I. Risk factors of coronary heart disease, symptoms and diagnosis
1, coronary heart disease “the first killer of human beings” coronary heart disease is called “the first killer of human beings” because of its high morbidity and mortality, which seriously endangers the health of human beings. In China, cardiovascular patients have more than 100 million people, including coronary heart patients reached 43 million, and the morbidity and mortality of coronary heart disease is gradually increasing trend.
2, coronary heart disease is short for coronary artery atherosclerotic heart disease. It refers to the serious atherosclerosis or spasm of the coronary arteries, the blood vessels supplying blood to the heart, resulting in the narrowing or blockage of the coronary arteries, which leads to myocardial ischemia, hypoxia and affects the function of the heart, also known as ischemic heart disease.
3, after epidemiological research found that the following factors are related to the development of coronary heart disease, these factors are called risk factors for coronary heart disease: age, gender, genetics, occupation, hyperlipidemia, hypertension, diabetes, smoking, diet, obesity, etc.
4.The symptoms of coronary heart disease are closely related to the degree and number of branches of coronary artery stenosis, that is to say, they depend on the degree of ischemia of the heart. It can produce angina pectoris, myocardial infarction, arrhythmia, heart failure, and even sudden death. Angina pectoris is a typical symptom of coronary heart disease. It is characterized by paroxysmal, crushing retrosternal pain that radiates to the back of the shoulder and upper extremities. It tends to come on easily after exertion, after a full meal, when emotionally excited, or when cold, and usually lasts for 3 to 5 minutes. It is accompanied by pallor, cold sweat and difficulty in breathing.
5. The patient’s symptoms, risk factors and other clinical tests, such as electrocardiogram, stress test, dynamic electrocardiogram, radionuclide test, coronary angiography, echocardiogram, myocardial enzyme measurement, etc. can help clinicians to make a clear diagnosis.
Second, the treatment of coronary heart disease
1.How to treat coronary heart disease
(1) Drug therapy: Although it can expand coronary arteries, it cannot fundamentally improve the narrowing of blood vessels.
(2) Interventional treatment: commonly used are percutaneous coronary endovenous angioplasty and coronary stent implantation. A catheter with a balloon is used to dilate the blood vessel and squeeze the plaque on the vessel wall, thus increasing blood flow. After surgery, a stent may be placed in the vessel to keep it open.
(3) Coronary artery bypass grafting: The patient’s own blood vessels are used to connect the aorta to the distal end of the narrowed or blocked coronary artery, restoring blood supply to the heart. The most commonly used bridges are internal mammary artery, saphenous vein, radial artery, etc.
2.What is the difference between coronary artery bypass grafting and interventional treatment?
(1) Indications for coronary artery bypass grafting:
(i) stenosis at the bifurcation.
(ii) long segmental stenosis.
(iii) Multi-branch lesions.
(4) Patients with poor stenting results.
(2) Indications for interventional treatment:
①Emergency hemodialysis for acute myocardial infarction.
(②Limited stenosis.
3.Advantages.
(1) High long-term patency rate.
(2) Low cost compared to stenting and less trauma.
4.Disadvantages: Highly traumatic and prone to restenosis after surgery.
5.Is coronary artery bypass grafting safe?
The mortality rate of coronary artery bypass grafting is only 1~2%, and although it is a major surgery itself, it is still a safe and effective treatment method. Especially the development of non-stop heart bypass surgery in recent years has further reduced the risk and complications of the operation.
Third, the precautions after coronary artery bypass surgery
1, diet, exercise and work (same as valve surgery)
2.In the early postoperative period, Yin saphenous vein is taken as the bridge vessel, blood return to the lower extremity is affected, and the patient will have swelling of the affected extremity, and at the same time, it is easy to complicate deep vein thrombosis in the lower extremity when lying in bed for a long time after surgery. Therefore, when lying in bed, elevate the lower limbs to promote blood return; when sitting, flatten the affected limbs and do not hang down for a long time; when standing and walking, wear medical elastic stockings or play elastic bandages to prevent lower limb edema and venous thrombosis.
3.Adhere to the medication for regular review
Both interventional treatment and coronary artery bypass grafting are palliative and symptomatic treatment methods for coronary heart disease. Therefore, it is necessary to adhere to regular medication after surgery, and strictly control hypertension, diabetes, hyperlipidemia and other risk factors. To slow down the development of atherosclerosis and reduce or delay the occurrence of restenosis. At the same time, regular review and coronary angiography or coronary CTA should be performed if necessary to check the patency of bridge vessels.