Coronary insufficiency
Introduction
Introduction to coronary insufficiency Coronary artery insufficiency is mainly caused by coronary atherosclerosis, but because of the mild degree, it has not caused symptoms, so the causes of arteriosclerosis such as hypertension, hyperlipidemia, diabetes and smoking are directly related to the occurrence of this disease. relationship. Insufficient blood supply causes myocardial ischemia, paroxysmal precordial pain, can be released to the shoulder or upper limbs, and pain can often be relieved quickly after rest or nitroglycerin. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: coronary heart disease, angina
Cause
Coronary artery insufficiency etiology
Coronary atherosclerosis (60%):
Coronary artery insufficiency is mainly caused by coronary atherosclerosis, but because of the mild degree, it has not caused symptoms, so the causes of arteriosclerosis such as hypertension, hyperlipidemia, diabetes and smoking are directly related to the occurrence of this disease. relationship.Prevention
Coronary artery insufficiency prevention
The causes of atherosclerosis, such as hypertension, hyperlipidemia and diabetes, should be prevented from aggravating atherosclerotic lesions. In addition, smoking is banned, and overtime work and excessive load-bearing are avoided. Should participate in appropriate amount of exercise according to the individual's physique, is conducive to the establishment of coronary collateral circulation, but should avoid the insufficiency of vigorous exercise or competitive exercise to avoid accidents.
Complication
Complications of coronary insufficiency Complications, coronary heart disease, angina
Can be complicated by coronary heart disease, angina pectoris, myocardial infarction.
Symptom
Coronary artery insufficiency symptoms Common symptoms Angina pectoris Chest pain Hypertension Heart sounds weak
Insufficient blood supply causes myocardial ischemia, paroxysmal precordial pain, can be released to the shoulder or upper limbs, and pain can often be relieved quickly after rest or nitroglycerin.
Examine
Coronary insufficiency check
The electrocardiogram is the most important, quiet, or ECG when given a certain amount of exercise, there is a typical coronary insufficiency, mainly ST segment decline and T wave inversion. When the electrocardiogram changes dynamically within a few hours or days, the erythrocyte sedimentation rate increases, and the concentrations of serum enzymes such as CPK, GOT, and LDH increase, indicating that the disease progresses toward myocardial infarction.
Coronary angiography can directly check the blood flow of coronary arteries. The blood flow of the coronary arteries is measured by a special catheter, and an exact diagnosis can be made on the site of blood flow obstruction.
In addition, routine examination of complications such as hyperlipidemia, diabetes and hypertension, and corresponding treatment.
Diagnosis
Diagnosis and diagnosis of coronary artery insufficiency
Differential diagnosis
1. Cardiac neurosis patients often complain of pain in the precordial area, located in the apex or nipple, limited position, showing acupuncture-like, lasting only a few seconds, with nitroglycerin ineffective or immediate "effective", or more than 10 minutes Only "effective"; patients often have sigh breathing, palm and underarm sweating, palpitations, insomnia, inattention and so on.
2. The pain characteristics of acute myocardial infarction in myocardial infarction are very similar to those of angina pectoris, but the following differences are true: 1 The pain of acute myocardial infarction is more serious and lasts longer, and nitroglycerin can not relieve it; 2 the onset of chest pain is usually not related to labor; 3 patients with uneasiness, and typical angina pectoris, patients are mostly forced to stop activities; 4 acute myocardial infarction often accompanied by varying degrees of left ventricular dysfunction, hypotension or even shock, arrhythmia and so on.
3. Aortic valve disease more obvious aortic stenosis or regurgitation can cause angina pectoris, according to the physical examination is not difficult to identify. If the age is over 40 years old, aortic valve disease is mild but angina pectoris should be considered with coronary heart disease. Coronary angiography should be routinely performed in patients with aortic valve surgery. It should be pointed out that such patients may induce syncope or severe arrhythmia during exercise stress test, so it should be strictly prohibited.
4. Mitral valve prolapse This disease may have symptoms of chest pain, but often lacks the characteristics of typical angina. One-third of patients with conventional lead electrocardiogram show that the inferior myocardial ischemic ST-T changes, 25% of patients step Car test positive; coronary angiography except a small number of patients with coronary artery fistula, no stenosis, echocardiography is of great value in the diagnosis of this disease.
5. Hypertrophic cardiomyopathy increases the demand for oxygen due to cardiac hypertrophy, and can induce angina in case of shortage of supply. Echocardiography can make a definitive diagnosis of the disease.
6. Pulmonary thromboembolism is the pathological and clinical state of pulmonary vascular occlusion due to thromboembolism. Trauma, long-term bed rest, venous intubation caused by deep venous thrombosis of the lower extremities, various types of heart disease combined with atrial fibrillation, subacute bacterial endocarditis is a common cause. Patients may have post-sternal pain, similar to myocardial infarction, clinical dyspnea and hemoptysis, nitroglycerin is not effective. X-ray and pulmonary angiography can help confirm the diagnosis.
Because the patient has no symptoms such as angina pectoris, it is often performed before surgery or during physical examination, and most of them are found by electrocardiogram. Most of the patients are middle-aged and above, with more males.
In the case of symptomatic coronary artery insufficiency, there may be swelling of the lower extremities and difficulty in breathing. Symptoms such as shortness of breath and palpitations may occur in the upper step. In addition, I often feel guilty about arrhythmia. The onset is slow and easy to be misdiagnosed.
