Coronary heart disease is a kind of heart disease in which coronary arteries are severely atherosclerotic narrowed or blocked, or combined with spasm and thrombosis on this basis, resulting in narrowing of coronary artery lumen and causing insufficient coronary blood supply, myocardial ischemia or myocardial infarction. Coronary heart disease is the leading cause of death in Western countries. Although China is a low incidence country, the incidence and mortality rate of coronary heart disease has been increasing year by year in recent years and has become the main cause of death. Epidemiological studies of coronary heart disease show that there are obvious regional differences in the incidence and mortality of coronary heart disease events in China, with the mortality rate of coronary heart disease being higher in urban than in rural areas. The northern provinces and cities in China are higher than the southern provinces and cities, the highest incidence rate for men is Qingdao, Shandong Province, 108.7/100,000, the lowest is Chuzhou, Anhui Province, the difference between the two is 32.9 times; the difference between the two mortality rates of 17.6 times.
I. Risk factors for coronary heart disease
1, hypercholesterolemia
Hypercholesterolemia is one of the most harmful risk factors for coronary heart disease among all risk factors, and cholesterol is treated as the number one in the interventional treatment of coronary heart disease.
2. Hypertriglyceridemia
Triglycerides have been shown to be an independent risk factor for coronary heart disease.
3.Smoking
Smoking is one of the important risk factors for coronary heart disease. Clinical studies have shown that: smoking 10 cigarettes a day, the risk of cardiovascular death increases by 18% in men and 31% in women; the risk of cardiovascular disease is reduced by 35%-40% in hypertensive patients who stop smoking a pack of cigarettes a day. The relative risk of sudden death from coronary heart disease was 10 times greater in male smokers and 4.5 times greater in women than in nonsmokers, and this risk decreased rapidly after stopping smoking, and after 3 years their risk of coronary heart disease was similar to that of nonsmokers. Therefore, smoking as a risk factor is the easiest and most economical in terms of treatment, and it is recommended that people who already have coronary heart disease or other risk factors combined with smoking should immediately abstain from smoking.
4.High blood pressure
Hypertension is also an important risk factor for coronary heart disease. According to statistics, there are about 110 million hypertensive patients in China, and only 30% have received drug treatment. Studies show that: the risk of coronary heart disease is 5-6 times higher in hypertensive patients with diastolic blood pressure > 105 mmHg than in patients with diastolic blood pressure < 76 mmHg, and the risk of coronary heart disease increases by 29% for every 7.5 mmHg increase in diastolic blood pressure.
5.Diabetes
Diabetes affects almost all aspects of the disease from atherosclerosis formation to cardiac death, and its role as a risk factor for coronary heart disease is unquestionable. Diabetes often co-exists with other risk factors, and diabetic patients are often accompanied by hypertension, obesity, hyperlipidemia, etc.
6. Family history of heredity
Coronary heart disease has a clear genetic predisposition. Studies have shown that: the risk of coronary heart disease increases 2.0-3.9 times for people with a family history of coronary heart disease compared to those without a family history of coronary heart disease, and the risk of myocardial infarction increases 2.2 times, and the occurrence of coronary heart disease is advanced by several years.
7, obesity
Obesity is an independent risk factor for cardiovascular disease. 50 years old after the incidence of cardiovascular disease in obese men is 2 times that of non-obese people, in women is 2.5 times. The risk of coronary heart disease is greater for those with centripetal obesity. If simple obesity is not accompanied by hypertension, diabetes and hyperlipidemia, the risk of coronary heart disease should be relatively reduced.
8.Drinking alcohol
The relationship between alcohol consumption and coronary heart disease has not been fully elucidated. At present, most research data show that the relationship between alcohol consumption and coronary heart disease is “U” type, the risk of coronary heart disease when light alcohol consumption (ethanol 10-30 grams/day) is lower than that of non-drinkers, but excessive alcohol consumption can increase the risk of coronary heart disease, hypertension and cerebral hemorrhage.
Second, the symptoms of coronary heart disease
Most patients can make a clear diagnosis based on medical history alone. The typical symptoms of coronary artery disease have four basic features: pain location, relationship between pain and movement, pain characteristics and pain duration.
1.Pain site
Typical angina pectoris is located behind the sternum and can radiate to both sides of the chest, both upper arms (common on the left side), as well as the neck and hips, or to the back. Most commonly, the pain starts at a certain location and radiates only to the center of the chest.
