Cardiovascular diseases
Introduction
Introduction to cardiovascular disease Cardiovascular disease, also known as circulatory system disease, is a series of diseases involving the circulatory system. The circulatory system refers to the organs and tissues that transport blood in the human body, including the heart and blood vessels (arteries, veins, microvessels), which can be subdivided into acute And chronic, generally associated with arteriosclerosis. These diseases have similar causes, disease processes and treatments. Susceptible patient group 1. The elderly: the physical quality of the elderly is declining, and the resistance is not as good as before. If there are symptoms such as numbness of the limbs and hearing loss, special attention should be paid. 2. Fat people: more body fat, cholesterol is one of the main causes of cardiovascular and cerebrovascular diseases. 3. Irregular diet: especially overeating, increasing the risk of cardiovascular and cerebrovascular diseases. 4. Like to smoke and drink: These two bad habits are easy to damage organs, hinder blood circulation, and further induce cardiovascular and cerebrovascular diseases. 5. People with high pressure: The pressure exerts great influence on the nervous system, which is easy to cause disorder of internal organs. If it is not regulated, it will easily increase the risk of cardiovascular and cerebrovascular diseases in the long run. basic knowledge Sickness ratio: 10-20% Susceptible people: no special people Mode of infection: non-infectious Complications: angina pectoris pulmonary edema
Cause
Causes of cardiovascular disease
High blood pressure (28%):
Long-term hypertension can thicken or harden the vascular wall of the cerebral artery, and the lumen becomes thinner. When the blood pressure rises sharply, the cerebral blood vessels are easily ruptured and cerebral hemorrhage occurs; or the hardened small arterioles form a kind of chestnut-sized microaneurysm, which causes cerebral hemorrhage when the blood fluctuates; or the hypertension accelerates In the process of arteriosclerosis, the arterial endothelial cell fluid is damaged, platelets are easy to accumulate in the wound, and it is easy to form a cerebral blood pressure plug, which causes cardiovascular and cerebrovascular diseases.
Blood is thick (30%):
The rhythm of modern life is tense, the pressure on families and careers is getting bigger and bigger, and people's emotions are becoming more and more unstable. At the same time, excessive drinking, excessive consumption of food fat, lack of necessary exercise, and pollution of living environment, in the air The negative ion content drops sharply, and the negative ions ingested in the body are insufficient. These factors directly cause the body's metabolic rate to slow down, the blood flow rate will slow down, and the blood viscosity will rise rapidly, causing insufficient blood supply to the heart and brain. If not prevented or conditioned in time, It will cause cardiovascular and cerebrovascular diseases such as coronary heart disease, hypertension, cerebral thrombosis and fatty liver.
Smoking (15%):
The incidence of smokers is much higher than that of non-smokers, and the subarachnoid hemorrhage is 3-5.7 times more. Among the risk factors of cerebral infarction, smoking is the first. Nicotine can promote the increase of adrenaline in plasma, promote platelet aggregation and endothelial cell contraction, causing an increase in blood viscosity.
Abnormal metabolism of smooth muscle cells in the vascular wall (15%):
It is well known that vascular tissue and other tissues of the human body complete the metabolism in a certain cycle, and the process of smoothing the smooth muscle cells of the blood vessel wall, but because the new cell tissue cannot form normally, the blood vessel wall itself has "defects", which is easy to produce inflammatory blood vessels. Poor shrinkage, like a broken old pipe, can block or rupture at any time. Blood vessels are important channels for blood circulation, and they are also dominated by the nervous system. Therefore, abnormal nervous system can also cause blood supply disorders. Therefore, the causes of cardiovascular and cerebrovascular diseases are various. Do not simply consider the effects of blood changes on blood vessels. It is necessary to comprehensively consider and carefully analyze the causes of cardiovascular and cerebrovascular diseases. Diversified treatment is the most Effective and fundamental.
Prevention
Cardiovascular disease prevention
Overweight
Excessive intake of saturated and polyunsaturated fatty acids can lead to overweight and high blood pressure. Studies have shown that body mass index is positively correlated with blood pressure, weight difference of 10 kg, systolic blood pressure difference of about 3.0 mm Hg (0.4 kPa), diastolic blood pressure difference of about 2.2 mm Hg (0.29 kPa), and hypertension is known to be An important risk factor for cardiovascular disease. Studies have conducted a follow-up of more than 110,000 women for 16 years and found that obesity and overweight are risk factors for ischemic cerebrovascular disease. Dietary saturated fatty acid and sodium intake are positively correlated with stroke and are the main determinants of mortality in stroke. In general, fat intake is not more than 50 grams per day, and the proportion of saturated fatty acids should not be too high.
