Section II Treatment
I. Western medicine treatment
Treatment during seizures.
1. rest, oxygen absorption, etc.
2. Drugs: ① Nitroglycerin 0.3-0.6mg sublingual, 1-2 minutes to take effect, half an hour to gradually disappear. Gastrodia and long-acting cardiac pain tablets: not suitable for glaucoma, intracranial hypertension and hypotension. Yang Ming, Department of Traditional Chinese Medicine, Henan Provincial People’s Hospital
② β-blocker: has the effect of blocking the stimulation of sympathetic amines on heart rate and myocardial contractility receptors, slowing down the heart rate, lowering blood pressure and reducing myocardial contractility and oxygen consumption, thus relieving the onset of angina pectoris. Commonly used drugs: insulin (propranolol, betaxolol), etc.: cardiac insufficiency, bronchial asthma and bradycardia are not suitable.
Calcium channel blockers: inhibit calcium ions into the cell, also inhibit the role of calcium ions in the excitation-contraction coupling of cardiomyocytes, thus inhibiting myocardial contraction, reducing myocardial oxygen consumption, coronary expansion, release coronary spasm, improve the blood supply to the subendocardial myocardium, dilate the peripheral blood vessels, reduce A pressure, reduce cardiac load, also reduce blood viscosity, anti-platelet aggregation, improve myocardial Microcirculation.
Commonly used drugs: isoproterenol (verapamil), cardiac painkiller (nifedipine), bacitracin, nicardipine, tranylcypromine, etc.
④Coronary A dilators: pansentine, amiodarone, cardioplegia, etc.
⑤Other: low molecular dextrose, etc. Thrombolytic therapy: urokinase at 30 minutes with 1,000,000 u to 1,500,000 u of static dosing.
II. Interventional treatment and surgical treatment
Interventional methods are used to dilate the narrowed coronary arteries and improve myocardial perfusion, and postoperative antiplatelet and lipid-regulating drugs help prevent restenosis.
1. Percutaneous transluminal coronary angioplasty (PTCA) is performed with a cardiac catheter with a balloon delivered to the coronary artery A via peripheral A. The stenosis is entered under the guidance of a guiding wire, and a contrast agent is injected into the balloon to dilate it. Indications for application: ① treatment of multiple lesions in multiple or single branches; ② treatment of recently completely occluded lesions, including infarction within 6h; ③ treatment of unstable angina after 2-3 weeks of initial stabilization; ④ treatment of stenosis after main A-coronary A bypass grafting. However, left coronary A mainstem lesions without blood supply protection are contraindicated. The immediate success rate of this procedure is around 90%, but restenosis can occur in 25%-35% of patients within 3-6 months after surgery.
2. Intracoronary A stenting (ISI)
A stent made of stainless steel or alloy is placed into the coronary A through a cardiac catheter, and the stent expands on its own or by balloon expansion to support the vessel wall and maintain patency in the lumen.
It is used for ① improving the efficacy of PTCA and reducing the incidence of restenosis; ② acute vascular occlusion due to endothelial avulsion, vascular elastic retraction or spasm, and thrombosis during PTCT; ③ near complete obstruction of coronary A in chronic lesions; ④ stenosis of bypass graft vessel segment; ⑤ acute heart attack. Postoperative prevention of in-stent thrombosis with antiplatelet therapy.
3. Other coronary A interventional treatments: coronary A plaque rotational excision, coronary A plaque rotational grinding, coronary A laser angioplasty, intracoronary A ultrasound angioplasty, microglass thermal balloon angioplasty, radiation irradiation, etc.
Surgical treatment: The main treatment is coronary artery bypass grafting (CABG): the patient’s own saphenous vein or internal mammary artery is used as bypass graft material, the former end is anastomosed to the main A and the other end is anastomosed to the distal end of the diseased coronary A segment to divert blood from the main A to improve the blood flow to the myocardium supplied by the diseased coronary A. Selective coronary A angiography is performed before surgery to understand the extent and scope of the coronary A lesion. A preoperative selective coronary A angiogram is performed to understand the extent and scope of the coronary A lesion for reference in surgical planning (to determine the number of roots to be transplanted). This procedure has become the most common elective cardiac surgery in countries with a high prevalence of coronary artery disease, and multiple bypass grafts can be performed simultaneously in a single operation.
The procedure is indicated for: (i) left coronary A trunk lesions; (ii) stable angina that does not respond well to medical treatment and affects work and life; (iii) worsening angina; (iv) variant angina; (v) intermediate syndrome; and (vi) patients with post-infarction angina. In addition, this procedure is also advocated within 6 h of acute infarction or after the occurrence of serious complications after treatment. The degree of coronary A stenosis in the patient should be 75% or more of the lumen obstruction. The distal lumen of the stenotic segment should be patent and the left ventricular function should be good. In recent years, surgery has also been considered for those with stenosis of 50% or more.
After surgery, angina symptoms can be improved by 80% to 90%, and the quality of life is improved in 65% to 85% of patients. However, it is not certain whether the surgery can improve the ventricular function, whether it can prevent serious arrhythmia, heart failure or infarction in the future, and whether it can prolong the patient’s life; in addition, the surgery itself can be complicated by myocardial infarction, and the transplanted vessels can be embolized after the surgery. Therefore, it seems that the indications for surgery should be strictly controlled. In patients with left coronary A trunk lesions or complete obstruction of the right coronary A with more than 75% obstruction of the anterior descending branch of the left coronary A, it is generally believed that surgery can prolong life and is the strongest indication for surgery.