Angina pectoris is an episodic chest pain syndrome caused by a temporary imbalance between myocardial oxygen consumption and oxygen supply. Most angina is caused by coronary atherosclerosis, and a few are caused by non-coronary atherosclerosis, such as coronary artery spasm, congenital malformation, inflammation and cardiomyopathy, severe aortic valve disease and sandwich aneurysm, syphilitic aortitis, anemia, etc. The disease is most common in men over 40 years of age, with an incidence of 0.2% and 0.08% in women.
According to Chinese medicine, this disease belongs to the categories of “chest paralysis”, “heart pain” and “syncope heart pain”. The pathogenesis is mainly attributed to the deficiency of the origin and the symptoms.
1. Diagnosis
1.1 Clinical manifestations
1.1.1 Symptoms: Often triggered by physical activity, emotional excitement, climate change, a full meal or cold. The typical manifestation is sudden onset of posterior sternal or precordial pain, which may radiate to the left shoulder and left upper limb medially to the little finger and ring finger, and in severe cases, there may be a sense of near death, which may stop at times, with repeated episodes of sweating. In atypical cases, the pain may radiate to the neck, jaw and upper abdomen, with gastrointestinal symptoms, or only chest discomfort.
1.1.2 Signs: There may be increased heart rate and increased blood pressure. There may be a systolic murmur in the apical region of the heart. Some patients may have a fourth heart sound. The second heart sound in the pulmonary valve area may be hyperactive and reverse split, and disappear after the pain is relieved.
1.2 Ancillary investigations
1.2.1 Electrocardiogram (ECG): ST-segment is depressed horizontally or obliquely by 0.1 mV, or elevated by 0.2 mV (V1-V4, elevated by 0.4 mV). Half of the patients may have arrhythmias (e.g., tachycardia, premature ventricular beats, bradycardia, conduction block, etc.). In angina pectoris, ECG changes are transient and can only be detected by tracing or monitoring during the attack. If there is no change in the ECG, a cardiac stress test or other tests should be performed to assist in the diagnosis.
1.2.2 ECG exercise test: positive.
1.2.3 Ambulatory ECG: 24-hour monitoring may reveal ischemic manifestations in the presence of chest pain.
1.2.4 Radionuclide examination: 201 thallium myocardial perfusion scan may reveal ischemic myocardium showing perfusion defect during cardiac stress test and reperfusion in the defect area when reexamined after rest. 99mTc cardiac cavitation angiography may measure left ventricular ejection fraction and show ventricular wall limitation dyskinesia.
1.2.5 Coronary angiography: It can show the degree of coronary artery stenosis and the number of branches. It is generally believed that stenosis of 70-75% or more can seriously affect the blood supply, and stenosis of 50-70% has some significance.
1.2.6 Drug test: positive dipyridamole test, dobutamine test, adenosine test, etc.
1.3 Typing and grading
1.3.1 Typing
Clinical classification into exertional angina pectoris, spontaneous angina pectoris and mixed angina pectoris.
1.3.2 Grading
Exertional angina grading: grade I:, grade II, grade III, grade IV
Spontaneous angina pectoris grading: mild, moderate, severe
1.4 Diagnostic criteria
①Symptoms and signs of angina pectoris.
② Objective basis of myocardial ischemia: ischemic change of ST-T during attack; positive ECG exercise test; myocardial perfusion contrast test suggesting myocardial ischemic change; coronary arteriography suggesting stenosis;
The diagnosis of angina pectoris can be made if any of the first and second items above are present.
2. Identification of evidence
2.1 Deficiency of heart energy: vague pain, shortness of breath, fatigue and spontaneous sweating. The face is less florid, with poor appetite and distension. The coating is thin and white, and the pulse is sunken and thin or substituted and rapid.
2.2 Heart-Yin deficiency: vague pain and chest tightness, worrying, dry mouth and dreaming, dizziness and tinnitus, alarm and restlessness, sleeplessness, net or little moss or thin yellow moss, red tongue, thin pulse or substitution, shortness of breath.
2.3 Qi-yin deficiency: vague pains, shortness of breath and weakness, vexation and heat in the five hearts, sweating and dry mouth, red tongue with little moss or light yellow tongue, thin pulse or knotted, generation.
2.4 Heart-Yang deficiency: stuffy pain, cold in the extremities, white face, swollen limbs, sweating with little urination, pale fat with thin white fur, sunken and weak pulse or sunken and late or knotted and substituted.
