Combination of Chinese and Western medicine for coronary heart disease.
Coronary Atherosclerotic heart disease, referred to as coronary A heart disease or coronary heart disease (CHD), is sometimes referred to as coronary A disease (CAD) or ischemic heart disease. It refers to heart disease caused by atherosclerosis of the coronary arteries narrowing or blocking the lumen resulting in myocardial ischemia and lack of oxygen.
Epidemiology.
The disease occurs mostly in people over 40 years old, more men than women, with brain work predominating, not many before and after World War I. After the Second World War, the disease gradually increased, and became the main cause of death in the population, reaching a peak after the 1960s. The disease is not as common in China as in Europe and the United States, but in recent years there is a trend of increase, in 1976, 12 cities in China statistics, the disease mortality rate of 29.6/100,000 people, higher in the north than in the south, 22 provinces and autonomous regions in the 1970s, the prevalence of people over 40 years of age 6.46%, and increasing year by year.
Etiology and pathogenesis.
The disease is due to Atherosclerosis. For coronary A atherosclerosis, the most important predisposing factors are advanced age, male, hyperlipidemia, hypertension, smoking and diabetes mellitus. The next most important factors are intense mental activity and reduced physical activity, food with high calorie content, high animal fat, high cholesterol and low antioxidant substances such as vitamin E and A, obesity, type A personality, etc.
As for the reason why coronary arteries are prone to atherosclerosis, it may be.
1, the blood supply of the inner membrane and part of the middle membrane of this A is directly supplied by the lumen, and the oxygen and nutrients in the blood are directly permeated into the inner and middle membranes, thus the lipids are also easily permeated.
2, the angle of intersection between this A and the main A is almost right angle, and the proximal end and the proximal end of the branches are subjected to high impact of blood flow, thus the endothelium is easily damaged.
In terms of pathogenesis, more emphasis has been placed on the increase and migration of macrophages and the proliferation and migration of smooth muscle C in recent years. in phagocytosis and lipid accumulation, the role of fibroblastic proliferation and migration in the formation of fibrofatty lesions; platelet adhesion and aggregation, which contribute to endothelial C damage and proliferation, thrombosis, and the role of these aforementioned C proliferation and migration. All of these cells, in turn, release a variety of factors that promote the formation of A atherosclerosis through different pathways, as well as the proliferation and migration of these cells, creating a vicious cycle that keeps the lesion moving forward.
Pathological anatomy and pathophysiology.
The coronary A has 2 branches, left and right, with openings in the left and right main A sinus, respectively. The left coronary A has a 1-3 cm long common trunk, which is then divided into anterior descending branches and gyral branches. The three coronary A branches have many small branches anastomosing with each other, and together with the left coronary A trunk, they are collectively called coronary A branches. Atherosclerosis may involve one, two or three of the four branches, or all four branches may be involved at the same time. The left anterior descending branch is the most common and has the most severe lesions, followed by the right coronary A, the left gyral branch and the left coronary A trunk in that order. The lesions were more severe in the proximal than in the distal part, and the main branches were more severe than the marginal branches. The atheromatous plaques are mostly distributed at the openings of vascular branches and are often on one side of the vessel, with a crescent shape, which develops enough to gradually cause lumen narrowing or occlusion.
When the blood vessel is mildly narrowed (<50%), the blood supply to the myocardium is not affected, the patient has no symptoms, and various cardiac stress tests do not show the manifestation of myocardial ischemia, so although there is atherosclerosis, it cannot be considered as coronary heart disease. This is coronary artery disease.
In addition, rupture or bleeding of atherosclerotic plaque, atherosclerotic coronary spasm or intra-A thrombosis can cause rapid and severe narrowing or blockage of the A lumen, resulting in acute ischemia or necrosis of the myocardium.
Clinical types.
The disease has different clinical features due to the location, extent and degree of lesions, and is generally divided into five types : –
1. Occult or asymptomatic coronary artery disease.
Asymptomatic, but with myocardial ischemic electrocardiographic changes or radionuclide myocardial imaging changes, no myocardial histomorphological changes.
2. Angina pectoris.
There is episodic retrosternal pain caused by transient myocardial blood supply deficiency, and the myocardium is mostly without histomorphological changes.
3, myocardial infarction.
The symptoms are severe, caused by coronary A obstruction and acute ischemic necrosis of the myocardium.
4, ischemic cardiomyopathy.
Prolonged myocardial ischemia caused by the gradual fibrosis of the myocardium in the past called myocardial fibrosis or myocardial sclerosis, manifested as an enlarged heart, heart failure and arrhythmia.
5, sudden death.
Sudden cardiac arrest and death, mostly due to localized cardiac electrophysiological disorders or pacing conduction dysfunction causing severe arrhythmias.