronary heart disease with insufficient blood supply to the heart. At present, it is generally believed that sodium intake can promote the onset of hypertension. Epidemiological data show that the incidence of hypertension in northern Japan is as high as 40%, which is significantly higher than the daily intake of about 5 grams of salt by Eskimos in North America. The study also proved that if the average daily intake of salt is less than 5 grams, the average diastolic blood pressure can be reduced by 0.53 kPa (4 mm Hg). Therefore, salt restriction can be used as a non-drug treatment for hypertensive patients.
So, how much salt should patients with coronary heart disease limit? It depends on whether the patient has high blood pressure at the same time and the situation of high blood pressure. Some people have put forward a stricter salt limit, which stipulates that it cannot exceed 5 grams per day. Some people are harder to do and harder to stick to. The author thinks that we should gradually limit the amount of salt according to our own situation, so that our taste can gradually adapt to a low-salt diet. The specific method is: when cooking, sprinkle salt on the dish before it is cooked, which can obviously feel the salty taste; You can also use condiments such as sugar, vinegar and spices to increase the taste of food and reduce the amount of salt. At present, the low sodium salt sold in the market is also a good choice for limiting salt (sodium).
Finally, it should be pointed out that potassium salt has protective effect on myocardial cells. Antihypertensive drugs that promote sodium excretion often increase potassium excretion, leading to potassium deficiency in the body. Therefore, while limiting salt (sodium) in the diet, we should eat more foods containing potassium, such as whole grains, beans, meat, vegetables and fruits all contain a certain amount of potassium. Although most animal foods contain more potassium than vegetables and fruits, they contain more sodium and cholesterol, while vegetables and fruits contain little sodium. So eat more fruits and vegetables to supplement potassium. Foods with high potassium content include spinach, radish, cabbage, celery stalks, pumpkins, fresh peas and lemons. , these are optional.
Harm of cold bath to elderly patients with coronary heart disease
Cold bath is commonly known as cold bath, including cold shower, cold rubbing bath, cold soaking bath and winter swimming. Cold water bath can improve physical fitness and cold resistance, which is very beneficial to delaying aging and preventing diseases. At present, not only many young and middle-aged people like cold water bath, but also attract many old people. But for patients with coronary heart disease, improper cold water bath often leads to serious adverse consequences. We have seen some elderly patients with coronary heart disease. The first time they wiped their bodies with cold water, they induced severe angina pectoris. Others took a cold bath immediately after sweating because of the hot weather, which induced acute myocardial infarction. What is the reason? Everyone knows the universal truth that heat expands and contracts. The same is true of human blood vessels, such as coronary arteries. If you encounter sudden cold stimulation, it will often cause vasoconstriction and spasm, leading to myocardial ischemia and hypoxia, angina pectoris and myocardial infarction. Therefore, the frail old people, especially those suffering from hypertension, coronary heart disease and cerebral arteriosclerosis, should not take a cold bath. For the elderly with good physique, we should slowly carry out adaptive exercise, first wipe the body with warm water, then use cold water, and then try to wipe it with cold water. After getting used to it, you can use a cold water bath, not too long and not too violent. If necessary, we should prepare a health care medicine box.
How do patients with coronary heart disease spend the winter?
Cold is even worse for middle-aged and elderly patients with coronary heart disease. Cold will not only cause strong contraction of blood vessels and increase blood pressure, but also induce diseases such as hypertension, acute myocardial infarction, angina pectoris and cerebrovascular accident, and even fatal arrhythmia. Therefore, in addition to routine diagnosis and examination in the hospital, you can also carry out health care according to the following prescriptions to prevent problems before they happen and successfully spend the cold winter.
Pay attention to keep warm, the temperature difference between morning and evening in winter is large, and middle-aged and elderly people are used to getting up early to exercise, so they should have proper "temperature buffer"; Pay attention to adding clothes when you go out. Prevent angina pectoris and even myocardial infarction caused by excessive temperature difference.
You should wake up in the morning and rest for 5 minutes before getting up. In the morning, the blood vessel elasticity of human body is the worst, and sudden activity is easy to cause cerebrovascular diseases, even cerebral hemorrhage and stroke.
Pay attention to stay calm, optimistic and confident, and don't be overjoyed or exercise vigorously. The so-called "quiet life, impetuous life lost" is about this philosophy of life.
Don't blindly tonic, although winter is the best season for health and tonic, patients with cardiovascular and cerebrovascular diseases should not blindly tonic at this time, and should eat lightly and maintain a balanced diet. Eat more foods rich in vitamins and minerals such as beans, fruits, milk and lean meat, and avoid spicy and greasy food. Get up in the morning and drink a cup of warm water to reduce blood viscosity and promote intestinal peristalsis.
Take appropriate drugs for active treatment and prevention, and be alert to "drug-induced stroke". Some drugs for the treatment of cardiovascular and cerebrovascular diseases, besides having obvious side effects on the liver and stomach, are easy to increase vascular tension and change blood viscosity in winter, leading to cardiovascular and cerebrovascular diseases and even "drug-induced stroke". Drugs such as blood pressure reduction and analgesia should also be used with caution. Therefore, treatment must be carried out under the guidance of a doctor.