Protein deficiency
Previous studies have shown that the Japanese native population has a three-fold higher rate of stroke than the Hawaiian immigrant population. There is no significant difference in blood pressure between the two groups, but the animal protein intake in the Hawaiian population is significantly higher than that in the Japanese population, and animal protein is found. There is a negative correlation between stroke and animal protein can inhibit the occurrence of stroke. However, excessive protein intake also leads to excessive fat intake and increases kidney burden. The elderly consume 1.2-1.5 grams of protein per kilogram of body weight per day, at least one-third of which is high-quality protein, such as fish, eggs, milk, lean meat, soy products, edible fish protein, soy protein can make the brain The incidence of stroke is reduced.
Lack of dietary fiber
American scholars have surveyed 30,681 healthy American men for 4 years. Comprehensive analysis of all nutritional factors found that only dietary fiber is negatively correlated with hypertension, that is, increasing dietary fiber intake can prevent high blood pressure. It has been reported that increasing daily intake of fruits and vegetables can reduce the risk of stroke. Advocate eating more cereals, eating less sweets, sweets, and eating more coarse grains, vegetables, fruits and other foods with higher dietary fiber.
Salt hazard
Hypertension is the first risk factor for cardiovascular disease, and the prevalence of hypertension in China is higher in the north than in the south. The highest prevalence of hypertension in the country is Tibet, Beijing, Inner Mongolia, Hebei, and Tianjin; the lowest is Hainan. Hypertension and salt intake are closely related. The higher the intake, the higher the systolic and diastolic blood pressure levels. Compared with those who consume less than 6 grams of salt per day, people who eat more than 12 grams of salt per day have a 14% increased risk of developing hypertension, and those who are 18 grams or more have an increased risk of hypertension by 27%. Chinese residents' daily salt intake is generally large, with an average of 15-16 grams, especially in the northern population, which is heavy and is very unfavorable for the prevention of high blood pressure. The Nobel laureate, Professor Ignaro, claimed to have "a young heart". In addition to emphasizing the role of sports, he also mentioned that there is no salt in his kitchen, which left a deep impression on people. impression. 1 gram of salt is also the amount of a toothpaste cover, 6 grams of salt does not add up. From the perspective of cardiovascular disease prevention, people's diet should be as light as possible, and gradually reduce the amount of salt until no special salt is added to the food.
Reasonable meal
In the prevention and treatment of cardiovascular diseases, a reasonable diet is very important, and patients should pay strict attention to the following points in their diet:
1. Control cholesterol intake. Studies have shown that people with high cholesterol have a five-fold higher incidence of coronary heart disease than normal people. Therefore, patients with cardiovascular disease should eat less cholesterol-rich foods such as animal brain, internal organs, egg yolk, and crab yellow.
2. Control the quality and quantity of fat intake. Saturated fatty acids can raise blood cholesterol, while polyunsaturated fatty acids can lower cholesterol. Therefore, it is necessary to control the intake of saturated fatty acids such as lard and tallow in the diet.
3. Eat more foods rich in vitamin C, such as vegetables and fruits. Vitamin C increases blood vessel elasticity and protects blood vessels.
4. Increase dietary fiber intake. Dietary fiber can absorb cholesterol and prevent cholesterol from being absorbed by the body.
5. Limit salt. High-salt diet can increase the incidence of cardiovascular disease. People with mild hypertension or a family history of hypertension should have a salt intake of less than 5 grams per day. For those with high blood pressure or heart failure, each The daily salt content is preferably 1 to 2 grams.
6. Eat small meals, avoid overeating, dinner should not be too full, otherwise it is easy to induce acute myocardial infarction.
Regular medical examination
Middle-aged people over 45 years old, obese people, family history of hyperlipidemia, frequent participation in eating and drinking, and highly mentally stressed workers are all high-risk subjects. Blood lipids and blood pressure should be checked regularly (at least once a year).
Complication
Cardiovascular disease complications Complications, angina pectoris, pulmonary edema
1. Intense exercise exceeds the body's ability to withstand an accidental exercise.
2, angina pectoris: chest pain is more fixed, mainly to the left chest, can be radiated to the left shoulder, the left chest wall, the back, the neck and the lower jaw. Chest pain is compression or twisting, mostly dull pain, rarely sharp pain. The pain is induced by labor and lasts for about 3 to 5 minutes. Relieve after stopping labor or taking medication.
