What is coronary heart disease
Coronary heart disease, coronary atherosclerotic heart disease, is a heart disease caused by atherosclerotic lesions in the coronary arteries that result in narrowing of the lumen of the arteries or obstruction of the arteries, resulting in myocardial ischemia, hypoxia, or necrosis, is often referred to as "coronary heart disease". However, the scope of coronary heart disease may be broader, including inflammation, embolism and other causes of narrowing or occlusion of the lumen. The World Health Organization classifies coronary heart disease into five major categories: asymptomatic myocardial ischemia (occult coronary heart disease), angina pectoris, myocardial infarction, ischemic heart failure (ischemic heart disease), and sudden death. In clinical practice, they are often divided into stable coronary artery disease and acute coronary syndromes.
Common causes: hypertension, dyslipidemia, overweight/obesity, hyperglycemia/diabetes mellitus, poor lifestyle including smoking, irrational diet, lack of physical activity, and excessive alcohol consumption.
Common symptoms:typical chest pain, precordial discomfort, palpitations, fatigue, sudden death, fever, sweating, panic, nausea, vomiting, heart failure.
The relationship between coronary heart disease and hyperlipidemia
Hyperlipidemia is the most important risk factor for atherosclerosis, and 1/3 of patients with hyperlipidemia also suffer from coronary heart disease.
Risk factors and triggers of coronary atherosclerotic heart disease:
Risk factors for coronary heart disease include modifiable risk factors and non-modifiable risk factors. Understanding and intervening with risk factors can help in the prevention and treatment of coronary heart disease.
The modifiable risk factors are: hypertension, dyslipidemia (high total cholesterol or high LDL cholesterol, high triglycerides, and low HDL cholesterol), overweight/obesity, hyperglycemia/diabetes mellitus, and poor lifestyles, including smoking, irrational diets (high-fat, high cholesterol, and high-calorie, etc.), lack of physical activity, and excessive alcohol consumption, as well as social and psychological factors. Psychological factors. Non-modifiable risk factors are: gender, age, and family history. In addition, associated with infections such as cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori.
Coronary heart disease episodes are often associated with seasonal changes, emotional stress, increased physical activity, satiety, heavy smoking and alcohol consumption.
Coronary atherosclerotic heart disease clinical manifestations
1.Symptoms
(1)Typical chest pain
Triggered by physical activity, emotional excitement and other triggers, a sudden pain in the anterior region of the heart, most often episodic colic or squeezing pain, but also for the sense of suffocation. The pain starts from the back of the sternum or precordial area, radiates upward to the left shoulder, arm, and even the little finger and ring finger, and can be relieved by resting or taking nitroglycerin. The area of chest pain discharge may also involve the neck, jaw, teeth, and abdomen. Chest pain can also occur in a quiet state or at night, caused by coronary artery spasm, also known as variant angina. If the nature of the chest pain changes, such as the recent onset of progressive chest pain, the pain threshold gradually decreased, to the point that a little physical activity or emotional excitement or even rest or sleep can also be attacked. Pain gradually intensified, frequency, duration prolonged, remove the trigger or nitroglycerin can not be relieved, this time is often suspected of unstable angina pectoris.
(2) It should be noted that the symptoms of some patients are not typical, only manifested in the precordial discomfort, palpitations or fatigue, or mainly gastrointestinal symptoms. Certain patients may have no pain, such as the elderly and diabetic patients.
(3) Sudden deathAbout 1/3 of patients with a first episode of coronary artery disease present with sudden death.
(4) Others may be accompanied by systemic symptoms such as fever, sweating, panic, nausea, and vomiting. Combined with heart failure patients may appear
2. Signs
Angina pectoris patients without an attack is not special. Patients may present with diminished heart sounds and pericardial friction. Complicated septal perforation, papillary muscle insufficiency, can be heard in the corresponding parts of the murmur. In the case of arrhythmia, the heart rhythm is irregular on auscultation.
Coronary atherosclerotic heart disease examination
1. Electrocardiogram
Electrocardiogram is the easiest and most commonly used method to diagnose coronary heart disease. In particular, it is the most important test when the patient's symptoms attack, but also able to detect arrhythmia. Most of them are not specific when there is no attack. The S-T segment is abnormally depressed during angina attacks, and patients with variant angina show transient S-T segment elevation. Unstable angina is mostly characterized by marked S-T segment depression and T wave inversion. Electrocardiogram in myocardial infarction: ①Abnormal Q wave and S-T segment elevation in acute stage. In the subacute stage, there are only abnormal Q waves and T wave inversion (a few days to a few weeks after infarction). (iii) Chronic or obsolete stage (3 to 6 months) with only abnormal Q waves. If S-T segment elevation persists for more than 6 months, there is a possibility of complication of ventricular wall tumor. If the T wave is persistently inverted, it is called old myocardial infarction with coronary ischemia.
