Coronary heart disease is the most common type of atherosclerosis leading to organ lesions, and is also a common disease that seriously endangers human health, its morbidity and mortality are in the top three, mostly occurring after the age of 40, more men than women, the incidence of coronary heart disease has been increasing year by year in recent years, and the age is gradually younger, some of the onset of age is even less than 30 years old. Therefore, it is especially important to master the basic knowledge of prevention and treatment of coronary heart disease.
1.What is coronary heart disease?
Normal coronary arteries have smooth walls, good elasticity and smooth blood flow in the lumen. The most common cause is the accumulation of lipid atherosclerotic plaque material along the inner wall of the vessel. In addition, spasm and constriction of the vessel wall and thrombosis are also common causes of luminal narrowing and even occlusion. Coronary artery disease is a kind of heart disease caused by severe atherosclerosis of coronary arteries, resulting in narrowing or obstruction of the lumen, or combined with spasm and thrombosis to aggravate the obstruction of the lumen, resulting in insufficient blood supply to the coronary arteries, myocardial ischemia, hypoxia or infarction. Generally speaking, mild stenosis of coronary arteries (<50%) does not cause obvious clinical symptoms; ≥50% stenosis can be diagnosed as coronary artery disease, but mild stenosis of ≥50% and <70% can have no obvious angina symptoms, unless combined spasm makes the stenosis more severe and may lead to myocardial ischemic symptoms; ≥70% is moderate stenosis of coronary arteries, which can have angina symptoms, and it is generally believed that ≥70% of the lesions should be treated with intervention. It is generally believed that ≥70% of the lesions should be treated with interventional therapy; ≥90% of the lesions are severe coronary artery stenosis, which may have angina symptoms and cardiac insufficiency symptoms at the same time, and should be treated with interventional therapy as soon as possible.
2.What are the risk factors of coronary heart disease? What is the significance?
The main risk factors for coronary artery disease are age (men >45 years; women >55 years), family history of early-onset coronary artery disease (immediate family member <55 years for men or <65 years for women), smoking, hypertension (blood pressure >140/90 mmHg or receiving anti-hypertensive therapy), dyslipidemia (high cholesterol, high LDL-C, low HDL CC). Other risk factors include obesity, physical inactivity, atherogenic diet, abnormal fasting glucose and glucose tolerance but not at the level of diabetes diagnosis. Because of the close relationship between diabetes and the development of coronary artery disease, it has been called the “equivalent disease” or “equal risk” of coronary artery disease. The more risk factors for coronary heart disease, the more serious the risk of coronary heart disease; age and family history among the above risk factors cannot be intervened, but the control of risk factors such as hypertension, dyslipidemia and poor lifestyle (e.g. smoking, lack of physical activity, poor diet) has been proved to prevent or delay the occurrence of coronary heart disease.
3.What are the main clinical manifestations of coronary heart disease?
Coronary heart disease is mainly manifested in the following seven clinical types: stable angina, unstable angina, acute or old myocardial infarction, primary cardiac arrest, ischemic cardiomyopathy (heart failure due to coronary heart disease), arrhythmia and asymptomatic myocardial ischemia. The same patient with coronary artery disease may have different clinical manifestations in different courses of the disease, such as stable angina pectoris at the beginning of the disease, which may develop into unstable angina pectoris after a period of time, or even acute myocardial infarction and sudden cardiac death; after acute myocardial infarction, it is called old myocardial infarction, and some patients with coronary artery disease may have angina pectoris again, or even acute myocardial infarction again. Unstable angina can also be stabilized after appropriate treatment, thus avoiding myocardial infarction.
4.What patients are commonly affected by atypical angina pectoris? What are the clinical manifestations?
