I. What is coronary heart disease? Coronary heart disease is known as coronary atherosclerotic heart disease. It is due to the action of some risk factors that cause atherosclerotic lesions on the walls of coronary arteries that supply blood to the heart, resulting in narrowing of the coronary artery lumen. When the narrowing reaches a certain level, ischemia occurs in the heart. In the case of physical activity, full meal, cold wind stimulation, emotional excitement, etc., myocardial ischemia increases and the patient will feel chest pain, or chest tightness, or a feeling of tightness in the chest, which is often referred to as angina pectoris. Atherosclerotic lesions, also known as plaque. Cholesterol, inflammatory cells, smooth muscle cells that have migrated from the mesentery, and some necrotic cells collect in the intimal layer of the blood vessel and cover the surface with a fibrous cap to form a typical atherosclerotic plaque. As the lesion develops, the plaque grows larger and the angina symptoms worsen. If the fibrous cap of the plaque suddenly ruptures and the contents underneath are exposed to the blood, it will immediately activate the coagulation system in the body and a thrombus will form at the rupture, resulting in complete occlusion of the vessel lumen, which is called myocardial infarction. Myocardial ischemia due to coronary artery spasm or microvascular dysfunction also belongs to the category of coronary heart disease. Second, how to diagnose coronary heart disease? The diagnosis of coronary heart disease must be made based on gender, age, symptom characteristics, and risk factors. In many cases, some auxiliary tests, such as ECG at the onset, ECG exercise stress test, and even selective coronary angiography, are also required to confirm the diagnosis. In general, men before the age of 40 and women before the age of 50 are less likely to develop coronary artery disease, unless the patient has more risk factors for coronary artery disease, especially when accompanied by diabetes mellitus, hypertension and hypercholesterolemia. The typical presentation of angina pectoris is a crushing pain behind the sternum or in the precordial region, or chest tightness or tightness in the chest; it lasts 3-5 minutes, usually no more than 15 minutes; it mostly occurs with physical activity, a full meal, cold wind stimulation, and emotional excitement; it is relieved within 2-3 minutes with nitroglycerin. Individual patients show episodic pain in the left shoulder and throat, but also triggered by the above factors, also lasting 3-5 minutes. men over 40 years old and women over 50 years old with the above typical angina symptoms have a high probability of having coronary heart disease, but there are more false positives in women; on the other hand, if patients often feel chest discomfort lasting for more than a few hours, or pins and needles-like pain lasting for a few seconds or jumping On the other hand, if the patient often feels chest discomfort that lasts for more than a few hours, or pins and needles or throbbing pain that lasts for a few seconds, coronary heart disease can be basically excluded, especially in young women. For those patients who lack typical angina symptoms and do not have very atypical chest pain, an ECG exercise stress test is required to establish the diagnosis: a positive presentation is an attack of angina or ischemic changes in the ECG during or after exercise. If the diagnosis still cannot be established, selective coronary angiography is required, which is the most accurate method to diagnose coronary artery disease, but not for those with coronary spasm or due to microcirculatory disorders. Therefore, in the diagnosis of coronary artery disease, two tendencies should be prevented: First, one should not jump to a rash conclusion. It is very wrong to make a diagnosis based only on the so-called myocardial ischemic changes shown in a resting ECG, which not only causes unnecessary economic burden but also psychological burden to the patient; secondly, the diagnosis should not be missed. Some patients show pain in atypical areas, such as the left shoulder, throat, etc., but other characteristics are consistent with angina pectoris, if not paid attention to, it is easy to miss the diagnosis. Third, what kind of people are prone to coronary heart disease? People with the following factors are at high risk for coronary heart disease. These risk factors include: ①Male > 55 years old, female > 65 years old; ②Smoking; ③Dyslipidemia: total cholesterol (TC) ≥ 5.7 mmol/L (220mg/dl) or low density lipoprotein cholesterol (LDL-C) > 3.6 mmol/L (130mg/dl) or high density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L ( 40mg/dl); ④ family history of early-onset cardiovascular disease (age at onset in first-degree relatives <50 years); ⑤ abdominal obesity or obesity (waist circumference ≥85cm in men, ≥80cm in women, body mass index BMI ≥28kg/m2); ⑥ C-reactive protein ≥1mg/dl; ⑦ hypertension; ⑧ diabetes mellitus. In addition, people with low physical activity and type A personality are also susceptible to coronary heart disease. Fourth, how to treat coronary heart disease? The