First, western medicine.
1, treatment at the time of attack
1. Rest immediately when the rest attacks, and the symptoms can be eliminated after the general patients stop their activities.
2. Drugs can be used to treat severe attacks, and quick-acting nitrate preparations can be used. These drugs not only dilate the coronary artery, reduce its resistance and increase its blood flow, but also reduce venous blood reflux, ventricular volume, intra-cardiac pressure, cardiac output and blood pressure, reduce the load before and after the heart and the oxygen demand of the myocardium by dilating peripheral blood vessels, thus relieving angina pectoris.
(1) Nitroglycerin: 0.3 ~ 0.6 mg tablet can be placed under the tongue to make it dissolve quickly and be absorbed by saliva. 1 ~ 2 minutes later, it takes effect and disappears after about half an hour. It is effective for about 92% patients, of which 76% are effective within 3 minutes. Delayed onset or complete ineffectiveness indicates that the patient does not have coronary heart disease or severe coronary heart disease, or the drugs contained may be ineffective or undissolved. If it is the latter, the patient can be instructed to chew gently and continue to take it. Long-term repeated use can reduce the curative effect due to drug resistance, and it can be recovered after stopping 10 days. In recent years, sprays and capsule preparations have also come out. Adverse reactions include dizziness, swelling and pain in the head, jumping head, blushing and palpitation. Occasionally, blood pressure drops. Therefore, when taking medicine for the first time, the patient should take the supine position and take oxygen when necessary.
⑵ isosorbide dinitrate (isosorbide dinitrate): 5 ~ 10 mg, which takes effect in 2 ~ 5 minutes and lasts for 2 ~ 3 hours. Or spray 1.25mg into oral cavity every time for 1min.
(3) Isoamyl nitrite: an easily gasified liquid. Put it in small ampoules, each ampoule is 0.2 ml. When using it, wrap it with a handkerchief and break it. Cover your nose and inhale immediately. The action is fast and short, starting about 10 ~ 15 seconds and disappearing after a few minutes. This medicine has the same effect as nitroglycerin, and its antihypertensive effect is more obvious. Use it with caution. Octyl nitrite is a similar preparation.
In addition to the above drugs, sedatives can also be considered.
Second, the treatment of remission should try to avoid all kinds of factors that are known to induce seizures. Adjust diet, especially one meal should not be too full; No alcohol or tobacco. Adjust daily life and workload; Reduce mental burden; Maintain proper physical activity, but do not cause pain symptoms; Generally, bed rest is not needed. Patients with the first attack (initial attack) or aggravated attack (aggravated attack), or supine position, variant, intermediate syndrome, post-infarction angina pectoris, etc. suspected to be the prelude to myocardial infarction. You should have a rest for a while.
Use long-acting anti-angina drugs to prevent angina pectoris. The following long-acting drugs can be used alone, alternately or in combination.
1. Nitrate preparation
⑴ isosorbide dinitrate: oral isosorbide dinitrate, 3 times a day, 5 ~10 mg each time; It takes effect half an hour after administration and lasts for 3-5 hours. Isosorbide mononitrate) 20mg twice a day.
⑵ pentaerythritol tetranitrate: take orally 3-4 times a day, each time10-30 mg; After taking 1 ~ 1 Hours, lasting 4 ~ 5 hours.
⑶ Long-acting nitroglycerin preparation: Nitroglycerin is released slowly after taking the long-acting tablet, and takes effect after oral administration for half an hour, lasting for 8 ~ 12 hours, and can be taken 1 time every 8 hours, with 2.5mg each time. Apply 2% nitroglycerin ointment or patch preparation (containing 5 ~ 10 mg) to chest or upper wall skin for 12 ~ 24 hours.
2. Beta blockers can block the stimulation of sympathomimetic amines on heart rate and myocardial contractility receptors, slow down the heart rate, lower blood pressure, reduce myocardial contractility and oxygen consumption, thus alleviating the attack of angina pectoris. In addition, it also reduces the hemodynamic response during exercise and reduces the myocardial oxygen consumption at the same exercise level; The arterioles (resistance vessels) in the non-ischemic myocardial area become narrower, which makes more blood flow into the ischemic area through the extremely dilated collateral circulation (delivery vessels). Use a lot. Adverse reactions include prolonged ventricular ejection time and increased cardiac volume, which may aggravate myocardial ischemia or cause heart failure, but its effect of reducing myocardial oxygen consumption far exceeds its adverse reactions. Commonly used preparations are: ① Propranolol, 65,438+00 mg each time, 3-4 times /d, and the dosage is gradually increased to 65,438+000-200 mg/d; ② Oxyprolol, 20-40 mg each time, 3 times a day. ③ Aproprolol, 25 ~ 50mg each time, three times a day. ④ Indolol (5mg /d each time, gradually increased to 60mg/d ⑤ Sotalol (20mg each time, three times a day) gradually increased to 240mg per day. ⑥ metoprolol 50 ~ 100 mg twice a day. ⑦ Atenolol, 25 ~ 75 mg twice a day. ⑧ Butanol acetate) 200 ~ 400 mg /d mg/d (9) Nadoprolol (40 ~ 80 mg 1 time/d, etc.
