A. When initially determining whether it is coronary heart disease, what are the main aspects to look for?
The typical symptoms of angina pectoris have the following characteristics.
1, site: usually located behind the sternum or left anterior chest, a few can be located in the pharynx, upper abdomen, jaw and other parts, the site of each attack is usually constant.
2. Nature: usually dull pain like heavy pressure, crushing sensation, tightness, girdling sensation, etc. Some patients show choking sensation, usually not pinprick-like, knife-like, burning-like sharp pain.
Duration: usually a few minutes, will not last only a few seconds, if the typical symptoms last more than 15 minutes should be considered to exclude the possibility of myocardial infarction.
4. Triggering causes: usually occurs at the time of physical activity or mood swings, and usually does not show symptoms when stopping to rest after a long period of labor.
5.Relief mode: It can be relieved after stopping the activity and resting, and it can be relieved quickly after taking nitroglycerin, and generally it will not be relieved after 10 minutes or so after taking nitroglycerin.
6.Radiological site: You can feel discomfort in the left shoulder, left back and left upper limb at the same time as the onset of chest discomfort.
7. Accompanying symptoms: In severe cases, sweating can be accompanied.
The symptoms of myocardial infarction are similar in nature to angina pectoris but much more intense, persistently unremitting, and may be accompanied by sweating, nausea, and a sense of near death.
ECG: The typical ECG manifestation of myocardial ischemia is horizontal or downward sloping ST-segment shift and T-wave inversion during the onset of symptoms, which rapidly returns to normal after the symptoms are relieved. The key point is that ECG changes are closely related to the symptoms. If there are “ST-T changes” in the ECG on physical examination but they are not related to the symptoms and there is no long-term dynamic change, then there is no diagnostic value.
Risk factors: The diagnostic accuracy is higher if it is a high-risk group and the symptoms are typical.
Who are the high-risk groups? What is the age of people with symptoms that should be considered for coronary heart disease?
Risk factors for coronary heart disease include: middle-aged men, postmenopausal women, hypertension, lipid metabolism disorders, diabetes, obesity, low physical activity, smoking, family history of premature arterial atherosclerosis (before the age of 55 for men and 65 for women in the immediate family), and hyperhomocysteinemia.
High-risk groups are people who have multiple risk factors at the same time.
Coronary artery disease should be considered except for men over 45 years of age and women over 55 years of age with corresponding symptoms.
Third, if young people in their 20s and 30s show typical symptoms of coronary heart disease, is it necessary to consider coronary heart disease?
Nowadays, it is not uncommon for young people to have coronary heart disease or even acute myocardial infarction, and the youngest coronary heart disease patient I have seen is 15 years old for men and 23 years old for women. So as long as there are typical symptoms, we should consider to exclude the possibility of coronary heart disease.
IV. What are the main aspects of past medical history?
Hypertension, hypercholesterolemia, diabetes, history of myocardial infarction, stroke, peripheral vascular atherosclerosis, history of heart failure, etc.
V. Do coronary heart patients always have changes in lipids, blood sugar and blood pressure?
Although hypertension, lipid metabolism disorders and diabetes are risk factors for coronary heart disease, it does not mean that all patients with coronary heart disease have these factors, in fact, it is not uncommon for people who cannot find any risk factors to have coronary heart disease or even acute heart attack. This is because the current medical research on the causes of coronary heart disease is still far from clear.
Sixth, is it necessary to screen for coronary heart disease in people who are not found to have three highs but have symptoms such as angina, chest tightness and shortness of breath?
Of course it is needed, for the same reasons as above.
Seven, what are the typical symptoms of coronary heart disease? Is angina pectoris the key to determine?
The typical symptoms of angina pectoris in coronary heart disease are chest tightness and pain at the time of activity, which can be relieved by resting for a few minutes after stopping the activity, and recurrence of symptoms under the same amount of activity.
The symptoms of acute heart attack are similar in nature to those of angina but are more severe and last for several hours without relief, and can be triggered by satiety, emotional excitement, heavy smoking, or no obvious trigger. Many patients have no obvious history of angina attack before the infarction, so the absence of previous angina cannot be taken as evidence to exclude the infarction.
How does angina pectoris really hurt?
Angina pectoris is a discomfort caused by the accumulation of local acidic metabolites that stimulate the nerves in a state of myocardial ischemia because the blood supplied to the myocardium by the coronary arteries cannot meet the needs of myocardial metabolism. In medical terms, “angina” usually refers to pain caused by ischemia.
Is there any relationship between the severity of symptoms and the severity of coronary artery disease?
There is no absolute correspondence between the severity of symptoms and the severity of coronary artery disease. In general, the symptoms of myocardial infarction are much more severe than angina pectoris, but there are some patients (mainly elderly and diabetic patients) who do not feel any pain at the time of infarction but seek medical consultation for symptoms of heart failure after the secondary heart failure.
On the other hand, the sensitivity of pain sensation varies from patient to patient, so it should not be assumed that the condition is serious if the pain is severe.
What are the atypical symptoms of coronary heart disease and what do they include? Is it easy to be mistaken for other diseases?
The atypical symptoms of angina pectoris are atypical in any aspect such as pain location, nature, duration and trigger. It can be manifested as toothache, sore throat, abdominal pain, etc., which may be mistaken for dental disease, acute abdomen, etc.
Is there any asymptomatic coronary heart disease?
Yes, there is a clinical classification of coronary heart disease called occult coronary heart disease, also called asymptomatic myocardial ischemia, which is manifested as patients without angina symptoms but evidence of myocardial ischemia is found in objective tests such as exercise ECG.
12.How to achieve early detection of coronary artery disease with atypical or asymptomatic symptoms?
For coronary heart disease with atypical symptoms, as long as the symptoms are closely related to physical activity, timely consultation with an experienced doctor in cardiology can usually lead to timely diagnosis.
Coronary heart disease that is completely asymptomatic is more difficult to be diagnosed early, and high-risk groups can go to the cardiology department of a large hospital for regular checkups.
XIII. Is there any coronary heart disease that looks like coronary heart disease but is not actually coronary heart disease at all? How should we distinguish?
There are too many. Aortic stenosis and hypertrophic obstructive cardiomyopathy can have typical myocardial ischemic manifestations, but this ischemia is not due to coronary causes, so it cannot be diagnosed as coronary heart disease. Cardiac neurosis, anxiety and depression, and menopausal syndrome can all have clinical manifestations that look like coronary artery disease, and need to be diagnosed by a doctor in the cardiology department.