The human heart is supplied with blood by the coronary arteries. If the coronary arteries become narrowed or blocked, it is called coronary heart disease, or coronary heart disease for short. The main cause of coronary heart disease is atherosclerosis, while other causes such as trauma, syphilis, and drug addiction are very rare.
If this plaque ruptures, a blood clot forms at the site of the rupture. If the thrombus is small and the blood flow is not smooth, the patient will have symptoms such as chest tightness and angina. If the thrombus is large and completely blocks the blood flow and the blockage lasts for more than half an hour, it will cause acute myocardial infarction, which may cause death, and even if it is rescued in time, it may cause local myocardial necrosis and the patient’s heart function will decline sharply.
1, the development and deterioration of coronary heart disease is a long-term continuous process, mainly including.
① The period of development of atherosclerosis ;
② The period of coronary heart disease development and deterioration, some patients lose their lives due to sudden death or acute myocardial infarction, others have repeated symptoms and quality of life decreases;
In general, patients with coronary heart disease have different degrees of quality of life, and even lose their job opportunities and economic resources.
Coronary heart disease is one of the most important diseases that endanger human health, and in recent years, the morbidity and mortality of coronary heart disease in China has increased significantly, and experts predict that if no effective intervention is made, a pandemic will be formed in China in the near future. The mortality rate of coronary heart disease was 64/100,000 and 106/100,000, respectively.
However, in the past 30 years, many studies at home and abroad have proved that coronary heart disease can be prevented and controlled, in other words, the most effective treatment for cardiovascular than prevention-oriented, prevention and treatment combined.
2, the prevention of coronary heart disease can be divided into primary prevention and secondary prevention.
Primary prevention: also known as etiological prevention or primary prevention, mainly for the purpose of coronary heart disease risk factors to take measures to prevent the occurrence of the disease.
Secondary prevention: It is an effective intervention to prevent recurrence and worsening of coronary events in individuals who already have the disease. The focus of secondary prevention of coronary heart disease has shifted from treating coronary stenosis to alleviating chest pain and other goals to preventing plaque rupture causing thrombosis, which has proven to have achieved good results in practice, such as clinical trials on lipid reduction in patients with coronary heart disease.
A large number of scientific studies have proved that people with high blood lipids, high blood sugar, high blood pressure, obesity, smoking, resting work style, genetic history of parents, etc., men over 45 years old and women after menopause have a significantly higher incidence of coronary heart disease, which are called risk factors for coronary heart disease. Among these risk factors, age and parents’ genetic history cannot be changed, while other risk factors such as blood lipids, blood pressure, and smoking can be corrected, so strong prevention and treatment should be taken to keep them in normal range regardless of the period of coronary heart disease. Blood pressure, lipids, blood glucose, overweight, obesity and smoking are the focus of our intervention. The specific elements are
I Lower blood pressure: control it below 140/90 mmHg. If there is a combination of diabetes or chronic kidney disease blood pressure should be controlled below 130/80 mmHg. For pre-hypertension people should lower blood pressure by changing poor lifestyle.
A large number of scientific studies have proved that timely control of blood pressure reduces the incidence of coronary heart disease and stroke. There are many drugs for hypertension that are currently treated, including Western medicine, Chinese medicine and Chinese herbal soup, which are also effective. It is important to note that different antihypertensive drugs should be taken according to your specific condition. Clinically used blood pressure lowering formula (Hooked Vine 45g, Huang Lian 12g, Scutellaria 15g, Ze Di 15g. Decoction with water or drink as a tea substitute), has a better effect, and can avoid some side effects. In addition, Chinese medicine has some non-drug therapies, such as drug foot soak, acupuncture point paste and other external treatment methods, suitable for some mild to moderate hypertension. Blood pressure should be measured frequently and medications should be adjusted according to blood pressure changes in a timely manner.
II Lowering blood cholesterol.
Adjusting blood lipids for different patients have different index ranges, adults generally speaking have 3 criteria. First, people without coronary heart disease or other atherosclerosis, and without risk factors such as hypertension and hyperglycemia, should have cholesterol <5.72mmol/L, LDL cholesterol <3.64mmol/L and triglycerides <1.7mmol/L; second, people without coronary heart disease or other atherosclerosis, but with risk factors for coronary heart disease, should have cholesterol <5.2mmol/L and LDL cholesterol <3.64mmol/L. LDL cholesterol <3.12mmol/L and triglycerides <1.7mmol/L; third, people with coronary heart disease or other atherosclerosis, cholesterol should be <4.68mmol/L, LDL cholesterol <2.6mmol/L and triglycerides <1.7mmol/L;
Chinese herbs for lowering blood lipids can be used: 30 grams of raw hawthorn, 30 grams of grass cassia, 30 grams of inoceramus, and 1.5 grams of aloe vera. It can be taken with water decoction or drink as tea.