2.5 Phlegm occlusion: stuffiness, pain and fullness, sometimes slow and sometimes urgent, mucous and tasteless mouth, dullness and distention, heavy head and vomiting, tiredness of limbs, greasy or yellow or white slippery coating, smooth or counted pulse.
2.6 Stasis of heart and blood: stabbing pain at a fixed place, the pain site is fixed and does not move, mostly attacking or worsening in the afternoon and night, with obscure face and lips, unsettled, blue claw nails, purple dull tongue or purple spots or purple swollen veins under the tongue, with astringent or knotted pulse or generation.
2.7 Cold stagnation evidence: pain when encountering cold, back and shoulders, hand and foot recoil, dizziness and agitation, fear of cold and like heat, blue or light red with thin white coating and smoothness, pulse sunken and tight or sunken and stringent.
In addition to the aforementioned types of symptoms, we can also see liver depression and qi stagnation, heart and kidney yin deficiency, heart and yang tyranny, or a combination of the above-mentioned symptoms.
3. Treatment
3.1 Chinese medicine treatment
3.1.1 Identification and treatment
3.1.1.1 Treatment during the seizure period: Follow the principle of “treating the symptoms when it is urgent” and use
①Tonic Heart Qi Oral Liquid. Tonify heart qi, regulate qi and relieve pain. 10ml～20ml each time, 3 times a day.
②Nourish Heart Yin Oral Liquid. Nourishing heart yin, promoting blood circulation and relieving pain. 10ml～20ml each time, 3 times a day.
③Musk Heart Protection Pill. Aromatic, warming and painful, benefiting Qi and strengthening the heart. Take 1~2 capsules each time or swallow.
④Quick-acting Heart Pill. Promote blood circulation and regulate qi. Take 5 to 10 pills each time.
⑤ Yi Xin Wan. Benefiting Qi and strengthening the heart, opening the orifice and resolving blood stasis. Take 1～2 pills each time or swallow.
⑥Heart Pain (Cold) Aerosol. Warming pain and dispersing cold, regulating qi and relieving pain. Align under the tongue and spray 1～2 times each time. It is suitable for people with cold symptoms in angina pectoris of coronary heart disease.
(7) Heart Pain Relief Spray. Cooling the blood, clearing heat, activating blood circulation and relieving pain. Aim at the sublingual area and spray 1 to 2 sprays each time. It is suitable for those with heat symptoms in angina pectoris of coronary heart disease. Angina pectoris nervosa. Promoting blood circulation and resolving blood stasis, aromatizing and opening the orifices. Apply to the anterior heart area.
(8) For severe heart pain or if the above pain relief is ineffective, it can be combined with oxygen inhalation or the use of Chuanxiongzin injection, Danshen injection and Shengvein injection for sedation.
3.1.1.2 Treatment in remission: Follow the principle of “treat the root of the disease if it is slow”, and choose the treatment method and prescription according to the results of identification.
3.1.1.2.1 Deficiency of heart qi
Treatment: Tonify the heart qi.
Treatment: Tonify heart qi.
3.1.1.2.2 Heart yin deficiency
Treatment: Nourish heart yin.
Direction: Nourish heart yin.
3.1.1.2.3 Qi and Yin deficiency
Treatment: Benefit Qi and nourish Yin.
Remedy: Sheng Mai San with addition and subtraction.
3.1.1.2.4 Heart-Yang deficiency
Treatment: Warming Yang and promoting paralysis.
Remedy: Juniper Piper Allium and White Wine Soup with addition and subtraction.
3.1.1.2.5 Evidence of phlegm occlusion
Treatment: resolving phlegm and opening the orifice.
Remedy: Wenzhao Tang with addition and subtraction or Guiding Phlegm Tang with addition and subtraction.
3.1.1.2.6 Evidence of blood stasis in the heart
Treatment: Invigorate blood circulation and resolve blood stasis.
Treatment: Invigorate the Blood to remove stasis.
3.1.1.2.7 Evidence of cold stagnation and qi stagnation
Treatment: Warming Yang and regulating Qi.
Treatment: Warming Yang and regulating Qi.
In addition to the aforementioned types, we can also see the evidence of liver depression and qi stagnation, heart and kidney yin deficiency, heart and yang tyranny, or a combination of the above.
3.1.2 Commonly used Chinese patent medicines
Heart Keshu Tablet: Promoting blood circulation and eliminating blood stasis, promoting Qi flow and relieving pain. Take 1.2g each time, 3 times a day.
