1. Are hypertension and coronary artery disease sister diseases?
If you have been to a geriatric cardiovascular ward, you will find many patients diagnosed with both “coronary artery disease” and “hypertension”, which are linked together. Epidemiologist J. Stamlar believes that the relationship between hypertension and coronary artery disease is a causal one. He concluded that hypertension is an independent factor in the development of coronary heart disease, independent of other known risk factors, based on data from 7065 individuals. In recent years, hypertension is considered to be a metabolic disease, mainly manifested as resistance to insulin-mediated glucose uptake, so that hypertension is often associated with coronary heart disease, diabetes mellitus, central obesity, hyperinsulinemia, reduced glucose tolerance, and hyperlipidemia.
Morbidity and mortality from coronary artery disease increases with increasing blood pressure levels. The incidence of myocardial infarction is twice as high in hypertensive patients as in those with normal blood pressure. The relative risk of death from coronary heart disease in patients with grade 1 hypertension (140-159/90-99 mmHg) is 1.33 times higher than that in those with normal blood pressure (120/80 mmHg); in patients with grade 2 hypertension (160-179/100-109 mmHg), grade 3 hypertension (210-120 mmHg) and DBP ≥120 mmHg, the risk of death from coronary heart disease is increased by 2.20, 2.20, and 2.20 times. The risk of death increased by 2.20, 3.64 and 5.88 times in patients with Grade III hypertension (210-/- 120 mmHg) and DBP ≥120 mmHg. More than 70% of patients with coronary artery disease in China are combined with hypertension. Hypertension accelerates the formation and development of atherosclerosis and coronary heart disease.
The causes of hypertension induced coronary heart disease are.
(1) hypertension, the senior nerve center activity is impaired, the cerebral cortex in a long-term state of excitement, causing sympathetic excitation, the release of excessive catecholamines. The increase of catecholamines can directly damage the arterial blood vessel wall, and also cause coronary artery spasm, and at the same time, the sensitivity of the cardiovascular system to catecholamines increases, thus accelerating the process of coronary artery atherosclerosis.
(2) In hypertensive disease, the following changes in hemodynamics occur: (1) the lateral pressure of blood flow on the arterial wall increases, and lipids in the blood easily invade the arterial wall; (2) increased vascular tone causes excessive stretching of the arterial intima and rupture of elastic fibers, resulting in intimal damage and thrombosis; (3) capillary rupture within the arterial wall causes subintimal bleeding and thrombosis, resulting in proliferation of intimal fibrous tissue, which eventually leads to atherosclerosis.
2. Are coronary heart disease and diabetes sister diseases?
According to the data, the chance of coronary heart disease in diabetic patients is 2 to 3 times higher than that of the general population. If a diabetic patient also has hypertension, the likelihood of getting coronary heart disease is even higher. Compared with non-diabetic coronary heart disease, diabetes is more serious, mainly because of high prevalence, high mortality, early age of onset, and high incidence of heart attack. In addition, diabetic patients with coronary heart disease are also prone to painless acute myocardial infarction, shock and heart failure and other comorbidities.
Diabetes mellitus is a disease of sugar, protein and lipid metabolism disorder mainly manifested by hyperglycemia. The reasons why diabetes mellitus is easy to complicate coronary heart disease are: (1) diabetes mellitus patients are often accompanied by lipid metabolism disorder and hyperlipidemia, the latter is an important factor in the occurrence of atherosclerosis and coronary heart disease; (2) diabetes mellitus patients have insulin deficiency or reduced number of insulin receptors, which can reduce the glucose uptake by cardiac muscle cells. (2) The lack of insulin or the decrease in the number of insulin receptors in diabetic patients can reduce the uptake of glucose by myocardial cells, resulting in insufficient myocardial energy supply and reduced myocardial contractility; (3) The high concentration of glucose in the blood of diabetic patients and the increase in glycosylated hemoglobin reduce the oxygen-carrying capacity of red blood cells and make the myocardium prone to hypoxia. (4) Diabetic patients have 4 times more hypertension than non-diabetic patients, and hypertension is a risk factor for coronary heart disease. (5) Diabetic patients have increased platelet adhesion and aggregation, increased blood viscosity, and reduced red blood cell deformation capacity, which can easily produce thrombosis. In addition, diabetes affects the higher nerve function disorder, causing the neuro-endocrine axis dysfunction, causing cardiovascular function derangement and lipid metabolism disorder, increasing blood cholesterol, contributing to atherosclerosis, and eventually forming diabetic heart disease.
