angina pectoris
Introduction
Introduction to angina Angina pectoris refers to a group of syndromes characterized by insufficient coronary blood supply due to coronary atherosclerotic stenosis, temporary myocardial ischemia and hypoxia caused by precordial pain. The disease is more common in men, most patients are over 40 years old, tired, emotional, full of food, cold, rainy weather, acute circulatory failure, etc. are common causes. It is characterized by paroxysmal chest compression pain, which can be accompanied by other symptoms. The pain is mainly located in the back of the sternum and can be radiated to the anterior and left upper limbs. It often occurs during labor or emotional excitement for several minutes. It disappeared after rest or with a nitrate ester preparation. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: arrhythmia myocardial infarction heart failure
Cause
Cause of angina pectoris
Insufficient blood supply to the heart muscle (30%):
The direct cause of angina pectoris is insufficient blood supply to the heart muscle. The lack of myocardial blood supply is mainly due to coronary heart disease. If fat is deposited in the blood vessels, plaque will form. If the plaque occurs in the coronary arteries, it will cause it to narrow, further reducing its blood supply to the myocardium, resulting in coronary heart disease.
Coronary plaque (25%):
The process of continuous deposition of visceral fat in the coronary arteries is called coronary arteriosclerosis. Some plaques are hard and stable, leading to narrowing and hardening of the coronary arteries themselves. Other plaques are softer and prone to fragmentation to form blood clots. Accumulation of this plaque on the inner wall of the coronary artery can cause angina in two ways: 1. The narrowing of the lumen of the coronary artery, which leads to a significant reduction in blood flow; 2. Partial or complete blockage of the formed blood clot Coronary artery.
Other factors (10%):
Other types of heart disease or uncontrolled high blood pressure can also cause angina.
Prevention
Angina prevention
1. Control salt intake
Eat less salt, the main component of salt is sodium chloride, long-term consumption of sodium chloride, high blood pressure, damage to the vascular endothelium. The daily salt intake of patients with angina should be controlled below 6 grams.
2, control fat intake
Eat less fat and reduce calorie intake. A high-fat diet increases blood viscosity and increases blood lipids. Hyperlipidemia is the cause of angina. The amount of cooking oil should be minimized, and oil is also an important substance for fat formation. However, vegetable oil containing unsaturated fatty acids can be selected instead of animal oil. The total daily oil consumption should be limited to 5-8 teaspoons.
3, avoid eating animal internal organs
Animal internal organs are rich in fatty alcohols such as liver, heart, kidney and the like.
4, quit smoking and alcohol
As we all know, tobacco and alcohol are harmful to the human body. It not only induces angina but also induces acute myocardial infarction.
5. Eat more foods rich in vitamins and dietary fiber.
Such as fresh vegetables, fruits, coarse grains, etc., eating more sea fish and soybeans is beneficial to the prevention and treatment of coronary heart disease.
6, eat more foods that help improve blood vessels
Such as garlic, onions, hawthorn, black fungus, jujube, bean sprouts, squid and so on.
7, avoid eating irritating food and flatulence food
Such as strong tea, coffee, pepper, curry and so on.
8, pay attention to eat less meals, avoid overeating
Dinner should not be too full to avoid acute myocardial infarction.
Complication
Angina complications Complications arrhythmia myocardial infarction heart failure
There may be complications such as myocardial infarction, fatal arrhythmia or heart failure.
1, arrhythmia
The cause of arrhythmia caused by variant angina pectoris is coronary artery spasm, sudden occlusion of blood vessels, repolarization inconsistent reentry and myocardial electrical instability after myocardial ischemia and reperfusion, the longer the ischemic time, the higher the ST segment elevation Obviously, the more prone to arrhythmia, the cause of coronary artery spasm is a large number of smoking, alcohol and infection, etc., because coronary artery spasm occurs on the basis of coronary artery disease, so should actively prevent risk factors, such as: quit smoking, lipid-lowering , lowering blood pressure, lowering blood sugar, etc., coronary artery sputum can not only induce severe arrhythmia, but also can cause sudden death due to myocardial infarction, clinically should be highly valued, common ECG sometimes difficult to capture arrhythmia, dynamic electrocardiogram and ECG monitoring It can provide evidence of arrhythmia. Therefore, patients with variant angina should be closely monitored for ECG, early detection of malignant arrhythmia, early treatment to prevent sudden death.
2. myocardial infarction
Due to acute coronary occlusion, blood flow is interrupted, causing severe and persistent ischemic myocardial necrosis, clinical manifestations are sudden, severe and persistent post-sternal pain, characteristic electrocardiographic dynamic progression and increased serum enzymes, heart rhythm can occur Malfunctions such as dysfunction, heart failure, shock, etc., can often be life-threatening. About half of patients with acute myocardial infarction have prodromal symptoms 1 to 2 days or 1 to 2 weeks before onset, the most common being the original stable type. Angina pectoris becomes unstable, or there is no angina, and there is a sudden long-term angina. The typical symptoms of myocardial infarction include sudden and severe post-sternal compression pain, rest and nitroglycerin can not be relieved, often accompanied by irritability. Sweating, fear or sudden death; a small number of patients without pain, initially manifested as shock or acute heart failure; some patients with pain in the upper abdomen, mistaken for gastric perforation, acute pancreatitis and other acute abdomen, stroke-like episodes Can be seen in older patients, systemic symptoms: fever, increased white blood cells, increased erythrocyte sedimentation rate; gastrointestinal symptoms: more common in patients with inferior wall infarction Arrhythmia: seen in 75% to 95% of patients, occurring within 1 to 2 weeks of onset, but more common within 24 hours, anterior wall myocardial infarction prone to ventricular arrhythmia, inferior myocardial infarction prone to compartment Conduction block; heart failure: mainly acute left heart failure, occurring in the first few hours of onset, the incidence rate of 32% to 48%, manifested as dyspnea, cough, cyanosis, irritability and other symptoms.
