1.What is coronary heart disease?
”Coronary heart disease” is the abbreviation of coronary arteriosclerotic heart disease.
The heart is an important organ of the human body, and its role is like a pump that never stops working. Adults generally have 70-80 heartbeats per minute, and with each contraction of the heart, the blood flow carrying oxygen and nutrients is transported to the whole body through the aorta to supply the metabolic needs of each tissue cell.
How does the heart get its own oxygen and nutrients?
At the root of the aorta there are two arteries that are responsible for the circulation of blood to the heart itself, called coronary arteries. As a result of abnormal lipid metabolism, lipids in the blood are deposited on the otherwise smooth inner lining of the arteries, forming a number of scattered white plaques of atherosclerotic-like lipid accumulation in the inner lining of the arteries, called atherosclerotic lesions. The gradual increase of these plaques causes narrowing of the arterial lumen and obstruction of blood flow, resulting in ischemia of the heart and angina pectoris. If the plaques on the artery wall form ulcers or rupture, a thrombus will be formed, which will completely interrupt the blood flow of the whole blood vessel, resulting in acute myocardial infarction and even sudden death.
2.The etiology and risk factors of coronary heart disease
The cause of coronary heart disease is coronary atherosclerosis, but the cause of atherosclerosis is not fully understood and may be the result of a combination of factors. The risk factors considered for the development of this disease are: age and gender (men over 45 years old, women over 55 years old or postmenopausal), family history (father and brother died of heart disease before 55 years old, mother/sister before 65 years old), dyslipidemia (LDL-C too high, HDL-C too low), hypertension, urinary glucose disease, smoking, overweight, obesity gout, etc.
3.Clinical manifestations of coronary heart disease
There are five clinical types: asymptomatic, angina pectoris, myocardial infarction, ischemic cardiomyopathy, and sudden death, the most common of which is angina pectoris, and the most serious are myocardial infarction and sudden death.
Angina pectoris is a group of syndromes due to acute temporary myocardial ischemia and hypoxia caused by.
(1) a feeling of pressure and suffocation in the chest, stuffiness, and severe burning-like pain, usually lasting 1-5 minutes, occasionally up to 15 minutes, which may resolve on its own.
(2) Pain often radiates to the left shoulder, the anterior medial aspect of the left arm up to the little finger and ring finger.
(3) The pain appears with increased cardiac burden (e.g., increased physical activity, excessive mental stimulation, and cold) and resolves after a few minutes of rest or sublingual nitroglycerin.
(4) Pain attacks may be accompanied (or not) by symptoms of weakness, sweating, shortness of breath, apprehension, palpitations, nausea, or dizziness.
Myocardial infarction is a critical symptom of coronary artery disease, usually based on frequent and aggravated angina attacks, but there are also cases of sudden myocardial infarction without a history of angina (this is the most dangerous situation, often resulting in sudden death due to lack of preparedness). The manifestations of myocardial infarction are.
(1) Sudden onset of severe pain in the retrosternal or precordial region, radiating to the left shoulder, left arm or elsewhere, and the pain lasts for more than half an hour and cannot be relieved by rest and nitroglycerin.
(2) Shortness of breath, dizziness, nausea, chills, excessive sweating, and a fine pulse.
(3) Cold, clammy, gray, and gravely ill skin.
(4) The only manifestation in about one in ten patients is syncope or shock.
4, prevention of coronary heart disease from daily life
(1) Regular living. Early to bed and early to rise, avoid staying up late to work, before going to bed, do not watch stressful, scary novels and television.
(2) happy body and mind. Avoid anger, panic, excessive thinking about the tiger and too happy.
(3) control the diet. Diet and light, easy to digest, eat less greasy, fat, sugar. To use enough vegetables and fruits, eat less and more meals, less dinner, for the desirability of drinking strong tea, coffee.
(4) Quit smoking and less alcohol. Smoking is an important factor causing myocardial infarction, stroke, should absolutely quit smoking. Drink a small amount of beer, yellow wine, wine and other low-grade wine can promote blood flow, Qi and blood reconciliation, but can not drink strong wine.