treatment of coronary heart disease must be comprehensive, and there is no one drug that is effective. These measures should include at least three aspects: ① control risk factors; ② improve patient prognosis; ③ control symptoms and improve the quality of life. 1.Control of risk factors. Since coronary heart disease is largely caused by the risk factors mentioned above, it is obvious that the development of coronary heart disease will not stop if these risk factors are not tried to control. Therefore, the control of these risk factors is as important as the treatment of coronary heart disease. Of course, things like age, gender, family history, etc. are beyond our control, but there are more things we can do, like quitting smoking, reducing weight, controlling blood pressure, blood sugar and blood lipids, etc. 2.Improve the prognosis. The most serious consequence of coronary heart disease is the occurrence of sudden death and myocardial infarction. As already described, when the fibrous cap on the surface of the plaque suddenly ruptures, it will cause acute thrombosis at the rupture, resulting in the complete occlusion of the segment of blood vessels and acute myocardial infarction. Patients with coronary artery disease are prone to ventricular fibrillation due to myocardial ischemia, which causes electrical instability. The following four drugs have well-documented ability to reduce these events: (1) aspirin; (2) beta-blockers; (3) statin lipid-modifying drugs; and (4) angiotensin-converting enzyme inhibitors. (1) Aspirin: Once coronary artery disease is diagnosed, it needs to be taken for life unless there are contraindications, such as allergy, active gastric or duodenal ulcer, thrombocytopenia, etc. The recommended dose is 75-150 mg/day, taken either in the morning or in the evening. Many patients will feel stomach upset after taking it, and it is not an indication to discontinue the drug, and an ion pump inhibitor, such as Loxac, can be added. (2) β-blockers: It is recommended to apply fat-soluble or water- and fat-dissoluble β-blockers, such as betaxolol, bisoprolol, etc. It is not recommended to apply pure water-soluble beta-blockers, such as atenolol. Contraindications are: asthma, severe hypotension, severe bradycardia, type II type II or higher conduction block, etc. It is recommended to start with a small dose and gradually increase the dose so that the heart rate at rest is around 60 beats/min and the blood pressure is not less than 100/60 mmHg. (3) Statin lipid regulators. Patients with coronary artery disease require low-density lipoprotein cholesterol (LDL-C) <2.06 mmol/L. It is better to be lower than this value at regular doses of drugs. Regular liver function tests are required. It must be done about half a month to 40 days after the first dose and annually thereafter. Increased transaminases can be recovered after stopping the drug and rarely cause liver necrosis. Commonly used are: Atorvastatin, Simvastatin, Rosuvastatin, Fluvastatin, etc. The domestic drug blood lipid Kang is effective. (4) Angiotensin-converting enzyme inhibitor: As long as the blood pressure is not low, it should be taken. Commonly used drugs are: captopril, ramipril, midapril, perindopril, benazepril, fosinopril, etc. 3.Control of symptoms, including drug and surgical treatment. (1) Medication: Nitroglycerin is the quickest and most effective medication when symptoms occur. Quick-acting heart pills also have a definite effect. Drugs to reduce the onset of symptoms include: (1) β-blockers; (2) long-acting nitrates, such as Lunanoxin, Imodium, Isradine, etc.; (3) calcium antagonists, such as thiodiazepine, felodipine, nifedipine, amlodipine, etc. Two or three drugs can be used in combination, but the combination should not be used in the same kind of drugs. In addition, ④ drugs that affect myocardial metabolism, such as trimetazidine, have also been shown to have definite efficacy. ⑤ Many herbal medicines also have certain efficacy. (2) Surgical treatment: including ① percutaneous coronary intervention, mainly stent implantation; ② coronary artery bypass grafting, which is often referred to as bypass surgery. When the lesion is so serious that the above drug treatment cannot relieve the symptoms and affect the quality of life, surgical treatment can be considered. In some cases, stenting and surgical bypass surgery can also improve the patient's prognosis. V. How to do secondary prevention of coronary heart disease? Secondary prevention of coronary heart disease refers to the prevention of myocardial infarction or death from coronary heart disease. The more recognized is the ABCDE program. 1, A: aspirin: aspirin; ACEI (angiotensin-converting enzyme inhibitor) (or ARB: angiotensin receptor antagonist). 2, B: beta-blockers; Blood pressure control (blood pressure control); BMI lowering (body mass index reduction). 3.C：cigarette quitting (quit smoking); cholesterol lowering (cholesterol lowering); Chinese medicine (Chinese medicine). 4.D：diabetes control (control diabetes); diet (reasonable diet); decavitamin (multivitamin). 5.E：exercise (moderate exercise); education (health education); emotion (emotional stability).