occult coronary atherosclerotic heart disease
Introduction
Introduction to occult coronary atherosclerotic heart disease Concealed coronary atherosclerotic heart disease (latentcoronary heart disease) referred to as occult coronary heart disease, is no clinical symptoms, but objectively examined coronary heart disease with myocardial ischemia, also known as asymptomatic coronary heart disease. The patient has coronary atherosclerosis, but the lesion is mild or has a good collateral circulation, or the patient has a higher pain threshold and no pain symptoms. The electrocardiographic manifestations of myocardial ischemia can be seen at rest, or only when the heart load is increased, often found in dynamic electrocardiographic recordings, also known as asymptomatic myocardial ischemia. The difference between this patient and other types of coronary heart disease patients is that there is no clinical symptoms, but it is not a simple coronary atherosclerosis, because there is an objective manifestation of myocardial ischemia, namely: electrocardiogram, radionuclide myocardial development, Or echocardiography shows that the heart has been affected by coronary insufficiency. It can be considered as an early coronary heart disease, but it is not necessarily an early coronary atherosclerosis. It may suddenly turn into angina or myocardial infarction, and may gradually evolve into myocardial fibrosis with cardiac enlargement, heart failure or arrhythmia. Individual patients may also die. Therefore, early diagnosis of such patients can create opportunities for them to be treated earlier. basic knowledge The proportion of illness: 0.035% Susceptible people: more than middle-aged Mode of infection: non-infectious Complications: arrhythmia heart failure cardiogenic shock ischemic cardiomyopathy mitral valve prolapse syndrome
Cause
The cause of occult coronary atherosclerotic heart disease
The causative factors are:
1 Age: Middle-aged and elderly people over 40 years old are more common. After 49 years old, they will progress faster, but young adults can also get sick.
2 Gender: Male is more common, the ratio of male to female is about 2:1, and female is common after menopause.
3 Occupation: Work with less physical activity, nervous brain activity, and often a sense of urgency is more susceptible to this disease.
4 diet: often eat higher calories, more animal fat, cholesterol, sugar and salt are prone to this disease, Western diet is an important factor in the disease.
5 blood lipids: fat and sugar overeating or metabolic disorders leading to increased blood cholesterol, triglycerides, low-density lipoprotein is easy to get sick.
6 Blood pressure: The prevalence of coronary atherosclerosis in hypertensive patients is four times higher than that of normal blood pressure, and both systolic and diastolic blood pressure are important.
In addition, smoking, obesity, genetics, diabetes and trace element deficiency are prone to the disease.
Prevention
Occult coronary atherosclerotic heart disease prevention
Cholesterol lowering measures to prevent atherosclerosis, to prevent atherosclerotic plaque aggravation, to fight atherectomy and promote the establishment of coronary collateral circulation. In recent years, some people think that even if the total cholesterol and low-density lipoprotein cholesterol are not high, the use of cholesterol-lowering measures is conducive to the regression of atherosclerotic plaque. For patients with myocardial ischemia changes at rest, such as electrocardiogram, radionuclide myocardial imaging or echocardiography, patients should be advised to reduce the work appropriately, or use nitrate, beta blocker, calcium channel blocker. Regular medical examinations. Avoid various causes of acute exacerbation of coronary heart disease, such as cold, overwork, hyperactivity, overeating. Actively treat high blood pressure, high blood fat and diabetes, adhere to appropriate exercise, choose a low cholesterol diet, avoid smoking and drink strong tea.
Complication
Concealed coronary atherosclerotic heart disease complications Complications arrhythmia heart failure cardiogenic shock ischemic cardiomyopathy mitral valve prolapse syndrome
Coronary heart disease can have complications such as sudden cardiac death, arrhythmia, heart failure, cardiogenic shock, ischemic cardiomyopathy, and mitral valve prolapse.
Symptom
Concealed coronary atherosclerotic heart disease Symptoms Symptoms in the precordial area, pain, blood pressure, angina
Most of the patients are middle-aged and above, without the symptoms of myocardial ischemia, but may have the risk factors of coronary heart disease. During the physical examination, the electrocardiogram (rest, dynamic or load test) has ST-segment depression and T-wave inversion. Radionuclide myocardial visualization (intravenous or load test), or echocardiography shows myocardial ischemia.
The difference between this patient and other types of coronary heart disease patients is that there is no clinical symptoms, but it is not a simple coronary atherosclerosis, because there is an objective manifestation of myocardial ischemia, namely: electrocardiogram, radionuclide myocardial development, Or echocardiography shows that the heart has been affected by coronary insufficiency. It can be considered as an early coronary heart disease, but it is not necessarily an early coronary atherosclerosis. It may suddenly turn into angina or myocardial infarction, and may gradually evolve into myocardial fibrosis with cardiac enlargement, heart failure or arrhythmia. Individual patients may also die. Therefore, early diagnosis of such patients can create opportunities for them to be treated earlier.
Examine
Examination of occult coronary atherosclerotic heart disease
1, ECG:
Electrocardiogram is the earliest, most commonly used and most basic diagnostic method in the diagnosis of occult coronary heart disease. ECG is easy to use and easy to popularize. When the patient's condition changes, it can capture its changes in time, and can continuously observe and carry out various load tests. To improve its diagnostic sensitivity. Whether it is angina or myocardial infarction, there are typical ECG changes.
