Coronary atherosclerotic heart disease, referred to as coronary heart disease, refers to heart disease caused by ischemia and hypoxia of the myocardium due to narrowing or blockage of the lumen by atherosclerosis of the coronary arteries. The disease is caused by atherosclerosis. For coronary atherosclerosis, the most important predisposing factors (or risk factors) are advanced age, male, hyperlipidemia, hypertension, smoking and diabetes. This is followed by intense mental activity and low physical activity, high-calorie, high-fat and high-cholesterol diet, obesity, type A personality, and family hyperlipidemia.
Due to the different sites, extent and degree of coronary artery lesions, the disease has different clinical features and can be generally classified into five types.
1, occult coronary artery disease: asymptomatic, but with electrocardiographic changes of myocardial ischemia.
2, angina pectoris: there are episodes of retrosternal pain, caused by transient myocardial blood supply deficiency.
3, myocardial infarction: severe symptoms, caused by coronary artery blockage and acute ischemic necrosis of the myocardium.
4, ischemic cardiomyopathy: myocardial fibrosis or myocardial sclerosis caused by long-term myocardial ischemia.
5.Sudden death: sudden cardiac arrest and death.
Diagnosis: For those who have “angina pectoris” and suspect coronary artery disease, electrocardiography is an effective and non-invasive method to diagnose myocardial ischemia, while coronary angiography is the most valuable method to show atherosclerotic lesions of coronary arteries. Echocardiography can determine the presence of myocardial ischemia by observing the motion of the ventricular wall and measuring the ventricular ejection fraction. Radionuclide cardiac imaging can distinguish between areas of myocardial ischemia or necrosis, and PET myocardial imaging can determine the presence of surviving myocardium in the area of myocardial infarction.
Treatment: Coronary artery disease is still prevention-oriented, but as symptoms worsen, drug therapy is necessary to dilate coronary arteries to increase myocardial blood and oxygen supply; or to slow down the heart rate, reduce myocardial oxygen consumption, and decrease ventricular wall tension. For patients who are not easily controlled by medications and whose coronary angiography indicates a coronary artery stenosis of 50% or more, especially for those with multiple diffuse lesions, coronary artery bypass grafting should be chosen as early as possible.
Coronary artery bypass grafting is performed by taking the patient’s own saphenous vein or internal thoracic artery as graft material and sewing one end to the distal end of the diseased coronary artery and the other end to the ascending aorta, so that blood from the aorta can be supplied directly to the distal end of the stenosis through the “bridge” to reduce the symptoms of myocardial ischemia.
Several conditions that are suitable for coronary artery bypass grafting (indications for surgery).
1.Left coronary artery trunk lesion.
2.Stable angina pectoris that does not respond well to medical treatment and affects work and life.
3, worsening angina, refers to the original stable angina, within 3 months the pain is frequent, the symptoms worsen, lighter rest force activity or emotional excitement that the attacker.
4, intermediate syndrome, refers to myocardial ischemia caused by angina attack for a longer period of time, up to 30 minutes or more than 1 hour, the attack often occurs at rest or during sleep.
5.Post-infarction angina pectoris.
6.Acute myocardial infarction within 6 hours after the infarction.
7.Myocardial infarction combined with post-infarction left ventricular ventricular wall tumor, septal perforation, mitral valve papillary muscle rupture leading to mitral regurgitation, and left ventricular free wall rupture.
Surgery: Coronary artery bypass surgery can be selected according to different conditions and ages under extracorporeal circulation or under normothermic heartbeat.
Effect: Post-operative improvement of angina symptoms can reach 80-90%, and the quality of life of 65-85% of patients is significantly improved.