Coronary artery disease is the abbreviation of atherosclerotic heart disease. It is a heart disease in which the coronary arteries, the blood vessels that supply nutrients to the heart, become severely atherosclerotic or spastic, causing narrowing of their lumen, thrombosis or lumen occlusion, resulting in ischemia, hypoxia or infarction of the myocardium, also known as ischemic heart disease. How do you get coronary heart disease? What are the risk factors? In recent years, epidemiological data suggest that the incidence of coronary heart disease is becoming younger internationally, with young people in their twenties also developing the disease from time to time. At present, the exact cause and pathogenesis of coronary heart disease are still unclear, therefore, objectively speaking, we cannot fundamentally eliminate or reverse coronary heart disease, but can only prevent or delay disease progression, reduce disease symptoms and improve prognosis by controlling multiple coronary heart disease risk factors. It seems that the common risk factors for coronary heart disease include advanced age, hypertension, diabetes, hyperlipidemia, smoking, obesity, lack of exercise, genetic variation, family history, etc. Some other risk factors are not yet well understood, such as environmental pollution, chronic periodontal disease, respiratory sleep disorders, etc. may also aggravate or trigger coronary heart disease, but for a specific patient with coronary heart disease, it is often the result of multiple risk factors. It is often difficult to conclude that one or several risk factors are responsible for the development of coronary artery disease in a particular individual. What are the manifestations of coronary artery disease? The clinical manifestations and prognosis of coronary artery disease are closely related to the location and degree of stenosis, the duration of the disease, the urgency of onset and the number of branches involved. Clinically, coronary artery disease has the following manifestations: angina There are two main scenarios for the occurrence of angina: first, when the myocardial oxygen consumption increases based on a fixed stenosis of the coronary vessels (when the patient is physically or/and mentally stressed or agitated), resulting in a relative lack of myocardial blood supply in the blood supply area of the stenotic vessels; second, when the myocardial oxygen consumption status is relatively stable (when the patient is not under significant exercise or/and mental stress). Second, in a relatively stable state of myocardial oxygen consumption (no significant changes in exercise or/and mental stress), a transient spasm or thrombosis or extension of the coronary vessels may lead to an absolute insufficiency of myocardial blood supply in the area supplied by the stenotic vessels. Both of these conditions can lead to transient and transient myocardial insufficiency and ischemia in the blood supply area of the diseased vessel, and the patient may experience ischemic symptoms such as transient episodes of chest tightness, heavy pressure, chest pain, chest tightness, etc. In a significant number of patients, the myocardial ischemia may be atypical, with transient painful symptoms such as headache, toothache, abdominal pain without obvious cause, or sweating, weakness, nausea, vomiting, or even fainting, We call them atypical angina symptoms. It is worth mentioning that whether the angina symptoms are typical or not, their clinical significance is the same, and usually, atypical angina symptoms are often not paid attention to and valued by people, which can easily lead to clinical omission or misdiagnosis. Myocardial ischemia in angina will mostly recover on its own within 5-10 minutes or after pharmacological intervention, therefore, its episodes usually last no more than 15-30 minutes. The myocardium tolerates ischemia and hypoxia for no more than 30 minutes in general. Myocardial necrosis, i.e. myocardial infarction, will occur if the myocardium is continuously subjected to ischemia and hypoxia for more than 30 minutes. Since angina pectoris is usually not accompanied by myocardial necrosis, it does not usually affect the function of the heart unless the attacks are very frequent. However, new onset of angina pectoris within two months and frequent and aggravated symptoms of existing angina pectoris indicate an aggravation of the disease and a high risk of disease deterioration within a short period of time, and should be seen as early as possible. Acute myocardial infarction is caused by severe stenosis or occlusion of one of the blood supplying coronary arteries (in rare cases, two or more vessels) or its branches, resulting in persistent myocardial ischemia in the blood supply area. The necrosis of the myocardium in the blood supply area will be completely necrotic, and the necrotic myocardium is like a drought-stricken crop, which is irreversible. Approximately 20% of patients with acute myocardial infarction die before arriving at the hospital, and if they still do not receive proper treatment upon arrival, the in-hospital mortality rate remains as high as 30%! Opening the occluded vessel as early as possible is the main means of improving the prognosis of patients with myocardial infarction, and the sooner the occluded vessel is opened within 6-12 hours, the better the patient’s prognosis. Remember, the time within 12-24 hours of the onset of myocardial infarction is the time when medical personnel can do the most! Sudden death This is due to sudden and severe myocardial ischemia (sudden and severe stenosis or occlusion of an important vessel in the coronary artery of the heart), resulting in massive or critical myocardial ischemia and necrosis, causing severe cardiac dysfunction and cardiac arrest or