2. Radionuclide myocardial imaging:
According to the medical history, this top examination can be done when the electrocardiogram can not rule out angina. Radionuclide myocardial imaging can show the ischemic area, the location of the ischemic area, and the extent of the lesion. Combined with exercise test and re-imaging, the detection rate can be improved.
3, coronary angiography:
It is the "gold standard" for the diagnosis of coronary heart disease. It is possible to determine the location, extent, and extent of the coronary artery with or without stenosis, and to guide the measures to be taken for further treatment. At the same time, left ventricular angiography can be used to evaluate cardiac function.
4. Ultrasound and intravascular ultrasound:
Cardiac ultrasound can examine heart shape, wall motion, and left ventricular function, and is one of the most commonly used examination methods. Intravascular ultrasound is a promising new technique for clarifying the shape and stenosis of the wall in the coronary arteries.
5, myocardial enzymology check:
It is one of the important means for the diagnosis and differential diagnosis of acute myocardial infarction. Clinically, a positive enzymatic change based on sequence changes in serum enzyme concentration and elevation of specific isozymes can be clearly diagnosed as acute myocardial infarction.
6, blood pool imaging:
It can be used to observe the dynamic image of ventricular wall contraction and relaxation, and has important reference value for determining wall motion and cardiac function.
Diagnosis
Diagnosis and diagnosis of occult coronary atherosclerotic heart disease
diagnosis
Mainly based on resting, dynamic or stress test ECG, radionuclide myocardial imaging and / or echocardiography, found that patients have myocardial ischemia changes, and no other explanation, accompanied by atherosclerosis When it is a predisposing factor, it can be considered as occult coronary heart disease. A selective coronary angiography or additional intracoronary ultrasound can establish a diagnosis. The diagnostic criteria for myocardial ischemia in the electrocardiogram exercise stress test finally revised by Chinese scholars are:
(1) ECG activity plate or treadmill grading exercise test (sub-maximum) to determine the standard of myocardial ischemia
Positive if one of the following conditions is met:
1. Typical angina occurs during exercise.
2. The ST-segment depression is 0.lmV in the horizontal or drooping type (ie, ischemic type) during and after exercise. If the original ST segment is depressed, the motion should be reduced to 0.lmV on the original basis.
3. Blood pressure drops during exercise.
(B) the standard of electrocardiogram secondary ladder double exercise test to determine myocardial ischemia
The ECG secondary ladder exercise test has now been replaced by a configurable active plate or treadmill exercise test. However, the latter two devices are expensive, and the former can be easily applied in primary medical units.
1. A typical angina in exercise or a change in ECG after exercise is positive for one of the following conditions:
(1) On the lead in which the R wave predominates, after the exercise, the horizontal or drooping type ST segment is depressed (the intersection angle between the ST segment and the R wave apex perpendicular line 900), which exceeds 0.05 mV for 2 minutes. If the original ST segment is depressed, after the exercise, the pressure is further reduced by more than 0.O5mV for 2 minutes.
(2) In the lead with R wave dominant, ST segment elevation (bow-back type) exceeds 0.2 mV after exercise.
2. After the exercise, the electrocardiogram changes to one of the following conditions as suspicious positive:
(1) On the lead with R wave dominant, after the exercise, the horizontal or drooping ST segment depression is 0.O5mV or close to 0.O5mV and the QX/QT ratio is 50% for 2 minutes.
(2) On the lead in which the R wave is dominant, the T wave from the upright to the inversion after the exercise lasts for 2 minutes.
(3) U wave inversion.
(4) Any of the following arrhythmias appear after exercise: multi-source ventricular premature beats, paroxysmal ventricular tachycardia, atrial fibrillation or flutter, sinus block, atrioventricular block (one or two) , third degree), left bundle branch block or left bundle branch block, complete right bundle branch block or indoor block.
In addition, it has also been suggested that the amplitude of the R wave after exercise (especially in the ST segment depression) is also an indicator of myocardial ischemia.
Differential diagnosis
Cardiac neurosis
The disease is a central nervous system dysfunction, affecting autonomic function, resulting in abnormal cardiovascular function. Among the types of adrenergic beta receptor excitability, patients showed more stress and increased heart rate, increased myocardial oxygen consumption, and ECG showed ST-segment depression and T-wave inversion, and concealed crown Heart disease is similar. The patients with this disease are mostly young and middle-aged women, and the propranolol test is performed. That is, after taking 10 to 20 mg of propranol for 2 hours, the heart rate is slowed down and then the electrocardiogram is checked. It can be seen that the ST segment and the T wave return to normal. Help with identification.
Other diseases that cause ST segment and T wave changes
All kinds of organic heart disease, especially myocarditis, cardiomyopathy, pericardial disease, electrolyte imbalance, endocrine disease and drug effects, can cause ECG ST segment and T wave changes, should be noted in the diagnosis, but according to these diseases And the clinical characteristics of the situation, it is not difficult to make an identification.
