I came across such a very unfortunate case in my clinical practice that has stuck in my mind. A middle-aged male with sudden onset of chest tightness with no obvious cause, which persisted without relief. The patient felt that it was a cold symptom after exertion, took cold medicine plus a bath, and persisted at home for 48 hours before the symptoms gradually worsened until a sense of near death appeared, and the patient was admitted to the hospital in an emergency. The doctor diagnosed typical coronary heart disease and acute anterior wall myocardial infarction. Although the stent surgery was later very successful, the blockage of the blood vessel was too long, resulting in a large myocardial infarction. Severe heart failure and ventricular wall tumor later developed, and the situation was irreversible, which greatly reduced the patient’s quality of life and poor prognosis. In contrast, our care unit often treats patients with all types of acute myocardial infarction. After timely vascular opening treatment (preferably within 6 hours of chest pain), the patient has essentially no impairment of cardiac function, even the ECG does not show that he or she has had an infarction, and the prognosis is better.
The main difference between these two outcomes for the same disease is the timing of the visit. People know that heart disease cannot wait. But the question is how do I know I have heart disease? According to the survey, more than half of the patients with coronary heart disease have acute myocardial infarction as their first symptom, which means that more than half of the heart attack patients do not know they have coronary heart disease beforehand!
So, what to do if sudden onset of chest pain and chest tightness?
First, we should do risk stratification to clarify whether we are a high-risk group for coronary heart disease
If two patients with chest pain come to the emergency room at the same time, a girl in her 20s and an old man in his 70s, it is definitely suspected that older men have a high probability of getting a heart attack.
What kind of people belong to the high-risk group?
A simple summary is: age, gender, three high (high blood pressure, high blood pressure, high blood sugar), obesity, smoking history, mental stress, poor lifestyle, genetic factors, etc.. If you belong to the high-risk group of coronary heart disease, then please raise your vigilance!
Second, carefully observe the symptoms
We often say that the pain, chest tightness, toothache, pinching sensation, burning sensation, epigastric pain, etc. occurring in this zone may be caused by myocardial ischemia. The classic manifestation of heart attack should be severe crushing pain behind the sternum with a sense of near death; however, many patients nowadays have very atypical symptoms, especially diabetic or elderly patients, who often have only persistent chest tightness, or show gastrointestinal symptoms such as epigastric pain and vomiting (lower wall infarction). Therefore, for high-risk patients, once persistent symptoms appear in this interval, it is recommended to promptly go to the emergency department of the hospital for an electrocardiogram as a precaution.
Third, if I happen to belong to the high-risk group and the above symptoms occur, what should I do?
1.No matter what the trigger of your attack is, such as anger, strenuous exercise, full stomach, etc., first of all, lie down and rest, pay attention to keep warm, try to calm down and reduce the oxygen consumption of your heart.
2, call 120 or 999 emergency personnel as soon as possible.
3.If you have nitroglycerin, quick-acting heart pills or aspirin and other drugs at hand, you can take them orally in time, and you can take oxygen if you have conditions at home, and calmly wait for the ambulance to come to your door.
4. If the preliminary diagnosis of heart attack is made by the electrocardiogram of the emergency vehicle, you must request to be transferred to the nearest hospital qualified for emergency coronary intervention for treatment.
4. How to diagnose myocardial infarction?
Very simple, just 3 criteria.
1. the appearance of the above-mentioned symptoms such as chest pain and chest tightness, and persistent non-remission.
2, dynamic changes in the ECG (ST-segment elevation or depression).
3, elevated cardiac enzymes (creatine kinase, creatine kinase isoenzyme, troponin, etc.).
Because the third one needs to be manifested about 4 hours after the occurrence of the infarction, as long as the first two criteria are met, the diagnosis of myocardial infarction can be made and timely treatment is given.
V. How to treat myocardial infarction?
There is no doubt that emergency coronary intervention (PCI surgery) to open the obstructed vessel combined with powerful antithrombotic drug treatment is the most effective rescue plan at present.
Our principle is that emergency PCI surgery is most beneficial within 6 hours of onset; if the patient is seen within 12 hours of the onset of the disease and the symptoms persist, emergency PCI surgery can also be performed; if the onset of the disease is more than 24 hours when the patient is seen, the time window for emergency surgery has been exceeded and the best time for resuscitation treatment has been missed.
Here, time is life, time is heart muscle! Never hesitate, never avoid treatment, because once the heart muscle necrosis is not recoverable! Once the sudden onset of chest pain and chest tightness, please deal with the above five items.