Diabetic heart disease differs from general coronary artery atherosclerosis heart disease in that the former has myocardial microangiopathy, intimal hyperplasia is more aggravated, myocardial ischemia and hypoxia are more serious, and the vegetative nerves (including sympathetic and parasympathetic nerves) innervating the heart are damaged to different degrees, therefore, the damage of diabetic heart disease is more serious.
Therefore, in addition to regular blood glucose and urine glucose checks and active treatment, diabetic patients should also have their blood pressure measured, fundus examination, electrocardiogram, and cardiac function tests when necessary. This is good for early detection and prevention of coronary heart disease.
3.What is the relationship between trace elements and the development of coronary heart disease?
Many trace elements play a beneficial role in cardiovascular function and structure, such as zinc, selenium, zinc, manganese, cobalt, copper, fluorine and magnesium, while excessive cadmium has a harmful effect on cardiovascular structure and function.
Chromium is involved in the action of insulin, an organic compound of chromium called glucose tolerance factor ( GT F ) , and chromium plays an important role in the control of hyperglycemia, a risk factor for coronary heart disease. Chromium deficiency increases the level of fat and fat-like substances in the blood, especially cholesterol, and makes people vulnerable to atherosclerotic coronary heart disease. Studies have shown that in areas with a high prevalence of atherosclerosis, chromium levels in patients are significantly lower than in areas without a high prevalence. In clinical practice, chromium supplementation is effective for coronary heart disease, hypertension, hyperlipidemia and diabetes. It can not only reduce the total cholesterol level in blood, but also increase the level of high-density lipoprotein, which has been recognized by the world medical community as a protective effect on the heart.
The Shamberger study showed that the incidence of heart disease in the elderly was 6 7% lower than the national average in selenium-rich areas and higher than the national average in selenium-deficient areas. Furthermore, the rate of death from age-related cardiovascular disease and hypertensive heart disease is very low in high selenium areas of the United States. In rats with experimental acute myocardial infarction, selenite injection was found to have multiple effects: 1) significant and rapid improvement in electrocardiogram; 2) reduction in infarct size; 3) accelerated myocardial sarcomere growth and myocardial synthesis and regeneration. It is believed that selenium has a protective effect on experimental myocardial infarction and hypoxic-ischemic myocardium.
As one of the essential trace elements of magnesium, has an important protective effect on the heart and blood vessels, has the name of “cardiovascular guardian”. Human body if magnesium deficiency, can lead to tachycardia, arrhythmia and myocardial necrosis and calcification. Therefore, it is said that magnesium deficiency is more dangerous to the heart than high blood pressure and high blood fat. Low magnesium can cause blood hypercoagulability, promote the formation of atherosclerosis, and cause disorders of lipid metabolism. Researchers found that the heart of patients who died due to myocardial infarction and other diseases, the magnesium content is much lower than normal people.
Copper is an essential trace element to maintain cardiovascular function, and copper deficiency can lead to elevated cholesterol and contribute to the occurrence of coronary heart disease, angina pectoris and myocardial infarction. However, too much copper will induce atherosclerosis.
Manganese is the main component of many enzymes, which can activate the enzymes and facilitate the utilization of fat, and it is proved that manganese can improve the lipid metabolism of patients with atherosclerosis.