2. ECG loading test
Including exercise loading test and drug loading test (e.g., Pansentin, isoproterenol test, etc.). For patients who are asymptomatic in the quiet state or whose symptoms are very short and difficult to capture, myocardial ischemia can be induced by increasing the load on the heart through exercise or drugs, and the presence of myocardial ischemia can be confirmed by the ST-T changes recorded on the electrocardiogram. Exercise load test is most commonly used and a positive result is considered abnormal. However, it is contraindicated in patients with suspected myocardial infarction.
3. Ambulatory electrocardiography
It is a method of continuously recording and analyzing changes in the electrocardiogram during active and quiet states over a long period of time. This technique was first used by Holter in 1947 to monitor electrical activity, so it is also known as Holter. It allows the recording of changes in the ECG during daily life, such as ST-T changes due to transient myocardial ischemia. It is non-invasive, convenient and easily accepted by patients.
4. Nuclear myocardial imaging
This test can be done when angina cannot be excluded on the basis of history and electrocardiogram, and when some patients are unable to perform an exercise stress test. Nuclear myocardial imaging can show the ischemic area and clarify the location and extent of ischemia. Combined with an exercise stress test, the detection rate can be improved.
5. Echocardiography
Echocardiography is one of the most commonly used tests to examine the heart's morphology, structure, wall motion, and left ventricular function. It has important diagnostic value for ventricular wall tumor, intracavitary thrombus, cardiac rupture, and papillary muscle function. However, its accuracy is closely related to the experience of the sonographer.
6. Hematology
Blood collection is usually needed to determine lipids, blood sugar and other indicators to assess the presence of risk factors for coronary heart disease. Myocardial injury markers are one of the most important tools in the diagnosis and differential diagnosis of acute myocardial infarction. Currently, cardiac troponin is the mainstay in the clinic.
7. Coronary CT
Multilayer spiral CT cardiac and coronary artery imaging is a noninvasive, low-risk, rapid examination method, and has gradually become an important means of early screening and follow-up of coronary heart disease. It is suitable for: ①Patients with atypical chest pain symptoms that cannot be diagnosed by auxiliary tests such as electrocardiogram, exercise stress test or nuclear myocardial perfusion. ② Diagnosis of patients with low risk of coronary heart disease. ③Suspected coronary artery disease, but cannot undergo coronary angiography. ④ Screening of asymptomatic high-risk patients with coronary artery disease. ⑤ Follow-up after known coronary artery disease or interventional and surgical treatment.
8. Coronary angiography and intravascular imaging technology
is the "gold standard" for the diagnosis of coronary heart disease, which can clarify the presence or absence of stenosis of coronary arteries, the location, degree, and extent of stenosis, and can guide further treatment accordingly. Intravascular ultrasound can clarify the morphology of the wall and the degree of stenosis in the coronary arteries. Optical coherence tomography (OCT) is a high-resolution tomography technique that allows better visualization of the vessel lumen and vessel wall changes. Left ventriculography allows evaluation of cardiac function. The main indications for coronary angiography are: ① for those who have severe angina despite medical treatment, to clarify the arterial lesions for consideration of bypass grafting; ② for those who have chest pains that resemble angina and cannot be diagnosed.
Diagnosis of coronary atherosclerotic heart disease
The diagnosis of coronary heart disease mainly depends on typical clinical symptoms, combined with auxiliary tests to find evidence of myocardial ischemia or coronary artery obstruction, and myocardial damage markers to determine whether there is myocardial necrosis. The most commonly used tests to detect myocardial ischemia include routine electrocardiography and electrocardiographic stress tests, and nuclear myocardial imaging. Invasive tests include coronary angiography and intravascular ultrasound. However, a normal coronary angiogram does not completely negate coronary artery disease. Usually, non-invasive and convenient auxiliary tests are performed first.
Coronary heart disease taboo
Smoke
Tobacco fog in the carbon monoxide, nicotine, etc. can make the tissue and myocardial hypoxia, induced by coronary artery spasm, blood viscosity increases, interfere with lipid metabolism, and promote cholesterol deposition; long-term smoking can reduce coronary artery vasodilatation, increase platelet aggregation, which can lead to and exacerbate coronary atherosclerosis plaque formation; smoking changes the blood fat The composition of blood lipids, so that high-density protein reduction, low-density protein increase, serum antioxidant effect is reduced, promoting the occurrence and development of atherosclerosis, coronary heart disease.
