chest pain after exertion
Introduction
Introduction Coronary heart disease (coronary heart disease referred to as coronary heart disease) means that due to abnormal lipid metabolism, lipids in the blood are deposited on the smooth inner membrane of the arteries, and some atherogenic lipids accumulate in the intima of the arteries. White plaques, called atherosclerotic lesions. These plaques gradually increase the arterial stenosis, causing blood flow, leading to cardiac ischemia, angina pectoris), angina pectoris, is the most common cause of chest pain, mostly tired, full meal After the emotional excitement.
Cause
Cause
The basic pathological basis is myocardial ischemia caused by stenosis caused by coronary atherosclerosis and coronary artery spasm.
1. Inflammation: dermatitis, non-suppurative costal cartilage, herpes zoster, myositis, epidemic myalgia, pleurisy, pericarditis, mediastinal inflammation, esophagitis, etc.
2. Visceral ischemia: angina pectoris, acute myocardial infarction, cardiomyopathy, pulmonary infarction, etc.
3. Tumor: Compression or infiltration of primary lung cancer, mediastinal tumor, myeloma, leukemia, etc.
4. Other causes: spontaneous pneumothorax, thoracic aortic aneurysm, dissecting aneurysm, hyperventilation syndrome, trauma, etc.
5. Cardiac neurosis.
Examine
an examination
Related inspection
ECG dynamic electrocardiogram (Holter monitoring)
Electrocardiogram
Electrocardiogram is the easiest and most common method for diagnosing coronary heart disease. Especially when the patient's symptoms are onset, it is the most important means of examination, and arrhythmia can also be found. Most are not specific when not attacking. In the onset of angina pectoris, the ST segment was abnormally depressed, and patients with variant angina had transient ST-segment elevation. Unstable angina has a significant ST segment depression and T wave inversion. Electrocardiogram performance during myocardial infarction: 1 abnormal Q wave and ST segment elevation in the acute phase. 2 In the subacute phase, only abnormal Q waves and T waves were inverted (days to weeks after infarction). 3 Chronic or old age (3 to 6 months) only abnormal Q waves. If the ST segment elevation lasts for more than 6 months, it may be complicated by ventricular aneurysm. If the T wave is permanently inverted, it is called old myocardial infarction with coronary ischemia.
2. ECG load test
Including exercise load test and drug load test (such as dipyridamole, isoproterenol test, etc.). For patients who are asymptomatic or have short symptoms in a quiet state, it is possible to induce myocardial ischemia by increasing the load of the heart by exercise or drugs, and to confirm the presence of myocardial ischemia by recording changes in ST-T by electrocardiogram. The exercise load test is most commonly used, and the result is positive. However, patients suspected of myocardial infarction are contraindicated.
3. Dynamic ECG
It is a method that continuously records and analyzes ECG changes in active and quiet states for a long time. This technique was first used by Holter in 1947 to study the study of electrical activity, so it is also known as Holter. The method can record changes in the electrocardiogram of the patient in daily life, such as ST-T changes caused by transient myocardial ischemia. Non-invasive, convenient, and easy for patients to accept.
Diagnosis
Differential diagnosis
Differential diagnosis of chest pain after exertion:
First, stable angina pectoris: in line with the characteristics of typical angina, the course of disease lasts for 1 month or more. This is because the coronary artery of the lesion can only satisfy the myocardial blood supply under quiet state or mild exhaustion. When the labor intensity increases, the myocardial oxygen consumption increases, resulting in transient hypoxia. This type of angina is characterized by a relatively constant intensity of labor that induces angina, and symptoms can be alleviated after discontinuation of activity. The pathological basis is often due to the fixed stenosis of the coronary arteries. The course of disease is longer and the condition is relatively stable.
Second, the initial hair fatigue angina: refers to the typical angina pectoral but the course of the disease within 1 month, no past or past angina, but has not been issued for several months. Some of them can be converted to stable labor angina, but some of the coronary atherosclerosis progresses rapidly, or acute myocardial infarction occurs in the short-term coronary thrombosis. Therefore, the clinical manifestations of this type are quite different, and the age of onset is relatively light, which is more common in men.
3. Deteriorating angina pectoris: The frequency, degree, time limit, and predisposing factors of pain in patients with stable angina often change progressively within 3 months. This type of angina activity is significantly reduced, even in quiescent state, pain time is prolonged, and sensitivity to nitroglycerin is weakened. It may be due to increased lipid infiltration in atherosclerotic plaque or plaque rupture, local platelet aggregation, and may develop into acute myocardial infarction.
Fourth, supine angina: its characteristics are often occur at rest or when sleeping, because some occur at night, sitting up or standing during the attack can reduce symptoms. Patients with this type of angina often have a long history of coronary heart disease. Because of long-term myocardial ischemia, there is a certain degree of myocardial sclerotherapy and cardiac insufficiency, or increased venous return due to supine, which increases cardiac workload and myocardial oxygen consumption. related. Can develop into myocardial infarction or sudden death.
V. Variant angina pectoris: The seizure is similar to that of supine angina pectoris, but the ST-segment elevation of the corresponding ECG is the episode, and the corresponding lead is ST-segment depression, which is induced by the occurrence of coronary artery spasm. .
Sixth, mixed angina: patients can have angina pectoris when myocardial oxygen demand increases, and angina can occur when there is no significant increase in myocardial oxygen demand. Coronary artery stenosis reduces coronary blood flow reserve, and this blood flow reserve is not fixed, and it is often volatility.
