When it comes to cramps, you must be no stranger to them, most of them occur in the muscular tissues of the body, especially the muscles of the lower limbs and calves cramps, so have you heard of heart cramps, today we will popularize heart cramps (coronary artery spasm).
1, what is coronary spasm Heart cramps actually refers to coronary artery spasm (referred to as coronary spasm) refers to various causes of transient contraction of the coronary arteries, causing incomplete or complete occlusion of blood vessels, resulting in myocardial ischemia, resulting in angina, arrhythmia, myocardial infarction and sudden death of the clinical syndrome. It has important clinical significance for the diagnosis, treatment and prognosis of myocardial ischemic diseases. The prognosis of those with frequent attacks and severe symptoms, with arrhythmias, atrioventricular block and heart failure is poor.
The typical coronary artery disease is the symptom of chest tightness and breath-holding during exercise, but it can be relieved after rest. In contrast, patients with coronary spasm may experience pain regardless of rest or exercise, which can only be relieved by taking nitroglycerin. And some of the patients with angina pectoris after PCI have no abnormalities on review coronary angiography, which should be alerted to the condition of coronary artery spasm and is an important cause of persistent angina pectoris after PCI.
Coronary spasm can confuse not only the patient, but also the physician. Sometimes the onset of symptoms is so short that some tests do not corroborate a heart cramp at all. But once a heart cramp occurs, if left untreated, it slowly turns from episodes of 10 minutes each to episodes of 30 minutes, and eventually it is likely to lead to a heart attack.
2, how to diagnose coronary spasm Clinical diagnosis of coronary spasm is more difficult, especially to identify whether it is accompanied by fixed coronary artery stenosis disease. Coronary spasm can be completely asymptomatic. Clinically, angina at rest most often occurs at midnight and early morning. Special cuts are painful episodes or more than 1ht often suggest the diagnosis of coronary spasm.
(1) Dynamic electrocardiography can improve the diagnosis of coronary spasm, especially in the quiet state, without episodes of angina pectoris, the presence of transient S-T segment and T wave changes, appears more important.
(2) Coronary angiography has some diagnostic value for coronary spasm. The diagnosis can be confirmed if the following conditions are met: ① A transient stenosis or complete occlusion of a normal coronary artery, or a transient further stenosis or complete occlusion at the site of atherosclerotic stenosis. ②Nitrates or calcium antagonists and other coronary dilation drugs cause the above stenosis or occlusion to disappear rapidly or on their own.
3.High-risk groups of coronary artery spasm People with poor sleep, anxiety and easy tension; people who smoke a lot, drink alcohol, or even take drugs; people who exercise strenuously, get emotional and hyperventilate.
4, how to treat coronary spasm Currently there are three main categories of drugs used to relieve angina: nitrates, beta-blockers and calcium antagonists (CCB).
(1) Sublingual oral nitroglycerin during an attack, and repeat administration if not relieved (pay attention to blood pressure).
2) Nitroglycerin should only be used for emergency treatment and should not be taken as a daily medication, as it can easily produce drug resistance. For patients with coronary artery disease, isosorbide mononitrate is a better choice for daily treatment.
(3) Beta-blockers can only be used with caution in patients with coronary spasm who have combined organic stenosis of coronary arteries or severe myocardial bridges, whose main clinical manifestation is exertional angina and for whom CCB and nitrates are not effective.
(4) CCB can be used in various types of angina pectoris. Long-acting calcium antagonists (such as long-acting nifedipine, amlodipine, diltiazem, verapamil, etc.) are recommended as the drug of choice for the treatment of coronary spasm and can be administered at night for frequent nocturnal attacks.
For the treatment of coronary artery spasm, a 5-treatment combination is most commonly used, including calcium antagonists, nitrates, potassium channel openers (nicorandil), statins, and antiplatelet therapy.
Coronary spasm is a specific type of unstable angina caused by myocardial ischemia and hypoxia due to constriction of the coronary arteries from various causes. Clinically, anti-myocardial ischemic therapy should be given to prevent the occurrence of coronary spasm based on active control of risk factors and improvement of lifestyle.