2.The relationship between pain and exercise
In most cases, angina is triggered by increased myocardial oxygen consumption during exercise, and the pain is relieved after rest. Some patients have resting angina. Emotional changes can also sometimes trigger an attack of angina pectoris.
3.Pain characteristics
Although angina is often depicted as pain, some patients often describe chest discomfort as a feeling of pressure or crushing.
4.Pain duration
Physical activity-induced angina usually resolves on its own within 1-3 minutes after stopping the activity, and can last for more than 10 minutes after very strenuous activity. The relief time of angina induced by emotional excitement is slower than that of those induced by physical activity.
Coronary heart disease examination
1.Electrocardiogram
Electrocardiogram cannot completely confirm or exclude coronary heart disease. Even in patients with very severe angina, it is not uncommon for the resting ECG to be normal. For the presence of myocardial infarction or cardiac conduction disorder, ECG can be helpful for diagnosis.
2.Stress ECG (plate exercise test)
The sensitivity of ECG is about 70% and the specificity is about 90% for the diagnosis of coronary artery disease. Stress ECG has important value for confirming asymptomatic ischemia, predicting prognosis of patients with stable angina and following up the treatment and progress of the disease.
3.Dynamic monitoring
The sensitivity and specificity for the diagnosis of coronary heart disease is lower than that of the stress ECG, but it can show myocardial ischemia that is not induced during exercise.
4.Echocardiography
Useful for evaluating the size of the heart chambers, the local and overall function of the left ventricle, the presence or absence of ventricular wall tumor formation and the morphology and function of the valves.
5.Myocardial perfusion scintigraphy
The specificity and sensitivity of this test for the diagnosis of coronary artery disease is higher than that of a stress ECG.
6.Coronary artery angiography
Coronary angiography is the most accurate method to confirm the diagnosis of coronary artery disease. It is performed by placing a very thin catheter through the femoral or elbow artery into the opening of the coronary artery and injecting contrast to accurately diagnose the presence and extent of coronary artery disease. Coronary angiography is basically painless and has become a routine test to diagnose coronary artery disease.
Treatment of coronary heart disease
The treatment of coronary heart disease includes drug treatment, medical interventional treatment and surgical treatment.
1.Medication
Drug therapy is suitable for patients with conscious symptoms but mild lesions that do not require medical or surgical treatment; patients with severe lesions, coronary artery vessels that are too thin for medical intervention or surgery, and patients with severe dysfunction of other organs of the body that cannot tolerate intervention or surgery.
Commonly used drugs include: nitrates (nitroglycerin, cardiac pain, long-acting isoprodine, etc.), calcium antagonists (cardiac pain, isoprodine, etc.), β-blockers (amiloride, betalactam, etc.), anti-platelet drugs (aspirin, pansentin, etc.).
2.Internal interventional therapy
In recent years, medical interventional therapy has been developing rapidly in the world, and it is accepted by more patients with coronary artery disease because of less trauma and faster recovery. Especially in recent years, the application of drug-coated stents has significantly reduced the incidence of restenosis after interventional treatment and greatly improved the long-term efficacy of interventional treatment.
3.Surgical coronary artery bypass grafting
Coronary artery bypass surgery is suitable for most patients with coronary artery disease, especially for patients with unstable angina and those who have failed to respond to systematic drug treatment.
Surgery is suitable for.
(1) lesions of the left main trunk or multiple vessels of the coronary artery
(2) Stenosis of the left main coronary artery ≥ 50% or stenosis of the main coronary artery of 75% or more with distal vessel patency and vessel diameter ≥ 1.5 mm
(3) failed medical intervention or restenosis after intervention
(4) Myocardial bridge, abnormal coronary artery origin, etc.
Materials of coronary artery bypass: including own internal mammary artery, saphenous vein, flexural artery, gastroretinal artery, etc.
The main methods of coronary artery bypass grafting are: coronary artery bypass grafting under extracorporeal circulation and coronary artery bypass grafting under non-extracorporeal circulation
Postoperative efficacy of coronary artery bypass grafting: the surgery has immediate effect in relieving angina symptoms and improving heart function, and a more satisfactory quality of life can be restored after the surgery. Most patients are able to engage in moderate or vigorous physical activity after surgery.