3, myocardial infarction: the symptoms are the same as above, but the degree is serious and lasts for a long time, often accompanied by other symptoms, such as blood pressure drop, sweating, cold limbs, etc., can not be relieved without special treatment, and is deadly Danger. Angina pectoris, acute myocardial infarction.
4, acute pulmonary edema, breathing is extremely difficult.
Symptom
Symptoms of cardiovascular disease Common symptoms Dizziness, fatigue, tachycardia, cardiogenic syncope, syncope, supine, difficulty breathing, difficulty breathing
Palpitation is a syndrome of subjective and objective signs. Subjectively, the patient feels that the heart beats quickly, is not perfect, or is powerful. Objective examination shows that the heart rate is too fast, too slow or not, that is, there is a change in heart rate and heart rate.
Dyspnea is also a comprehensive manifestation of subjective and objective signs. Subjectively feels that breathing is laborious, the number of objective breathing increases, and the movement is fast and the amplitude is increased.
Symptoms of difficulty breathing can occur in various organs of the chest. Such as cerebral infarction, pneumonia, acute pneumothorax, airway obstruction, chest wall muscle inflammation, rib fractures, etc., even skin herpes zoster disease pain can also cause breathing difficulties. The difficulty of breathing in heart disease is mostly gradual and gradually worsened.
1. Exercisional dyspnea: The normal person of the Institute of Nephrology, Chinese Academy of Sciences also has a feeling of difficulty breathing during strenuous exercise, and recovers quickly after stopping the exercise. Patients with heart disease develop symptoms when the amount of activity in which people do not have difficulty breathing, and recovery is slow or even unrecoverable.
2. Orthopnea: The patient's performance can not be supine or can not be lying flat for a long time, leaning against the seat or even sitting, the lower limbs hanging on the edge of the bed. The mechanism that cannot be supine is:
1 When lying down, the blood in the lower limbs and the abdominal cavity loses gravity, and the returning to the heart increases, which increases the workload of the heart;
2 The lung capacity is reduced when lying down. The lung capacity of the normal person in the supine position was slightly reduced (-5%), and the patient's lung capacity decreased more (up to -25%) due to factors such as pulmonary congestion.
3. Paroxysmal nocturnal dyspnea: also known as "cardiac asthma" to distinguish from asthma caused by lung disease.
In addition to the above two points, the respiratory center sensitivity is reduced after falling asleep, and the lung congestion to a certain extent causes obvious hypoxia, which makes the patient feel extremely difficult to breathe from sleep. The patient immediately changes from lying position to sitting position, even standing position, the symptoms can be gradually relieved.
4. Acute pulmonary edema (acute pulmonary edema): It is the most serious type of dyspnea, which can affect the life of patients and requires acute emergency treatment. The patient presented with extreme dyspnea, sitting breathing, obvious hypoxia, and coughing pink foamy sputum.
Cyanosis
Cyanosis means that the mucous membrane and skin are blue-purple. The absolute value of reduced hemoglobin (unoxygenated hemoglobin) in the body exceeds 5 g% (6-7 vol% unsaturation).
The mechanism of purpura is hypoxic blood, excessive hemoglobin, and stasis of blood. There are two types of center type and peripheral type.
1. Central type: refers to purpura that occurs at the level of the heart and lung organs. Arterial blood is not saturated with oxygen or mixed with excessive unoxygenated blood. Seen in right-to-left shunt congenital heart disease, such as tetralogy of Fallot, Eisenmenger's syndrome, etc., and delayed right-to-left shunt due to increased pulmonary hypertension. Blood oxygenation disorder caused by lung disease is also an important cause of central purpura. In severe heart failure, lung congestion affects oxygenation to produce central purpura.
The central purple is aggravated during exercise. Long-term oxygenation can occur with increased hemoglobin and clubbing.
2. Peripheral purpura: Seen in the surrounding blood flow rate is too slow, tissue intake of excessive blood oxygen per unit time. Peripheral purpura did not significantly increase during the event.
When heart failure occurs, blood flow is slow, and peripheral tissues take more oxygen. Therefore, its purpura combines two forms.
dizziness
Vertigo is a common symptom in the clinic. It is a directional sensory disturbance or a balanced sensory disturbance in the human body. It makes the patient feel that the surrounding scenery or itself is rotating and shaking. The vertigo is often accompanied by balance disorders, unstable standing and nausea. Symptoms of autonomic dysfunction such as vomiting, pale sweating, bradycardia, and decreased blood pressure.