Dan Qi Tablets: Promote blood circulation and remove blood stasis. Take 0.9~1.5g each time, 3 times daily.
Tongxinluo Capsules: Benefiting Qi, promoting Blood circulation, promoting circulation and relieving pain. Take 0.76~1.52g each time, 3 times a day.
Blood Mansions and Stasis Oral Liquid: Promoting blood circulation and removing blood stasis, promoting circulation of Qi and relieving pain. Take 10mlg each time, 3 times a day.
Heart Tong Oral Liquid: Benefiting Qi and nourishing Yin, resolving phlegm and clearing the ligaments. Take 10-20ml each time, 3 times a day.
Heart Blood Nurture Tablets: Promoting blood circulation and relieving blood stasis, promoting circulation and relieving pain. Take 0.8g each time, 3 times a day.
Diu Xinhekang Capsules: Promoting blood circulation, resolving blood stasis, promoting circulation and relieving pain. Take 0.2~0.4g each time, 3 times a day.
Heart-Qi Tonic Oral Liquid: Tonifying Heart-Qi. Regulating Qi and relieving pain. 10ml each time, 3 times a day.
Guanxintai Water Pill: Benefiting Qi and nourishing the heart, activating blood circulation and promoting blood circulation. 6g each time, 2 times a day.
Musk Heart Protection Pill: Aromatic and warming, benefiting Qi and strengthening the heart. Take 1~2 capsules each time with or by swallowing, 3 times a day.
Quick-acting Heart Pill: Promote blood circulation and regulate Qi. 5-10 capsules to be taken by mouth, 3 times a day.
Shengyun capsule: Benefit Qi and nourish Yin. 0.9 each time, 3 times daily.
Xiangdan injection: 10-20ml each time, diluted with 5%-10% glucose injection or 0.9% sodium chloride injection 250ml, intravenous drip, once a day.
Danshen injection: 10-20ml each time, diluted with 5%-10% glucose injection or 0.9% sodium chloride injection 250ml, intravenous drip, once a day.
Pueraria Mirifica Injection: 200-400mg each time, diluted with 5%-10% glucose injection or 0.9% sodium chloride injection 250ml, intravenously, once a day.
Lanzan Fine Sin Injection: 10-20ml each time, diluted with 5%-10% glucose injection or 0.9% sodium chloride injection 250ml, intravenously, once a day.
Raw vein injection: 10-20ml each time, diluted with 5%-10% glucose injection or 0.9% sodium chloride injection 250ml, intravenous drip, once a day.
Chuanxiongzin injection: 40～80mg each time, diluted with 5%～10% glucose injection or 0.9% sodium chloride injection 250ml, intravenous drip, once a day.
3.1.3 Other treatment: Acupuncture treatment and other methods can also be used.
3.2 Western medical treatment
3.2.1 General treatment: low-salt, low-fat diet, avoid straining, keep emotionally stable, pay attention to insulation, quit smoking, and actively treat susceptibility factors, such as hypertension, hyperlipidemia, diabetes, obesity, etc.
3.2.2 Drug treatment.
3.2.2.1 Treatment at the time of seizure.
① Immediate quiet rest.
②Sublingual nitroglycerin tablets.
③Nitroglycerin injection.
④Isosuggestion injection.
3.2.2.2 Treatment in remission.
①Nitrates: nitroglycerin tablets, nitroglycerin skin patch tablets, isosorbide dinitrate tablets (cardiac pain relief), isosorbide 5-mononitrate tablets (Demin, Lunan heart health tablets, long-acting cardiac pain treatment), nitroglycerin injection, isosuggil injection, Aibe injection.
②Calcium antagonists: nifedipine tablets, thioprostone tablets (Heshinshang, Tianerxin), verapamil tablets (Isoptin), nicardipine tablets, nicardipine tablets, amlodipine besylate tablets (Loxin), etc.
③ β-adrenergic receptor blockers: propranolol (Jinan), atenolol (aminoglutethimide), metoprolol (betaxol g, medoxin, metoprolol tartrate), conco. This class of drugs is suitable for exertional angina pectoris, but is prohibited for those with coronary artery spasm attack or with peripheral vascular disease.
④Anti-platelet drugs: Acetylsalicylic acid tablets (Bamir, Aspirin), Ticlopidine, etc.
⑤ Anticoagulants: heparin, low fraction.