Of course, cholesterol is not a beast, the lower the better. Studies have proven that cholesterol below 2.6 mmol/L is prone to complications such as brain hemorrhage and tumors. So please take a close look at your labs and the above 3 rulers to see if they are in the normal range.
III Weight control.
Reach normal weight and keep body mass index (BMI) between 18.5-24.9. BMI = weight (kg)/height (m2)
IV Lifestyle improvement.
Smoking cessation: inform the population and patients about the dangers of smoking and provide guidance on smoking cessation.
Limit alcohol consumption: It is best to quit drinking alcohol, and those who cannot quit drinking alcohol should drink less than 20 grams of alcohol per day or 50 ml of general medium white wine.
Limit salt: daily salt intake should be less than 6 grams.
Increase physical activity: engage in regular physical exercise. 1-2 times a day, at least 3-4 times a week, for more than 30 minutes each time. The type of exercise and the amount of exercise should be chosen according to your physical condition. Walking at a brisk pace is a good way to exercise.
Improve the dietary structure: diet based on cereals; eat more fresh vegetables and fruits, beans and soy products; drink milk every day; eat less fatty meat and animal offal, 1-2 eggs per day; edible oil about 25 grams per day; candy pastry to eat less; reasonable distribution of the three meals, generally in the morning, middle and evening energy accounted for 35%, 40%, 25% of the total energy.
Five reasonable choice of treatment methods
At present, there are three main methods for coronary heart disease, one is to take medicine, including traditional Chinese medicine and western medicine, the second is interventional therapy, put stents, the third is coronary artery bypass graft. Each of the three methods has its own indications. The treatment and medication that is most suitable for the patient should be chosen for the patient with good efficacy, great benefit and least risk. In foreign countries, health and economic departments also have to analyze the efficacy/risk and efficacy/cost, i.e., spend the least money, take the least risk, and get the maximum efficacy, but in China, we have not done the efficacy/risk and efficacy/cost analysis yet.
1. Drug therapy.
Drug therapy is the basic treatment for coronary artery disease and is suitable for (1) less severe coronary artery disease; (2) more severe disease that has lost the opportunity for interventional and coronary bypass therapy; (3) those who are not suitable or unwilling to do interventional and bypass surgery; and (4) those who take drugs as needed after interventional or bypass surgery.
In the past 10 years, the treatment of coronary heart disease has developed rapidly in clinical medicine, and the western drugs used in the treatment of coronary heart disease can mostly be subjected to better efficacy in clinical practice. These basic drugs include aspirin, nitrates (anti-cardiac pain, Lunan Xin Kang and the like), calcium channel blockers (such as Heshinshang), beta-blockers (aminocardium, betalactam and the like). These drugs have been used for a long time, and their efficacy is also good, and they are also cheap. The expensive drugs are mostly new drugs, which have their own characteristics and can be used according to your economic conditions and illness.
Chinese medicine has greater advantages in the treatment of coronary heart disease, first of all, it can reduce the side effects caused by these drugs, such as taking beta-blockers, some patients feel weak, after taking Heshinshang, some patients feel bloated or headache after taking anti-cardiac pain, Lunan Xinkang, etc. Chinese medicine focuses on conditioning and individualized treatment, which can greatly reduce the above side effects. In addition, the above-mentioned drugs only control the symptoms and have little effect on the development of coronary arteriosclerosis, i.e. vascular lesions, while Chinese medicine has greater advantages, as it has a profound theoretical basis and rich experience in treating “pulse” disease, and has a definite effect on preventing the further development and deterioration of coronary heart disease. More importantly, taking Chinese medicine may delay the onset and development of heart failure. A decoction of 30 grams of Astragalus, 15 grams of Medlar and 12 grams of Schisandra in water is good for preventing and treating heart failure.
Western medicine can be reduced or discontinued through herbal treatment. It should be noted that there may be some compatibility between traditional Chinese medicine and western medicine. When the two types of drugs are used together, some can promote each other and increase the efficacy, while some may increase the side effects.
2.Interventional therapy
Interventional therapy is a leap forward in the treatment of coronary heart disease in the past 20 years. Most of the coronary heart disease is due to the hardened plaque in the coronary artery wall which supplies blood to the heart, this plaque will directly block the blood flow through, or because the plaque rupture forms a thrombus (i.e. blood clot) and block the blood flow, because the blood flow is obstructed or not smooth, it will cause insufficient blood supply to the heart muscle. If a stent made of special material is placed in the blocked blood vessel to open up the blood vessel, it will allow the blood flow to pass smoothly and achieve the treatment purpose.