So, for the sake of your health, please quit smoking.
Cola-type drinks
Caffeine, a large amount of caffeine can cause vascular spasm, so that patients with coronary heart disease was due to the occurrence of anomalous sclerosis surface narrowing of coronary arteries spasms, resulting in insufficient blood supply to the myocardium, which triggered angina pectoris, a serious myocardial infarction can occur.
Strong tea
Tea contains theophylline, acid and a variety of vitamins, can enhance capillary toughness, dilate blood vessels, reduce blood cholesterol, improve heart function. If the tea is combined with certain traditional Chinese medicine, but also can form an ideal treatment of coronary heart disease therapeutic prescriptions, drink some tea, for patients with coronary heart disease, is beneficial. But strong tea, especially too strong tea, for patients with coronary heart disease is more harm than good, because tea contains caffeine, caffeine intake can cause excitement, restlessness, insomnia, rapid heartbeat and arrhythmia, thus increasing the burden on the heart. In addition, strong tea in more tannins, easy to cause constipation. These factors are very unfavorable to coronary heart disease patients. Especially fasting or drinking strong tea at night, it is more likely to make the coronary heart disease patients aggravate the condition, induced angina pectoris or arrhythmia, so patients with coronary heart disease tea should be light, and can not be the night and early in the morning, and even more can not be drunk on an empty stomach.
Crab
Crab is nutritious, but cold, and contains much cholesterol, coronary heart disease. Arteriosclerosis, hypertension, high blood pressure, high blood fat patients, credit high cholesterol food, will aggravate the development of cardiovascular disease, and therefore, should be eaten sparingly or do not eat, especially crab, it is best not to eat.
High-fat food
High fat and high heat will further increase the blood fat, so that the blood viscosity increases, so that atherosclerotic plaque is more likely to form, which will lead to the recurrence of blood clots.
Coronary heart disease patients, fat meat, animal offal, fish eggs, peanuts and other fat, high cholesterol food should be eaten sparingly, full-fat milk, cream, egg yolks, fat pork, fat mutton, fat beef, liver, viscera, butter, animal oil, coconut oil, etc. should be used sparingly or avoided, and the plain diet should be less fried, grilled and other ways to cook food.
At the same time, patients with coronary heart disease should also eat less sweet food, and reduce the intake of cream cakes. In addition, avoid eating too much salty sauce, salty vegetables and so on.
Coronary atherosclerotic heart disease treatment
Coronary heart disease treatment includes: ① lifestyle changes: quit smoking and alcohol, low-fat and low-salt diet, appropriate physical activity, weight control, etc.; ② drug therapy: anti-thrombotic (antiplatelet, anticoagulation), to reduce myocardial oxygen depletion (β-blocker), relief of angina pectoris (nitrate), lipid stabilization of plaque (statin lipotropic drugs) ; ③ Blood flow reconstruction therapy: including interventional therapy (endovascular balloon dilatation angioplasty and stent implantation) and surgical coronary artery bypass grafting. Medication is the basis of all treatments. Long-term standard drug therapy is also maintained after interventional and surgical treatments. In the same patient, medications can be used to ideally control the disease at one stage, while at another stage medications alone are often ineffective and need to be combined with interventional or surgical procedures.
1. Drug therapy
The goal is to relieve symptoms, reduce angina attacks and myocardial infarction; delay the development of coronary atherosclerotic lesions, and reduce coronary heart disease deaths. Standardized drug therapy can effectively reduce the mortality of patients with coronary heart disease and the occurrence of reischemic events, and improve the clinical symptoms of patients. For some patients with severe vascular lesions or even complete obstruction, revascularization on the basis of drug therapy can further reduce the mortality of patients.
(1) Nitrate drugs
This class of drugs are mainly: nitroglycerin, isosorbide nitrate (cardiac pain), 5-isosorbide mononitrate, long-acting nitroglycerin preparations (nitroglycerin ointment or rubber ointment patch) and so on. Nitrates are routinely used in patients with stable angina. Nitroglycerin can be taken sublingually or a nitroglycerin aerosol can be used during angina attacks. For patients with acute myocardial infarction and unstable angina pectoris, the drug is given intravenously first, and then changed to oral or skin patch after the condition is stabilized and the symptoms are improved, and the drug can be stopped after the pain symptoms disappear completely. Nitrate drugs continuous use can occur resistance, the effectiveness of the decline, can be taken at intervals of 8 to 12 hours to reduce drug resistance.