even death before the patient has time to receive medical assistance or even to be diagnosed. Heart failure This is caused by the patient having a large and extensive myocardial infarction (one or more times) or prolonged severe myocardial ischemia resulting in a reduced number or/and poor condition of effective working myocardium, resulting in cardiac insufficiency. These patients often present with heart failure as the first symptom of seeking medical attention. Arrhythmia This is mostly due to myocardial ischemia or necrosis affecting the tissues that produce the heart’s autonomous rhythm or/and agonistic conduction tissues, resulting in irregular heart rhythm and/or conduction irregularities, with varying degrees of prognostic impact, which can be lifelong untreated or instantly fatal. What is the treatment for having coronary artery disease? As mentioned earlier, there is no curative treatment for coronary artery disease and all treatments can only reduce symptoms and improve prognosis. In addition to medication, interventional therapy (mechanical opening of narrowed or occluded coronary vessels) or surgical bypass therapy (using one’s own blood vessels to bypass the diseased vessel segments to achieve blood supply to the myocardium in the ischemic area) are two important treatments, which are medically known as revascularization therapy. It is worth mentioning that coronary heart disease is a lifestyle disease, and timely correction of poor lifestyle is one of the important aspects of coronary heart disease treatment, among the above-mentioned coronary heart disease risk factors, a considerable part of them can be corrected through medication or health education, such as hypertension, diabetes, hyperlipidemia can be controlled by medication under the guidance of specialist physicians, while weight loss, smoking cessation, alcohol restriction, exercise, etc. can be achieved through health education and other activities. Of course, there is no way to change factors such as family history, genetic variation, advanced age, etc. For individuals with these risk factors, the only way to prevent and identify coronary heart disease early is through a more rigorous lifestyle, timely treatment of coexisting risk factors and regular targeted health checkups and screenings. Do all coronary heart diseases require stenting? Among the above five types of coronary heart disease manifestations, the risks are unequal and the various types can transform and evolve in transition with each other. Therefore, they should be treated differently in clinical practice. Studies have shown that stable angina pectoris and arrhythmias with relatively benign manifestations of coronary artery disease are relatively mild and stable in a short period of time, so they do not require urgent stenting or bypass treatment, and only for some patients with stenosis that provides blood supply to a large area of myocardium, doctors may recommend further stenting or bypass treatment on the basis of drug therapy, while other patients generally need only stenting or bypass treatment. Other patients generally require only lifestyle modification and standardized drug therapy with regular follow-up. Coronary artery disease manifesting as sudden death requires the most urgent treatment time, requiring immediate resuscitation on the scene, emergency coronary angiography if possible, and revascularization (mainly stenting) for suitable cases; coronary artery disease manifesting as acute myocardial infarction requires a race against time, striving to perform revascularization (mainly stenting) within the shortest possible time (60-90 minutes after arrival at the hospital, the earlier the better). About 1/3 of patients with unstable angina pectoris will deteriorate within a short period of time (minutes to days) and should be treated with caution and hospitalized for careful treatment and observation. For high-risk patients, coronary angiography should be performed as soon as possible (within 2-3 days) and stenting should be required if necessary. It should be noted that patients who have had previous myocardial infarction and patients who have been treated with stenting or bypass surgery for important vessels in the past are at significantly higher risk than other people if they experience symptoms such as angina associated with myocardial ischemia again, and extra attention should be paid to this group of patients, who need to undergo angiography as soon as possible to evaluate the vascular lesions and also likely need revascularization treatment ( stenting or bypass treatment). In conclusion, stenting and bypass therapy may improve the prognosis, reduce symptoms, and reduce risk in patients with stable angina due to some significant vascular disease and in most patients with unstable angina. For the majority of patients with acute myocardial infarction and sudden death, early opening of the occluded vessel and early selection of stenting can significantly reduce mortality and improve prognosis. What are the things to pay attention to after stenting for patients with coronary artery disease? Coronary intervention is one of the effective means to treat coronary heart disease. Whether the medication is standardized after intervention is directly related to the safety and long-term prognosis of patients, so what should patients pay attention to after stenting and how to use medication? Coronary heart disease and interventional therapy should be properly understood Coronary heart disease is a lifestyle disease, and so far, the cause of the disease is unclear, and there is a lack of effective means to cure it. Although the stent is placed, it only opens the diseased blood vessel mechanically and restores the coronary blood flow, but does not eliminate the soil for the