Patients with atypical angina are mostly seen in the elderly and diabetic patients because of their reduced perception of pain; or in combination with other chronic diseases (chronic inflammation of the stomach, duodenum and esophagus, cholecystitis and cholelithiasis, cervical spondylosis, kidney stones, periodontal disease, etc.). When an atypical angina attack occurs, it is easy to mistake the diagnosis of angina as a symptom of a pre-existing chronic disease. The site of pain during an attack of atypical angina can be outside the chest, with discomfort or pain in the upper abdomen, followed by the left upper extremity, neck, throat, jaw and teeth, with individual patients presenting with headache and back pain. The site of pain dispersion may be in the neck, pharynx, mandible, teeth, cheeks, head, and individually to the abdomen, legs, left scapula, right shoulder, arm, and even the inside of the right hand. The site of pain and the site of dispersion are usually relatively fixed for each attack. The nature of pain in atypical angina may be burning or dull, and some patients may experience chest tightness and suffocating sensations of lack of room air. Some patients have difficulty describing the nature of the pain or describe it accurately, and often describe it as chest discomfort in general, and often use the palm of their hand or a clenched fist to indicate the site of discomfort. Some patients show chronic fatigue or episodes of fatigue and weakness without obvious pain symptoms.
5.What are the main methods currently used to treat coronary heart disease?
There are three main methods currently used to treat coronary artery disease: drugs, interventional therapy and surgical coronary artery bypass grafting. The drugs used to treat coronary heart disease include.
(1) Anti-anginal drugs: such as nitrates, beta-blockers, calcium antagonists.
(2) Anti-platelet agents, which can reduce the chance of thrombosis, such as aspirin, clopidogrel, etc. The latter two drugs are mainly used for unstable angina, acute myocardial infarction and after coronary intervention.
(3) Anticoagulants, which can prevent thrombosis, such as low-molecular heparin.
(4) Thrombolytic drugs, which can dissolve the formed thrombus at the coronary occlusion, are used after acute myocardial infarction attack.
(5) Statin lipid-regulating drugs, which can stabilize the lipid plaque at the coronary artery lesion, prevent its rupture, continue to increase or even make it abate.
Chinese medicine treatment: According to the specific diagnosis and treatment of different patients, Chinese patent medicines or Chinese medicine tonics can be chosen to enhance the efficacy of western medicines, reduce some side effects of western medicines and improve the quality of life of patients. Interventional therapy and surgical coronary artery bypass grafting are non-open or open methods to normalize or basically normalize the pipeline through which the coronary circulation flows, and are now collectively referred to as “myocardial revascularization”. Among the three treatment methods of coronary heart disease, each of them has a certain status and value, and often need to complement each other and be applied jointly.
6.How to prevent coronary heart disease?
(1) Control hypertension. Patients with hypertension should eat a light diet, prevent excessive salt, eat more vegetables, beans and other foods containing high potassium and calcium, avoid alcohol and obesity, and appropriate exercise, keep a happy spirit. In the choice of antihypertensive drugs, we should pay attention to the control of other risk factors such as high blood lipids, high blood sugar, elevated fibrinogen and abnormal electrocardiogram, so that we can receive the best effect on the prevention and treatment of hypertension, not only to bring blood pressure down to normal, but also to reduce the incidence of coronary heart disease.
(2) Reduce blood lipids. In the dietary structure, we should maintain the traditional advantages of low fat, more green vegetables and vegetarian diet, and change the disadvantages of low protein, low calcium and high salt, so that the total cholesterol level in the population can be kept below 5.2mmol/L (200mg/dl), and those whose total cholesterol level is above 6.24mmol/L (240mg/dl) should take both drug and non-drug lipid-lowering measures under the guidance of doctors. (3) Quit smoking.
(3) Quit smoking. According to the survey, the number of smokers in China is about 290-310 million people, in addition to 220 million people are passive smokers. A study shows that 25-year-old people, smoking 1 to 9 cigarettes a day, life expectancy is reduced by 4.6 years; 10 to 19 cigarettes reduce life expectancy by 5.5 years; 20 to 29 cigarettes 6.2 years; more than 40 cigarettes 8.3 years. Therefore, the World Health Organization (WHO) has proposed “Smoking or health?” Called to quit smoking.
(4) Increase physical activity. Exercise is the most effective means of health. Rhythmic movement of the body such as walking, stairs, running, bicycling, and swimming are more beneficial than other types of activities. If you can daily or at least every other day for 20-30 minutes of moderate activity (up to 50% to 70% of the extreme amount) can effectively enhance heart function.
(5) Adjustment of type A personality. type A personality has a sense of time urgency, competitive, irritable, lack of patience and other characteristics. Therefore, type A personality should be targeted to use psychological adjustment, taijiquan and other methods to adjust.