coronary heart disease
Introduction
Introduction to coronary heart disease Coronary atherosclerotic heart disease is a coronary artery angiogenic atherosclerotic lesion that causes stenosis or obstruction of the vascular lumen, causing heart disease caused by myocardial ischemia, hypoxia or necrosis, often referred to as "coronary heart disease." However, the scope of coronary heart disease may be more extensive, including inflammation, embolism, etc. leading to stenosis or occlusion of the lumen. basic knowledge The proportion of illness: 0.15% Susceptible population: men over 45 years old, women over 55 years old or postmenopausal women. Mode of infection: non-infectious Complications: arterial embolization, myocardial infarction, sudden death
Cause
Cause of coronary heart disease
Supplying the atherosclerotic plaque of the coronary artery wall of the heart itself causes a heart disease caused by stenosis of the vascular lumen. The clinical symptoms vary depending on the number and extent of coronary stenosis.
The etiology of this disease has not yet been fully understood, but it is thought to be related to hypertension, hyperlipidemia, hyperviscosity, diabetes, endocrine function and age.
Hyperlipidemia (15%):
In addition to age, lipid metabolism disorders are the most important predictors of coronary heart disease. There is a close relationship between total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) levels and the risk of coronary heart disease events. For every 1% increase in LDLC levels, the risk of coronary heart disease increases by 2-3%. Triglyceride (TG) is an independent predictor of coronary heart disease, often accompanied by low HDLC and impaired glucose tolerance, the latter two are also crowns Risk factors for heart disease.
High blood pressure (15%):
Hypertension is closely related to the formation and development of coronary atherosclerosis. Systolic blood pressure is more predictive of coronary heart disease than diastolic blood pressure. The systolic blood pressure of 140-149 mmhg is more likely to increase the risk of death from coronary heart disease than the diastolic blood pressure of 90-94 mmhg.
Age and gender (25%):
After 40 years of age, the incidence of coronary heart disease is higher. The premenopausal incidence rate of women is lower than that of men, and it is equal to men after menopause.
Smoking (10%):
Smoking is an important risk factor for coronary heart disease and is the single most avoidable cause of death. There is a significant dose-response relationship between coronary heart disease and smoking.
Diabetes (15%):
Coronary heart disease is the leading cause of death in juvenile diabetic patients. Coronary heart disease accounts for nearly 80% of all death causes and hospitalization rates in diabetic patients.
Obesity (20%):
It has been identified as the primary risk factor for coronary heart disease and can increase coronary heart disease mortality. Obesity was defined as body mass index (BMI = body weight (kg) / height squared (m2)) in men = 27.8, women = 27.3. BMI was positively associated with TC, TG, and HDL-C decline.
Sedentary lifestyle: People who do not love sports will double the risk of coronary heart disease and death.
There are still genetics, drinking, and environmental factors.
Prevention
Coronary heart disease prevention
Prevention method
Prevention of coronary heart disease must start with lifestyle and diet. The main purpose is to control blood pressure, blood lipids, blood sugar, etc., and reduce the risk of recurrence of cardiovascular and cerebrovascular diseases.
1, living often, go to bed early and get up early, avoid working day and night, do not watch nervous, horrible novels and TV before going to sleep.
2, happy mind and body, avoid anger, panic, excessive thinking tiger and overjoyed.
3, control diet, diet and light, easy to digest, eat less greasy, fat, sugar. Eat more vegetables and fruits, eat less and eat more, and have less dinner. It is better to drink strong tea and coffee.
4, quit smoking and alcohol, smoking is an important factor causing myocardial stiffness, stroke, should absolutely quit smoking, a small amount of beer, rice wine, wine and other low-grade wine can promote blood circulation, blood and blood, but can not drink hard alcohol.
5, work and rest, to avoid excessive physical labor or sudden exertion, after a meal is not suitable for exercise.
6, physical exercise, exercise should be based on their own physical conditions, hobbies, such as tai chi, table tennis, aerobics and so on. It is necessary to do what it takes to make the whole body circulate and reduce the burden on the heart.
Complication
Coronary heart disease complications Complications, arterial embolism, myocardial infarction, sudden death
1. Papillary muscle dysfunction or rupture.
2, cusp papillary muscle due to ischemia, necrosis and other systolic function disorders, resulting in varying degrees of mitral valve prolapse and insufficiency.
3, heart rupture: often appear within 1 week of myocardial infarction, mostly rupture of the ventricular free wall, causing acute cardiac tamponade caused by pericardial hemorrhage and sudden death.
4, embolism: left ventricular wall thrombus caused by the fall, causing arterial embolism of the brain, kidney, spleen, or limbs.
5, ventricular wall tumor: mainly seen in the left ventricle, physical examination showed that the left heart expansion, the heart beat range is wider.
6, after myocardial infarction syndrome: myocardial infarction within a few weeks to several months, can occur repeatedly, manifested as pericarditis, pleurisy or pneumonia, fever, chest pain and other symptoms, may be the body's allergic reaction to necrotic substances.
Symptom
Coronary heart disease symptoms Common symptoms Cardiovascular blockage fatigue palpitations Chronic atrial fibrillation Pain heart left ventricular diastolic dysfunction arrhythmia dyspnea tachycardia combined with valve prolapse
Different people have different angina attacks. Most people describe it as "chest pressure", "swelling feeling" and "sorrowful feeling". Some patients feel relaxed to the shoulders, back, neck, and throat, rest or take nitroglycerin to relieve.
Disease symptoms
The clinical classification is divided into five types: occult, angina pectoris, myocardial infarction, heart failure (ischemic cardiomyopathy), and sudden death. The most common type is angina pectoris, the most serious of which are myocardial infarction and sudden death.