Manganese, silicon, molybdenum, vanadium and fluorine play a role in maintaining the elasticity of blood vessels, inhibiting the formation of atherosclerosis, supporting cellular energy metabolism, inhibiting cholesterol formation and avoiding arterial calcification, thus preventing the formation of coronary heart disease.
Cobalt is an essential component of the vitamin B 12 molecule and is one of the most important elements beneficial to cardiovascular function. Some studies have shown that the cobalt content in the hair of patients with hypertension, atherosclerosis and coronary heart disease is lower than that of healthy people of the same sex and age. It reveals that cardiovascular diseases are related to the long-term low or lack of the trace element cobalt.
4.What does asymptomatic coronary heart disease refer to?
Asymptomatic coronary artery disease, also known as “hidden coronary artery disease”. Although patients with occult coronary artery disease have the pathological basis of coronary artery disease, they can not show symptoms and do not know they have the disease, but when running, drinking, overwork, excitement, excessive smoking, severe insomnia, sudden rain, long-distance travel, excessive intercourse can induce coronary artery spasm, causing myocardial ischemia and hypoxia, resulting in local electrophysiological disorders, serious arrhythmias, or even cardiac arrest Or, on top of that, it can cause coronary artery embolism, resulting in massive myocardial necrosis. Hidden coronary heart disease is the enemy of “healthy people” and often causes sudden death of “healthy people”. Summarizing the autopsy findings of sudden death at home and abroad, it is agreed that the main cause of sudden death is cardiovascular disease, especially occult coronary heart disease is the most common.
In order to detect and treat this disease as early as possible, it is recommended that middle-aged and elderly people with a high incidence of coronary heart disease should undergo regular cardiac checkups at hospitals, and that people with high risk factors for coronary heart disease, such as middle-aged and elderly people over 40 years old, postmenopausal women, and women with a high risk of coronary heart disease, should undergo regular cardiac checkups at hospitals. For people with high risk factors for coronary heart disease, such as middle-aged and elderly men over 40 years old, postmenopausal women, people with hyperlipidemia, hypertension, excessive smoking, diabetes or family history of coronary heart disease, in addition to routine cardiac examinations, exercise tests should be performed to detect and screen for coronary heart disease, along with ambulatory electrocardiogram and nuclear myocardial perfusion imaging to confirm the diagnosis if necessary.
5.How to recognize angina pectoris as the main symptom of coronary heart disease?
Angina pectoris is a clinical syndrome caused by temporary ischemia and hypoxia of the myocardium, with episodes of crushing or tightening pain or chest discomfort behind the upper or middle part of the sternal body as the main clinical manifestation, which can spread to the precordial area. Angina pectoris has the following characteristics.
(1) The site of pain is often in the anterior or posterior sternum, or the precordial region. It may radiate to the left shoulder, left arm, neck, jaw, throat, and back. It even runs to the teeth or fingers.
(2) The pain sensation is not “colic” like, but a feeling of pressure and tightness, suffocation, stuffiness or burning. Patients often unconsciously stop what they are doing until the pain subsides. Anyone with straight stab-like or knife-like pain is mostly non-anginal.
(3) The pain is not obviously related to deep breathing (i.e. the pain does not increase or decrease when inhaling deeply), if the pain increases when inhaling deeply or decreases or even disappears with a long sigh, most of them are not angina.
(4) The duration of pain is short, mostly 3 – 5 minutes, usually not more than 10 – 15 minutes. If the pain lasts only half a minute or more than 30 minutes, it is not considered to be angina pectoris. The pain may come on once every few days or weeks, or multiple times in a day.
(5) The pain usually resolves within 2 – 5 minutes (up to 5 – 10 minutes) when the patient rests or takes a nitroglycerin tablet (1 – 2 tablets) under the tongue. If this is ineffective, it suggests a more severe lesion, or non-coronary disease, or that the nitroglycerin tablets have failed.
(6) Pain can be triggered by a variety of factors, such as physical labor, emotional excitement (anger, anxiety, excitement, etc.), satiety, fast walking, walking against the wind, climbing buildings, hills, cold, smoking, etc.