In this procedure, a very thin catheter is inserted into the femoral or radial artery, along which a balloon or stent is inserted into the blocked coronary artery, and then the balloon or stent is opened to achieve the treatment. The advantage of interventional procedures is that they are less invasive and require only a puncture needle in the vessel. Nowadays, this technique is becoming more and more sophisticated, and this type of procedure is even being performed abroad on an outpatient basis, with the patient being able to walk around in bed for only 24 hours. There are, of course, risks associated with this type of procedure, mainly related to the extent of the patient’s vascular disease.
Interventional therapies are expensive, mainly because most of the relevant surgical materials such as balloons and stents need to be imported from abroad. Generally speaking, if a stent is placed directly without a balloon, it costs about 25-30 thousand RMB, if a balloon is used in advance, it costs 35-40 thousand, and if 2 stents are placed, it costs about 50-60 thousand. So interventional therapy is suitable for (1) patients who are not well controlled by medication and still have frequent angina; (2) patients who can control angina with medication but have poor quality of life, for example, you want to live a better life or continue to work very well and have sufficient financial resources; (3) patients who are relatively young. This therapy can be used. The advantage of interventional therapy is that the treatment effect is immediate, you may feel chest tightness and panic chest pain even climbing two floors before the surgery, and you can run, climb mountains, fly around by airplane after the surgery, as long as you have enough physical strength.
3.Coronary artery bypass
Before interventional therapy or bypass, coronary angiography is needed. If the condition is serious, such as severe stenosis in all three vessels, or diffuse lesions, interventional therapy is risky or not suitable for intervention, bypass can be chosen. Bypass surgery requires open-heart surgery, but at present, bypass surgery is progressing rapidly and the risk is not as great as imagined.
4.The advantages of Chinese medicine therapy with intervention and after bypass surgery
Intervention or bypass surgery is only a local repair, not a once-and-for-all solution. If no attention is paid to practical prevention and control of coronary heart disease after surgery, restenosis or stenosis or occlusion of other branches of coronary vessels may occur, so the development of atherosclerosis is still strictly prevented after surgery, and it is a good method to choose Chinese medicine therapy at this time. In our experience, taking herbal medicine can delay the time to perform interventional surgery or bypass surgery, and in some patients, even avoid it. Taking herbal medicine after surgery can avoid the occurrence of complications and restenosis, etc. Some patients still have chest pain or chest discomfort after surgery, which can be significantly improved by herbal treatment, and specific TCM herbal treatment prescriptions should be identified and treated.
Medication should generally be continued after interventional therapy and bypass surgery. The medication should be taken strictly for six months after interventional therapy to prevent restenosis. Intervention or bypass surgery is only a local repair, not a once-and-for-all solution. If no attention is paid to practical prevention and control of coronary artery disease after surgery, restenosis or stenosis or occlusion of other branches of coronary vessels may occur, so the development of atherosclerosis is still strictly prevented after surgery. Taking Chinese medicine after surgery can avoid complications and restenosis, etc. Some patients still have slight chest pain or chest discomfort after surgery, which can be significantly improved by Chinese medicine treatment.
There are large and small arteries in the heart, just like the main roads and small roads in city traffic. Generally, there are 3 main blood vessels in the heart, then there are many branch vessels, and the tiniest vessels are capillaries that supply blood and nutrients to each heart muscle cell. Just like when you come home from work, you first pass through the big road to the small road, then from the small alley to your door. A blockage in the large blood vessels of the heart will cause a large area of the heart muscle to be deprived of blood and nutrients, and if it is not cleared in time, it will cause myocardial infarction, just like a blockage in the main roads of a city, which will cause traffic paralysis in a large area. Interventional and bypass treatment is the best treatment for this kind of trunk blockage. The thicker the blockage, the greater the risk and the more effective the intervention or bypass treatment. For small blockages, interventional treatment is not possible and bypass treatment is not very meaningful, which is when TCM has the greatest advantage. Just like a blockage in the main road, you can take a small detour to get back home. In other words, TCM herbs can improve the small branch blood vessels.
Diabetes is most likely to damage the small blood vessels, and the heart muscle cells remain deprived of blood and nutrients, which can cause a decrease in heart function. It is like when the main road is very clear and the smaller roads are all damaged and blocked, people still have a hard time getting back home.
If a thicker blood vessel is blocked, it will cause a myocardial infarction, and then the human heart will adjust itself to transform the original small blood vessels into thicker ones, which is the establishment of the collateral circulation vessels. Therefore, in clinical practice, patients with myocardial infarction can recover their heart function faster after taking traditional Chinese medicine for a period of time. This is also the advantage of TCM herbal medicine.