(5) Combine work and rest. Avoid excessive physical labor or sudden exertion, and should not exercise after a full meal.
(6) physical exercise. Exercise should be selected according to each person’s own physical condition, interests, such as playing tai chi, table tennis, gymnastics, etc.. To do according to the strength, so that the whole body circulation, reduce the burden on the heart.
5.ABCDE of secondary prevention of coronary heart disease
The so-called secondary prevention refers to pharmacological and non-pharmacological interventions to delay or stop the progression of atherosclerosis in patients with definite coronary heart disease (including post-stenting and post-bypass surgery). The English-speaking countries are summarized in five areas of ABCDE.
(1) angiotensin-converting enzyme inhibitors versus aspirin.
(2) beta blockers versus blood pressure control.
(3) smoking cessation and cholesterol lowering.
(4) Proper diet and diabetes control.
(5) Exercise and education.
Aspirin acts as an antiplatelet aggregator. The incidence of cardiovascular disease and mortality were significantly reduced in patients taking aspirin. The side effect of vomiting blood occurs in 1 out of every 5,000 patients treated with aspirin, but prevents 95 serious cardiovascular events per year.
Aspirin should not be used in patients with gout, as it inhibits uric acid excretion. For gout patients and those who really cannot tolerate aspirin for various other reasons, they can switch to Pansentine at 50 mg three times a day, or oral ticlopidine 250 mg once a day, or the more effective Poliovel 75 mg once a day.
Aspirin is taken 75-150 mg daily for secondary prevention of coronary heart disease; for acute myocardial infarction, acute ischemic stroke and acute attack of unstable angina, the dose can be increased to 150-300 mg daily.
6.Treatment of coronary heart disease
(1) Treatment during attack.
Rest and sublingual nitroglycerin. Once the symptoms of angina, rest immediately, and at the same time to sublingual nitroglycerin, usually by rest or nitroglycerin, usually within a minute or two angina can be relieved. You can also contain or take Chinese medicine compound Danshin drops or heart pills, but it takes a longer time to relieve angina pectoris. If nitroglycerin is not relieved after five minutes, another nitroglycerin can be included. If angina occurs for the first time, regardless of whether the drug can relieve, you need to go to the hospital as soon as possible, because the first occurrence of angina, there is a risk of myocardial infarction.
(2) Systematic treatment.
(1) Drug treatment
Nitrates, such as nitroglycerin, cardiac pain relief, Xinkang, long-acting cardiac pain treatment.
Statin lipid-lowering drugs, such as Lipitor, Sulforaphane, Lovastatin, can slow down or stop the progress of atherosclerosis.
Antiplatelet agents, aspirin 100-300mg daily for life. In case of allergy, take Raltegravir or Bolivar.
b-blockers, commonly used are betalactam, atenolol, and canco.
Calcium channel blockers, preferred in patients with coronary artery spasm, such as Hersinol and Bexinol.
② Percutaneous coronary intervention (PCI): stenting.
Interventional therapy is not a surgical procedure but a cardiac catheterization technique. Specifically, a stent or other device is inserted into the coronary artery through the femoral artery at the root of the thigh or the radial artery at the wrist through a vascular puncture for the purpose of relieving coronary artery stenosis.
Interventional treatment is less invasive, more effective, and carries less risk (<1%). The restenosis rate of common bare metal stents is 15-30%. The application of drug-coated stents has further improved the long-term efficacy of stenting, with restenosis rates of 3% in the general population and approximately 10% in diabetic/complex lesions, with results comparable to those of coronary artery bypass surgery.
(iii) Coronary artery bypass grafting (aorta-coronary artery bypass grafting)
Coronary artery bypass grafting takes a section of blood vessel from other parts of the patient’s body and connects it to the two ends of the narrowed or blocked coronary arteries so that the blood flow can be bypassed through the “bridge”, thus allowing the ischemic myocardium to receive oxygen supply and relieving the symptoms of myocardial ischemia.
This procedure is a cardiac surgery, which is more traumatic but effective. It is mainly used for patients with severe coronary artery disease that are not suitable for stenting (left main stem lesions, chronic occlusive lesions, diabetic multivessel lesions).