development of coronary heart disease from the etiology, in addition, for the organism, the stent made of alloy itself is a foreign body, and the organism naturally forms the ability to reject the foreign body in the process of evolution, and the fastest and most effective rejection reaction is when the platelet wraps the stent to prevent it from contacting with the blood. We can imagine that if the surface of the stent is surrounded by platelet thrombus, the lumen of the stent will be blocked by the thrombus, therefore, we have to use antiplatelet drugs for a long time after stenting to ensure that the surface of the stent is not surrounded by thrombus and keep the vessel open; it takes about 1 year for the endothelial cells of the endothelium to gradually grow to the surface of the stent and to stent. The endothelial cells are arranged in a single layer, which is a normal cell structure of the intima, and has good lubricating effect and anti-thrombotic effect. After the endothelial cells wrap the stent intact, it means that the stent structure is buried by the human tissue and becomes a part of the vascular structure, and the possibility of forming thrombus in the stent is obviously reduced, so the doctors can reduce the use of anti-platelet drugs according to the situation. As you can see, stenting is not a once-and-for-all technology, and post-stenting requires comprehensive control of coronary heart disease risk factors based on comprehensive lifestyle improvement in order to improve the prognosis. Can patients with coronary heart disease exercise? Lack of physical activity is an important risk factor for coronary heart disease. Appropriate increase of physical activity is one of the important links in the treatment of coronary heart disease. Moderate exercise can help burn excessive calories, help control weight, blood lipids, blood sugar and blood pressure, maintain better body coordination and balance, improve cardiopulmonary function and skeletal muscle function, enhance self-confidence, and also help detect the progress and changes of the disease at an early stage. How should patients with coronary artery disease master exercise and the amount of exercise? There are several situations: First, for patients with chronic coronary artery disease who are not treated with revascularization, maintain moderate exercise intensity, and control the intensity and amount of exercise so that angina does not occur, or you can take a nitroglycerin tablet 3-5 minutes before the exercise that is expected to occur to prevent its onset. If the exercise endurance decreases significantly within a period of time, or if the frequency or duration of angina attacks becomes longer, it indicates that the condition has changed, so you should go to the hospital promptly. Thirdly, for patients after surgical bypass, if they have no previous history of myocardial infarction and good heart function, they can generally return to basic self-care in 7-10 days. 15-30 days, they can take care of themselves completely and perform appropriate limb exercises. After the sternotomy heals in 2-3 months, the patient can return to the pre-morbid exercise level or even gradually increase to a greater intensity of activity and adhere to it; fourth, for patients with angina pectoris or myocardial infarction that occurred within 1-2 months recently, they should rest in bed or perform exercise and exercise under the assessment and guidance of a doctor; fifth, for patients with cardiac insufficiency and frequent angina attacks, they should perform exercise and exercise under the guidance of a specialist. exercise. Drugs to be used for a long time after stenting Drugs to control the risk factors of coronary heart disease or associated diseases such as hypertension, diabetes, hyperlipidemia, etc. The first is aspirin, 100mg per day for a long time, and the second is clopidogrel, 75mg per day for at least 1 year, which should be adjusted after 1 year under the guidance of a doctor. Drugs for lowering blood lipids Commonly used drugs include simvastatin, pravastatin, atorvastatin, etc. The preparation and dosage should be correctly selected under the guidance of a doctor. It should be noted that patients with coronary heart disease need to control their lipids to a lower level than normal in order to maximize the patient’s prognosis. Therefore, the reference value attached to the laboratory test sheet should not be used to determine whether to take lipid-lowering drugs or not, nor should it be used to measure whether to meet the standard or stop the drugs. Drugs that stabilize the electrical activity of the heart and improve the prognosis of the original period, such as studies have found that beta-blockers, such as medoxin or bisoprolol, can reduce the occurrence of malignant arrhythmias in patients with coronary heart disease, reduce blood pressure, and may improve cardiac function, but the drugs should be taken under the guidance of a doctor, and it is not advisable to stop taking these drugs suddenly or to eat and stop taking them. Other Sometimes doctors also prescribe some drugs to protect the gastrointestinal tract, such as omeprazole, pantoprazole, ranitidine, etc.; drugs to dilate blood vessels, such as nitrates, etc.; drugs to improve myocardial metabolism, such as trimetazidine, etc.; anti-vascular spasm drugs, such as Hepesol, etc.; and cardiac diuretic drugs to improve heart failure, etc. These should also be added and deleted under the guidance of a doctor. Patients with coronary artery disease should be followed up regularly The general postoperative follow-up period is defined as 1 month, 3 months, 6 months, 12 months, and then every six months to a year even if there are no symptoms, and promptly seek medical consultation if there are symptoms.