(2) Antithrombotic drugs
Including antiplatelet and anticoagulant drugs. Antiplatelet drugs mainly include aspirin, clopidogrel (Polivir), tirofiban, etc., which can inhibit platelet aggregation to avoid thrombosis and blockage of blood vessels. Aspirin is the drug of choice, with a maintenance dose of 75 to 100 milligrams per day, and all patients with coronary artery disease without contraindications should take it for a long time. Aspirin's side effect is the irritation of the gastrointestinal tract, gastrointestinal ulcer patients should be used with caution. Daily oral clopidogrel should be adhered to after coronary intervention, usually for six months - 1 year.
Anticoagulant drugs include ordinary heparin, low molecular heparin, Juan da heparan decyl sodium, bivalirudin and so on. They are usually used in the acute phase of unstable angina and myocardial infarction, and during interventional procedures.
(3) Fibrinolytic drugs thrombolytic drugs mainly include streptokinase, urokinase, tissue-type activator of fibrinolytic enzymes, etc., which can dissolve the thrombus that has been formed in the coronary occlusion, open the blood vessels, and restore the blood flow, and are used in acute myocardial infarction.
(4) β-blockers
β-blockers that have the effect of con angina pectoris, but also can prevent arrhythmia. In the absence of obvious contraindications, beta-blockers are the first-line drugs for coronary heart disease. Commonly used drugs are: metoprolol, atenolol, bisoprolol and both alpha-blocking carvedilol, alopecia (Almal), etc. The dose should be to reduce the heart rate to the target range. beta-blocker contraindications and cautions are asthma, chronic bronchitis and peripheral vascular disease.
(5) Calcium channel blockers
Can be used in the treatment of stable angina and angina caused by coronary artery spasm. Commonly used drugs are: verapamil, nifedipine controlled release, amlodipine, diltiazem and so on. The use of short-acting calcium channel blockers, such as nifedipine plain tablets, is not advocated.
(6) Renin angiotensin system inhibitors
Including angiotensin-converting enzyme inhibitors (ACEI), angiotensin 2 receptor antagonists (ARB), and aldosterone antagonists. These drugs should be used especially in patients with acute myocardial infarction or recent myocardial infarction combined with cardiac insufficiency. Commonly used ACEIs include enalapril, benazepril, ramipril, and fosinopril. If obvious dry cough side effects occur, angiotensin 2 receptor antagonist can be changed.ARB includes: valsartan, timosartan, irbesartan, chlorosartan, etc.. Care should be taken to prevent low blood pressure during medication.
(7) Lipid-regulating therapy
Lipid-regulating therapy is applicable to all patients with coronary heart disease. Coronary heart disease in the change of lifestyle habits on the basis of giving statins, statins mainly reduce low-density lipoprotein cholesterol, the therapeutic goal is to fall to 80mg / dl. Commonly used drugs are: lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin and so on. Recent studies have shown that statins can reduce mortality and morbidity.
2. Percutaneous Coronary Intervention (PCI)
Percutaneous Transluminal Coronary Angioplasty (PTCA) applies a special catheter with a balloon, which is delivered to the coronary stenosis through the peripheral artery (femoral artery or radial artery). The filled balloon dilates the narrowed lumen, improves the blood flow, and places a stent in the widened stenosis to prevent restenosis. It can also be combined with thrombus aspiration and rotational milling. It is suitable for patients with stable angina, unstable angina and myocardial infarction that are poorly controlled by drugs. Emergency intervention is preferred in the acute phase of myocardial infarction, and time is very important, the earlier the better.
3. Coronary artery bypass grafting (referred to as coronary artery bypass grafting, CABG)
Coronary artery bypass grafting by restoring myocardial blood flow perfusion, relief of chest pain and local ischemia, improve the patient's quality of life, and can prolong the patient's life. It is indicated for patients with severe coronary artery disease, patients who cannot undergo interventional therapy or recurrence after treatment, and patients with angina after myocardial infarction, or complications such as ventricular wall tumor, mitral valve closure insufficiency, or septal perforation, who should undergo coronary artery bypass grafting while treating the complications. The choice of surgery should be decided by the cardiologist and cardiac surgeon in conjunction with the patient***.
Snoring is not a sign of a good night's sleep in terms of cardiovascular disease, but, rather, a threat.