Syncope
Syncope is a clinical symptom of sudden, reversible, transient loss of consciousness due to transient cerebral ischemia and hypoxia, resulting in transient dysfunction of the cerebral cortex. It is often accompanied by autonomic dysfunction such as paleness, nausea, vomiting, dizziness, and sweating before loss of consciousness occurs.
The most common causes of syncope are:
1. Reflex syncope: the most common, accounting for about 90% of the total number of syncopes, most of which are reflected by vascular vagus, leading to cardiac inhibition and systemic vasodilation, causing decreased blood flow to the heart, lowering cardiac output leading to cerebral ischemia Hypoxia causes syncope. Most of them are caused by dysfunction of the baroreceptor reflex arc in the incoming pathway. Clinically, there are simple syncope (vascular decompression syncope), orthostatic hypotension (upright hypotension) syncope, carotid sinus allergic syncope, coughing syncope, urinary syncope, swallowing syncope and so on.
2. Cardiac syncope: syncope that occurs as a result of a sudden decrease in cardiac output. Common causes are: 1 arrhythmia: common complete atrioventricular block, sick sinus syndrome, paroxysmal supraventricular or ventricular tachycardia, ventricular flutter, ventricular fibrillation. 2 heart beat disorders: acute pericardial tamponade, acute myocardial infarction and angina pectoris, left atrial myxoma, aortic or carotid artery height stenosis.
3. Brain-derived syncope: syncope caused by blood circulation disorder of the brain or brain nerve tissue lesions, clinically common in hypertensive encephalopathy, vertebral basilar artery insufficiency, cervical spondylosis, and craniocerebral injury.
4. Metabolic syncope: syncope due to abnormal blood components, common in hypoglycemia, carbon monoxide poisoning, carbon dioxide retention during respiratory failure.
5. Mental syncope: rickets.
fatigue
It is a common symptom of various heart diseases. When heart disease causes poor blood circulation, metabolic waste (mainly lactic acid) can accumulate in tissues, stimulating nerve endings and causing fatigue. Fatigue can be light and heavy, light can not care, heavy can hinder work. However, there is no specificity in heart disease fatigue, which is indistinguishable from fatigue caused by other diseases.
Examine
Cardiovascular disease examination
Common cardiovascular diseases include coronary heart disease, cardiomyopathy, valvular disease, heart failure and arrhythmia, among which coronary heart disease is the most important.
Coronary heart disease is mostly caused by a series of risk factors including hypertension, hyperlipidemia and diabetes. Therefore, the blood test should first check blood pressure, blood lipids and blood glucose (glucose tolerance test), if any Risk factors require active control to avoid the development of heart disease. Secondly, various organic heart diseases have many abnormalities of electrocardiogram and echocardiography. These two tests are of vital value in the diagnosis of heart disease. Therefore, patients suspected of having cardiovascular disease need to have ECG and cardiac ultrasound.
In addition, for clear or highly suspected cardiovascular disease, it is necessary to supplement the necessary examinations, such as labor chest tightness, chest pain, or suspicious coronary heart disease, and need to supplement ECG load test, coronary CT test and even coronary artery for coronary heart disease. Contrast and so on. If you have arrhythmia, you may need to do 24-hour ECG or even cardiac electrophysiological examination.
Diagnosis
Diagnosis of cardiovascular disease
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
Chest pain caused by heart disease has its regularity, and attention should be paid to the identification of chest pain in the respiratory system.
Normal people also have difficulty breathing when exercising vigorously, and recover quickly after stopping exercise. Patients with heart disease develop symptoms when they do not have difficulty breathing, and they recover slowly or even recover, so they should be differentiated from dyspnea after normal exercise.
The patient's performance should not be supine or not lying for a long time, leaning against the seat or even sitting on the side of the bed. The mechanism that can not be supine is that the blood of the lower limbs and the abdominal cavity loses gravity when 1 is lying down, and the returning to the heart increases, which increases the workload of the heart. 2 The lung capacity is reduced when lying down. The lung capacity of the normal person in the supine position was slightly reduced (-5%), and the patient's lung capacity decreased more (up to -25%) due to factors such as pulmonary congestion. To be differentiated from some flat diseases caused by bone diseases.