Beta blockers can be used in combination with nitrates, but it should be noted that: ① Beta blockers and nitrates have synergistic effect, so the dose should be small, especially the initial dose should be reduced to avoid adverse reactions such as postural blood pressure; ② When β -blockers are stopped, the dosage should be gradually reduced. If they are stopped suddenly, myocardial infarction may be induced. ③ Patients with cardiac insufficiency, bronchial asthma and bradycardia should not use it. Slow down the side effects of heart rhythm and limit the increase of dose.
3. Calcium channel blockers These drugs inhibit the entry of calcium ions into cells and the utilization of calcium ions in the excitation-contraction coupling of myocardial cells. Thereby inhibiting myocardial contraction and reducing myocardial oxygen consumption; Dilating coronary artery, relieving coronary artery spasm and improving blood supply of subendocardial myocardium; Dilating peripheral blood vessels, reducing arterial pressure and reducing heart load; It can also reduce blood viscosity, prevent platelet aggregation and improve myocardial microcirculation. Commonly used preparations are: ① verapamil (80 ~ 1.20 mg 3 times /d) and sustained-release agent (240 ~ 480mg/kloc-0 times /d). Side effects include dizziness, nausea, vomiting, constipation, bradycardia, prolonged PR interval and decreased blood pressure. Nifedipine (10 ~ 20mg 3 times /d) can also be taken sublingually; The adverse reactions of sustained-release agent 30 ~ 80 mg 1 time /d include headache, dizziness, fatigue, decreased blood pressure and increased heart rate. ③ Diltiazem 30 ~ 90 mg 3 times /d, sustained-release agent 90 ~ 360 mg/kloc-0 times/d. Side effects include headache, dizziness and insomnia. The new preparations are nicardipine 10 ~ 20mg 3 times /d, nisoldipine 20mg 2 times /d, amlodipine 5 ~10mg/kloc-0 times /d and felodipine.
Calcium channel blockers are the best drugs to treat variant angina pectoris. These drugs can be combined with nitrate drugs, among which nifedipine can be combined with beta blockers, but verapamil and diltiazem combined with beta blockers are in danger of excessive inhibition of the heart. When stopping using this kind of drugs, it is also advisable to gradually reduce the dose and then stop taking drugs to avoid coronary artery spasm.
4. Coronary vasodilators can dilate coronary vasodilators, which will theoretically increase coronary blood flow, improve myocardial blood supply and relieve angina pectoris. However, due to the complexity of coronary artery lesions in coronary heart disease, some vasodilators, such as dipyridamole, may dilate the arteries with no lesions or mild lesions more significantly than those with severe lesions, reduce the blood flow of collateral circulation, cause so-called "coronary steal", increase the blood supply of normal myocardium and reduce the blood supply of ischemic myocardium, so they are no longer used to treat angina pectoris. At present, it is still used as follows: ① Modomine 1 ~ 2mg 2 ~ 3 times /d, and the adverse reactions are headache, flushing and gastrointestinal discomfort. ② Amiodarone (100 ~ 200mg, 3 times /d) is also used to treat tachyarrhythmia. Adverse reactions include gastrointestinal reaction, drug eruption, corneal pigmentation, bradycardia and abnormal thyroid function. ③ Efloxacin 30 ~ 60mg 2 ~ 3 times/D4 carbomer 75 ~ 150 mg 3 times/D5 oxydoline 8 ~ 16 mg 3 ~ 4 times/D6 aminophylline 100 ~ 200mg 3 ~ 4 times/D7 papaverine 30 ~ 4 times.
Three, other low molecular dextran or hydroxyethyl starch injection, 250 ~ 500ml/d, intravenous drip 14 ~ 30 days as a course of treatment, can improve microcirculation perfusion, can be used for frequent angina pectoris. Anticoagulants such as heparin, thrombolytic drugs and antiplatelet drugs can be used to treat unstable angina pectoris. Hyperbaric oxygen therapy can increase systemic oxygen supply and improve intractable angina pectoris, but the curative effect is not easy to consolidate. External counterpulsation therapy may increase the blood supply of coronary artery, which can also be considered. For patients with early heart failure, digitalis preparation with rapid action should be used while treating angina pectoris.
