Vivid metaphor Myocardial ventricular wall tumor after infarction is like a “thin inner tube of a bicycle”, when it is inflated, the thin area will protrude. Stable plaque is a kind of stable plaque with small lipid nuclei, thick fibrous cap and no active inflammatory cells, just like a “small thick-skinned dumpling” attached to the vessel wall, which is not easy to break, so there will be no platelet adhesion and activation of aggregation, and there will be few thrombotic events! Unstable vascular plaques are like “dumplings with thin skin and big filling”, which are easy to break; stable plaques are “dumplings with thick skin and little filling”, which are not easy to break, but will slowly block the blood vessels. Time is life, time is myocardium —-AMI after the coronary artery re-circulation need to fight for time! Warm tip type 1. persistence of ST-segment elevation 2 months after myocardial infarction suggests the presence of a ventricular wall aneurysm! 2. atypical aortic coarctation: one is low blood pressure, because blood accumulation in the pericardium was found on CT examination of both lungs before the aortic coarctation broke into the pericardium; the second is sudden paralysis of both lower limbs, due to the coarctation affecting the blood supply to the spinal artery. Voice of medicine micro signal vom120 3. ACEI, B-blockers and aldosterone receptor antagonists are the three cornerstones of chronic congestive heart failure treatment. 4. ST-segment elevation is thrombolytic (red thrombus) and ST-segment depression is antithrombotic (white thrombus). Short and sweet type 1. When viewing the ECG, look at the rhythm first rather than the heart rate. 2. Always exclude aortic coarctation before anticoagulation in acute infarction! 3. right ventricular infarction to rehydrate mainly, left ventricular infarction cautious rehydration. 4. Young people should think of the stomach when talking about the heart, and older people should think of the heart when talking about the stomach. 1. dilated cardiomyopathy “a large, two thin, three small, four weak”: large (heart enlargement) thin (thin ventricular wall) small (relatively small valve, more valve regurgitation) weak (ventricular wall motion is reduced) 2. treatment of heart failure 3 + X + TWO: 3 represents diuretic, cardiac, vasodilatation X represents the fight to treat the causes of heart failure TWO stands for Block and AcEI two categories of drugs 3. anterior chest discomfort, are to think of heart attack, especially elderly patients, a routine electrocardiogram is very necessary: up – toothache, sore throat, nausea, vomiting down – abdominal discomfort around –shoulder, arm discomfort anterior-posterior–costal discomfort 4. Secondary hypertension shorthand: “two renal primary aldehyde pheochromocytoma” renal vessels, renal parenchyma, primary aldosteronism Cortical artery and hypertension (cortisolism, aortic constriction, gestational hypertension) Easy-to-understand type 1. 6 lines of defense for coronary heart disease, one against onset, two against events, three against consequences, four against recurrence, five against heart failure and reinfarction, and six against psycho-emotional abnormalities. 2. Left heart failure treatment: sitting down position, oxygen, morphine, diuretic cardiodilator, aminophylline drip. 3. education of hypertensive patients: it is better to eat one less meal than to take one less medication! 4. arrhythmia is the heart’s fast beating, slow beating, chaotic beating or not beating. 5. Gyration is more like spine, anterior descending often towards the heart tip; anterior descending has like a comb to help you distinguish gyration. (When reading coronary images and pictures, no matter what position is close to the spine, it is the gyrus, and the anterior descending branch is often toward the apex of the heart.) Image apt type 1. To describe the opening sound in mitral stenosis, “a good elastic valve is like a riding crop” —- The elasticity of the crop is very good, and when it is swung out hard and then pulled back hard, there will be a loud sound. 2. The mechanism of atrial fibrillation is like an engine, once the “ignition” is successful, it will “cycle” on. 3. Heart failure is like water logging, when flooding occurs in the lungs, it is left heart failure. When flooding occurs in a part of the body other than the lungs, it is right heart failure. 4. One degree of atrioventricular block is like a small relationship between two people deteriorating, and the interval between words becoming longer (P-R interval prolongation); the second degree is like a relationship deteriorating even more, one party not going home from time to time (QRS shedding); the third degree is divorce, each living their own ~ (atrial jumping atrial, ventricular jumping ventricular). 5. stenosis drop preload, close incomplete drop afterload? If you unload the stone first (diuretic), let him take a break (vasodilatation), and then give him a whip after the break (cardiac stimulation), the horse will be able to pass the difficult time. If you don’t first unload the stone (diuretic), let him rest again (vasodilatation), but directly up to give it a few whips, the horse will certainly be exhausted. The nature of angina is not just pain, but the nature of the “pain” includes four different symptoms: boredom, suffocation, wheezing and pain. 2. Diabetes is a cardiovascular disease risk, and patients with coronary artery disease are at high risk of hyperglycemia. 3. Patients taking digoxin with yellow-green vision and arrhythmia must check the blood concentration of digoxin and be alert to digoxin poisoning. 4. Patients with very slow or fast heart rate should routinely have their “thyroid function” checked to rule out abnormal thyroid function. 5. Patients who usually have atrial fibrillation should be careful of electrolyte disorders, especially hyperkalemia, if the ECG is suddenly regularized. Summarize the type in place 1. Contraindications to digitalis drugs: hypertrophic obstruction diaphyseal narrowing, acute infarction with heart failure; second degree high atrioventricular block, preexcited disease sinus should not be. 2. Unstable angina 3 mechanism: plaque rupture, stenosis aggravation, coronary spasm. 3. Patients with unexplained syncope ECG to look for 3 waves: Brugada wave, obvious J wave, Epsilon wave, there is a suggestion that the syncope is cardiogenic! 4. The 5 10s of platelets: – The life span of platelets is about 10 days, about 1010 platelets are produced every day, and the production can increase 10 times when needed. (Since new platelets are produced every day, and the function of platelets can be restored to normal when new platelets are produced to 10% of the whole, daily maintenance doses are required.) 5. Five complications of heart attack: arterial embolism ventricular expansion, papillary dissection heart break, late infarction syndrome. Experience-sharing type 1. sudden tossing and turning with changes in heart rate and blood pressure (increase or decrease), back discomfort first consider aortic coarctation separation 2. patients with aortic coarctation may not have obvious chest and back pain, manifesting as abdominal pain, caused by organ ischemia. 3. Do not forget to consider pulmonary infarction if the patient suddenly develops chest tightness and shortness of breath with general sweating and decreased blood pressure when getting out of bed after PCI. 4. –Ventricular tachycardia. 5. If a patient with chest pain presents with “shock-like manifestations” with elevated blood pressure, the diagnosis should be aortic coarctation. 6. In patients with acute chest pain considering acute inferior wall myocardial infarction, the right chest lead must be added because the sensitivity and specificity of V3r-V5r in diagnosing right ventricular infarction are high, but the duration is short and many times can only be seen in the emergency room ECG. This article is published with permission from Dr. Ren Shuo.