Angina is a group of syndromes caused by acute transient myocardial ischemia and hypoxia:
1, chest compression suffocation, swell, sensation of burning pain, the general pain lasts 1-5 minutes, occasionally up to 15 minutes, can be relieved.
2, the pain is often radiated to the left shoulder, the front left side of the left arm until the little finger and the ring finger.
3. Pain occurs when the burden on the heart is aggravated (such as increased physical activity, excessive mental stimulation, and cold), and disappears after a few minutes of resting or sublingual nitroglycerin.
4, when the pain occurs, may be accompanied (with or without) prostration, sweating, shortness of breath, anxiety, palpitations, nausea or dizziness symptoms.
Myocardial infarction is a critical symptom of coronary heart disease. It is often the case of frequent and exacerbation of angina pectoris. There are also cases of sudden myocardial infarction with no history of angina (this situation is the most dangerous, often resulting in sudden death due to lack of preparedness).
The manifestations of myocardial infarction are:
1. Sudden pain in the posterior sternum or precordial area, radiation to the left shoulder, left arm or other areas, and the pain lasts for more than half an hour. It can not be relieved by rest and nitroglycerin.
2, shortness of breath, dizziness, nausea, sweating, pulse pulse.
3, the skin is cold, gray, and seriously ill.
4. The only manifestation of approximately one in ten patients is syncope or shock.
Examine
Coronary heart disease examination
Common examination methods for coronary heart disease are:
1. Electrocardiogram: Electrocardiogram is the earliest and most common and most basic diagnostic method in the diagnosis of coronary heart disease. Compared with other diagnostic methods, ECG is easy to use and easy to popularize. When patients' conditions change, they can capture their changes in time and can Continuous dynamic observation and various load tests to improve the diagnostic sensitivity, whether it is angina or myocardial infarction, have typical ECG changes, especially the diagnosis of arrhythmia has more clinical value, of course, there are certain Limitations.
2, ECG load test: mainly including exercise load test and drug test (such as dipyridamole, isoproterenol test, etc.), ECG is the most common simple method for clinical observation of myocardial ischemia, when angina pectoris, ECG can record myocardial ischemia The abnormal electrocardiogram performance, but many patients with coronary heart disease, although the maximum reserve capacity of coronary artery dilation has decreased, usually at rest, coronary blood flow can still maintain normal, no myocardial ischemia, ECG can be completely normal, to reveal reduction or Relatively fixed blood flow, the heart can be loaded by exercise or other methods, induce myocardial ischemia, and thus confirm the existence of angina pectoris. Exercise test is also essential for ischemic arrhythmia and evaluation of cardiac function after myocardial infarction. .
3, dynamic electrocardiogram: is a method that can continuously record and compile and analyze the ECG changes of the heart in active and quiet state for a long time. This technique was first used by Holter in 1947 to monitor the study of electrical activity, so it is also called Holter monitoring. The conventional electrocardiogram can only record the waveform of the resting state with only a few dozen cardiac cycles, and the dynamic electrocardiogram can continuously record up to 100,000 ECG signals within 24 hours, which can improve the non-sustained ectopic rhythm. In particular, the detection rate of transient arrhythmia and transient myocardial ischemic attack, thus expanding the scope of clinical use of electrocardiogram, and the occurrence time can correspond to the patient's activities and symptoms.
4, radionuclide myocardial imaging: according to the history, ECG can not rule out angina when the examination can be done, nuclear myocardial imaging can show the ischemic area, clear the location and extent of ischemia, combined with exercise test re-image, Then the detection rate can be increased.
5, coronary angiography: is the current "gold standard" for the diagnosis of coronary heart disease, can determine the presence or absence of coronary artery stenosis, stenosis, extent, range, etc., and can guide the measures to be taken for further treatment, at the same time, Left ventricular angiography can be used to evaluate cardiac function. The main indications for coronary angiography are:
(1) For patients with angina pectoris who are still under severe medical treatment, the arterial lesions should be determined to consider bypass graft surgery.
(2) Chest pain is like angina and cannot be diagnosed.
6, ultrasound and intravascular ultrasound: cardiac ultrasound can check the heart shape, wall motion and left ventricular function, is currently one of the most commonly used examination methods, for ventricular aneurysm, intracardiac thrombosis, heart rupture, papillary muscles Function and other important diagnostic value, intravascular ultrasound can determine the shape and stenosis of the wall in the coronary artery, is a promising new technology.
7, myocardial enzymology examination: is one of the important means of diagnosis and differential diagnosis of acute myocardial infarction, clinically based on the sequence of serum enzyme concentration and the increase in specific isozymes and other positive enzymatic changes can be clearly diagnosed as Acute myocardial infarction.
8, blood pool imaging: can be used to observe the dynamic image of ventricular wall contraction and relaxation, for the determination of wall motion and cardiac function has important reference value.
Diagnosis
Diagnosis and diagnosis of coronary heart disease
diagnosis
The diagnosis of coronary heart disease mainly depends on clinical manifestations (patient symptoms) and examination. When a patient with a coronary heart disease (aged, multiple risk factors) develops chest pain with the following characteristics, coronary heart disease is highly suspected.
1. Pain area: behind the sternum.
2. Radiation: lower jaw, left upper limb, left shoulder.
3, nature: crushing, burning like.
4, duration: 1-5 points, no more than 15 points.
5, incentives: tired, cold or full meal.
6, mitigation: rest, sublingual nitrates (1-3 points).
Differential diagnosis
Angina is distinguished from acute myocardial infarction, intercostal neuralgia, and costal cartilage. Myocardial infarction was differentiated from angina pectoris, acute pericarditis, acute pulmonary embolism, and aortic dissection.