Fourth, the surgical treatment is mainly aortic-coronary artery bypass grafting (CABG), with the patient's own great saphenous vein or internal mammary artery as the bypass graft material. One end is anastomosed with the aorta, and the other end is anastomosed with the distal end of the diseased coronary artery segment to draw blood from the aorta, thereby improving the blood flow of the myocardium supplied by the coronary artery. Selective coronary angiography was performed before operation to understand the degree and scope of coronary artery lesions, and to provide reference for making surgical plans (including determining the number of transplanted blood vessels). At present, this operation has become the most common elective heart surgery in countries with high incidence of coronary heart disease. One operation can carry out multiple bypass at the same time, which is considered to have a good effect on relieving angina pectoris.
The operation is suitable for: ① left main coronary artery disease; ② Stable angina pectoris does not respond well to drug therapy, which affects work and life; ③ Angina worsening; ④ Variant angina pectoris; ⑤ Intermediate syndrome; ⑥ Patients with angina pectoris after infarction. The degree of coronary artery stenosis should reach more than 70% of lumen obstruction, the lumen at the distal end of the stenosis segment is unobstructed, and the left ventricular function is good.
The symptoms of angina pectoris can be improved by 80 ~ 90% and the quality of life of 65 ~ 85% patients can be improved. However, it is uncertain whether surgery can improve ventricular function, prevent serious arrhythmia, heart failure or myocardial infarction in the future and prolong the life span of patients. The operation itself will lead to myocardial infarction, and the transplanted blood vessels can be embolized after operation. Therefore, it seems that the indications of surgery should be strictly controlled. Among them, more than 70% patients with left coronary artery main lesion or right coronary artery complete occlusion generally believe that surgery can prolong life, and the surgical indication is the strongest.
5. Percutaneous transluminal coronary angioplasty (PTCA) uses a cardiac catheter with a balloon, sends it into the coronary artery through the peripheral artery, enters the stenosis under the guidance of a guide wire, and injects contrast agent into the balloon to expand it, which can replace surgical treatment in patients with indications and achieve the same effect. The ideal indications are: ① the course of angina pectoris (
Other interventional therapies of intransitive verbs coronary artery have a high incidence of restenosis after PTCA, and some other angioplasty methods, such as laser coronary angioplasty (PTCLA), rotational atherectomy of coronary atherosclerotic plaque, coronary stent implantation, etc. It has been adopted recently, hoping to reduce the incidence of restenosis. The preliminary results show that none of the other methods can be reduced except the latter.
Seven, exercise therapy, careful arrangement of appropriate exercise is helpful to promote the development of collateral circulation, improve the tolerance to physical activity and improve symptoms.
Most patients, especially patients with stable angina pectoris, can relieve or disappear their symptoms after treatment, and can have no pain for a long time after sufficient collateral circulation is established. Some initial angina pectoris, worsening angina pectoris, supine angina pectoris, variant angina pectoris and intermediate syndrome may cause myocardial infarction, so some people call it "pre-infarction angina pectoris".
prognosis
Most patients, especially patients with stable angina pectoris, can relieve or disappear their symptoms after treatment, and can have no pain for a long time after sufficient collateral circulation is established. Some initial angina pectoris, worsening angina pectoris, supine angina pectoris, variant angina pectoris and intermediate syndrome may cause myocardial infarction, so some people call it "pre-infarction angina pectoris".
The pathogenesis of angina pectoris is still inconclusive, and the controversy can be traced back to the beginning of this century. COLBECK put forward that the pain of myocardial ischemia is caused by the stretching of ventricular wall more than 80 years ago (that is, mechanical hypothesis), and 20 years later LEWIS thought that the pain was related to some substances released locally by myocardium (that is, chemical hypothesis). These two theories have been debated for decades. Now it seems that the mechanical hypothesis is unlikely to explain angina pectoris. On the contrary, the chemical hypothesis has been confirmed by experiments. Experiments show that the pain-causing substances produced by myocardial ischemia and hypoxia are adenosine, lactic acid, potassium ion, hydrogen ion and plasma kinin. The receptors of the heart are mainly sympathetic nerve endings, and the distribution of these nerve endings in internal organs is far less than that of somatic receptors, mainly distributed in the proximal end of coronary arterioles. When myocardial ischemia and hypoxia occur, the metabolically produced pain-causing substances stimulate these receptors, resulting in nociceptive nerve impulses, which are transmitted to the corresponding spinal cord segments through 1-4 thoracic sympathetic ganglia, and then transmitted to the cerebral cortex through afferent nerves, resulting in pain. Because visceral pain is often reflected in the skin area where the spinal nerves in the corresponding segments of the spinal cord are distributed, the pain in the anterior chest area is often reflected in angina pectoris, which is mainly located in the posterior sternum or precordial area and radiates to the left shoulder and left forearm, and so on, which can explain many different types of angina pectoris.