3, heart failure
Also known as congestive heart failure or cardiac insufficiency, the heart due to disease, overwork, blood loss function, and even the amount of blood can not meet the needs of organ and tissue metabolism, the main symptoms are difficulty breathing, wheezing, edema, etc., heart failure For left heart failure and right heart failure, left heart failure is mainly characterized by fatigue and fatigue, difficulty in breathing, initial labor fatigue, and eventually evolved into difficulty breathing at rest, only sitting breathing, paroxysmal dyspnea is The typical manifestations of left heart failure, more than the onset of sleep, chest tightness, shortness of breath, cough, wheezing, particularly serious can become acute pulmonary edema and severe asthma, sitting breathing, extreme anxiety and cough with foam Mucous sputum (typically pink foamy sputum), purpura and other symptoms of lung stagnation, right heart failure mainly manifested as lower extremity edema, jugular vein engorgement, loss of appetite, nausea and vomiting, oliguria, nocturia, drinking water and urination Separation phenomenon, etc., the main signs are lung bottom wet rales or whole lung wet rales, pulmonary valve second sound hyperthyroidism, galloping and alternating veins, hepatomegaly, liver neck reflux positive X-ray examination was mainly caused by left ventricle or left atrial enlargement. Laboratory examination showed that the left heart failure had prolonged arm time. The floating catheter was used to measure the increase of pulmonary capillary wedge pressure. Right heart failure had prolonged arm and lung time, and venous pressure was obvious. Increase.
Symptom
Symptoms of angina pectoris common symptoms chest pain chest tightness suffocation anxiety skin pale irritability anxiety cardiovascular occlusion tachycardia chest pain backache
More manifestations of dull pain, crushing pain or sternal rear, throat tightness, some patients only have chest tightness, can be divided into typical angina and atypical angina:
1, typical angina symptoms
Sudden squeezing, swelling or suffocating pain in the upper or middle part of the sternum may also affect most of the precordial area. It can be radiated to the left shoulder, the anterior medial side of the left upper extremity, reaching the ring finger and the little finger, even with Sudden death often forces the patient to stop the activity immediately, and the heavy one is still sweating. The pain lasts 1 to 5 minutes, rarely more than 15 minutes; rest or with nitroglycerin, the pain disappears within 1 to 2 minutes (rarely more than 5 minutes). Often tired, emotional (angry, anxious, over-excited), cold, satiety, smoking, anemia, tachycardia or shock can also be induced.
2, atypical angina symptoms
The pain can be located in the lower sternum, the left anterior region or the upper abdomen, radiating to the neck, lower jaw, left scapula or right anterior chest. The pain can quickly disappear or only the left front chest is uncomfortable and nausea.
Examine
Examination of angina
1, ECG examination.
2, cardiac X-ray examination.
3. Radionuclide inspection.
4. Coronary angiography.
5, intravascular ultrasound imaging examination.
6, angioscopy.
Diagnosis
Diagnosis of angina pectoris
Differential diagnosis should consider the following various situations:
1, cardiac neurosis: patients with this disease often complain of chest pain, but for a short (several seconds) of tingling or more persistent (hours) of pain, patients often like to take a deep breath or sigh breath from time to time The chest pain area is mostly near the apex of the left chest breast, or changes frequently. The symptoms appear after fatigue, but at the time of fatigue, the mild activity is reflexive and comfortable, sometimes it can tolerate heavier physical activity without happening. Chest pain or chest tightness, with nitroglycerin ineffective or "effective" after more than 10 minutes, often accompanied by symptoms of heart palpitations, fatigue and other nervous failure.
2, acute myocardial: infarction The pain site of this disease is similar to angina pectoris, but the nature is more intense, the duration can be several hours, often accompanied by shock, arrhythmia and heart failure, and fever, containing nitroglycerin can not make it alleviate In the electrocardiogram, the ST segment elevation of the lead to the infarction site, and abnormal Q wave, laboratory tests showed white blood cell count and serological examination showed creatine phosphokinase, aspartate aminotransferase, lactate dehydrogenase, myoglobin The myosin light chain is increased, and the erythrocyte sedimentation rate is increased.
3, Syndrome X (syndrome X): This disease is caused by small coronary artery systolic dysfunction, with repeated episodes of exertional angina pectoris as the main performance, pain can also occur at rest, electrocardiogram can show myocardial during or after the load Ischemia, myocardial perfusion can show defects, echocardiography can show segmental wall motion abnormalities, but this disease is more common in women, the risk factors of coronary heart disease are not obvious, pain symptoms are not typical, coronary angiography is negative The left ventricle has no hypertrophy, the ergometrine test is negative, the treatment response is unstable and the prognosis is good, and it is different from coronary heart disease angina.
4, angina pectoris caused by other diseases: including severe aortic stenosis or regurgitation, rheumatic fever or other causes of coronary arteritis, syphilitic aortitis caused by coronary stenosis or occlusion, hypertrophic cardiomyopathy, congenital Coronary artery malformation and other causes angina pectoris, according to other clinical manifestations to identify.
5, intercostal neuralgia: the pain of this disease often involves 1 or 2 intercostal, but not necessarily confined to the front chest, for tingling or burning pain, mostly persistent rather than seizure, cough, forced breathing and body Rotation can aggravate the pain, there is tenderness along the nerve path, and there is local pain during the lifting of the arm, so it is different from angina.
In addition, atypical angina needs to be differentiated from chest and abdomen pain caused by esophageal lesions, sputum, ulcer disease, intestinal disease, and cervical spondylosis.