Second, Chinese medicine.
Chinese medicine treatment adopts palliative and radical methods according to TCM syndrome differentiation.
Traditional Chinese medicine believes that angina pectoris of coronary heart disease belongs to the category of "chest pain" and "heartache" in traditional Chinese medicine. In recent years, it is more common in middle-aged and elderly people, which is related to spleen, liver and kidney. Chinese medicine believes that "when a person is forty years old, Yin Qi is half full", and the kidney qi is already deficient, and the power of promoting blood circulation is insufficient. There is a tendency in the body, that is, slow blood circulation, accumulation of damp evil, phlegm turbidity and blood stasis, which is the premise and foundation of this disease. Clinical treatment of angina pectoris should start with strengthening the spleen and resolving phlegm, promoting blood circulation and removing blood stasis, soothing the liver and regulating qi. Especially since this year, the application of "Sanqi", a holy medicine for promoting blood circulation and removing blood stasis, has achieved fruitful results in treating angina pectoris. Clinical tests show that the effective rate for angina pectoris and coronary heart disease is 92%.
Notoginseng indications:
Angina pectoris, coronary heart disease, coronary heart disease complicated with hypertension, arrhythmia, hyperlipidemia, hypercholesterolemia, hypertriglyceridemia, headache, dizziness, hemoptysis due to tuberculosis, vomiting blood due to gastric ulcer, uterine bleeding, hysteromyoma, uterine prolapse, and tubal obstruction in women.
Use of Notoginseng Radix in treating angina pectoris;
Grind Radix Notoginseng into powder (the powder can be ground at the place of purchase or directly purchased from Radix Notoginseng), and take the raw powder once in the morning and evening, 2-4g each time, and take it with warm water.
Traditional Chinese medicine prescription for treating angina pectoris;
[Ingredients] Polygonum multiflorum Thunb. is prepared from Radix Salviae Miltiorrhizae in Beishan.
【 Fang Jie Pharmacology 】 Hawthorn can treat hyperlipidemia, hypertension, coronary heart disease, cancer and anti-aging. Rosa laevigata has the functions of hematopoiesis, promoting blood circulation and softening arterial blood vessels; Salvia miltiorrhiza can dilate blood vessels and increase coronary artery flow, and can treat coronary heart disease, angina pectoris, myocardial infarction and tachycardia. Polygonum multiflorum Thunb can treat dizziness and hypercholesterolemia. Honey is a protector of health and effective in treating heart disease.
[Usage and dosage] Take 10g once a day, one pack 1-2 times, one month 10 day, and three packs are taken with honey or warm water. 1-2 months.
Treating the symptoms, mainly in the painful period, mainly in "dredging", including promoting blood circulation and removing blood stasis, regulating qi and activating yang, and resolving phlegm; Cure the root cause, generally applied in remission period, mainly by regulating yin and yang, viscera and qi and blood, and nourishing yang, yin, qi and blood and regulating viscera. Among them, the method of "promoting blood circulation and removing blood stasis" (commonly used salvia miltiorrhiza, safflower, Ligusticum chuanxiong, Pollen Typhae, Radix Curcumae, etc. ) and the method of "aromatic warming" (commonly used Su Hexiang Pills, Subing Dropping Pills, Kuanxiong Pills, Baoxin Pills, Musk Baoxin Pills, etc. ) is the most commonly used. In addition, acupuncture or acupoint massage therapy also has certain curative effect.
Black sesame can treat angina pectoris.
Modern scientific research shows that eating sesame seeds can lower cholesterol, so black sesame seeds have obvious therapeutic effect on cardiovascular and cerebrovascular diseases. In addition, eating sesame seeds can also enhance physical strength and be beneficial to health. According to legend, the ancient Roman gladiators ate 0.5 kg sesame seeds per hour before physical fighting to increase their physical strength. In view of this, sesame can cure diseases and strengthen the body.
Formula composition: 0.5 kg of black sesame and 0.5 kg of white sugar.
Production: Wash black sesame seeds with clear water, then dry them in the sun, then put them in a pot and bake them with slow fire (low fire), then pour them into a large dry porcelain bowl, break them with a wooden hammer, and add sugar and stir them evenly. Put it in a dry and clean glass bottle, tighten the bottle cap and put it in a cool and dry place, which can be stored for a long time.
Be careful not to burn too much when baking, and keep turning black sesame seeds with a shovel until you smell the fragrance of sesame seeds. Don't bake too much black sesame seeds.
Usage: Take orally, 3 ~ 4 spoonfuls each time, 3 times a day.
Efficacy: Patients with mild illness can take it for 2 months.
I hope it helps you!