6.What are the causes of angina pectoris in Chinese medicine?
Chinese medicine believes that the main causes of the disease are long-term improper diet and physical weakness in old age, cold invasion and emotional disorders as a proximate cause or trigger. Excessive physical or mental labor, on top of the deficiency of heart qi and heart yang, can also further deplete heart qi, which can trigger and aggravate the disease. Prolonged ambulation and static movement can cause the spleen to lose its health and function, breeding phlegm and turbidity, or the chest and yang to lose their strength, resulting in poor flow of qi and blood, all of which can contribute to this disease.
① Irregular diet: including eating disorders (irregularity, overeating, binge eating), alcoholism or frequent over-filling of meals. When the spleen and stomach cannot transport water and grain, phlegm and dampness will be produced, which can cause phlegm and dampness to attack the heart and chest, blocking the blood vessels and causing the chest and Yang to become unstable. Excessive consumption of high-fat, high cholesterol food, the spleen and stomach disorders, the spleen for wet trapped, weak, paralyzed heart Yang, the heart is not blocked, and induced angina pectoris
② Old age and physical weakness: this disease mostly occurs in the middle-aged and elderly, over half a century, the kidney is gradually deficient. Deficiency of kidney yang cannot stimulate the yang of the five organs, causing deficiency or lack of heart yang. The heart is the master of the blood vessels. Insufficient heart qi is unable to push the blood to move, the blood circulation is obstructed, the qi and blood stagnate in the heart vessels, and the vessels do not pass, “if not pass, it hurts”. Insufficient kidney yin can not nourish the yin of the five viscera, which can make the heart yin depleted, and the pulse channel is not moistened, or on this basis there is phlegm obstruction of the heart, then it can develop into angina pectoris.
(3) Emotional disorders: The seven emotions refer to the mental and emotional activities of people, which are summarized in Chinese medicine as joy, anger, worry, thought, grief, fear and fright. The seven emotions belong to normal physiological activities, but due to long-term mental stimulation or sudden severe trauma, beyond the normal range, it will cause the body’s yin and yang, qi and blood bias, and thus the occurrence of disease. It is often seen clinically that angina pectoris is easily triggered by emotional excitement, which is due to qi depression, qi stagnation, blood stasis, paralysis of heart veins and pain.
④ Cold: Cold can directly affect the normal operation of the blood vessels. Su Wen. In the treatise on pain, it is pointed out that: “the cold gas guest outside the veins, the veins are cold, the veins are cold, the veins are curled up, curled up, the veins are dull and urgent, dull and urgent is external to the small loops, so the pain is sudden”. This means that cold can lead to vascular spasm, thus triggering angina pectoris.
7.How does angina pectoris of coronary heart disease develop according to Chinese medicine?
According to Chinese medicine, the basic pathogenesis of the disease is paralysis of the heart arteries, which causes pain if it does not pass. Under the action of many pathogenic factors, it can cause imbalance of Qi and blood in the internal organs, resulting in phlegm (heat), Qi stagnation and blood stasis, thus paralyzing the heart arteries and producing heart pain. The disease is mainly located in the heart, but can also affect other organs, especially the kidney.
8.How is the diagnosis of angina pectoris made by Chinese medicine?
According to Chinese medicine, the pathological changes of this disease are mainly manifested as deficiency and mixed with deficiency and reality. This deficiency can be different from Qi deficiency, Yang deficiency, Yin deficiency and Blood deficiency; the standard reality is different from Qi stagnation, cold condensation, phlegm and blood stasis, and can be intermingled with each other.
When angina pectoris attacks in coronary heart disease, the pathogenesis is mostly based on the blockage of the heart vessels by qi stagnation, cold condensation and blood stasis. The heart artery is not smooth or suddenly closed, so suddenly and pain. At this time, the treatment should be aromatic and warm, smooth the blood vessels to open the paralysis as the main method, so that the pass is not painful. The only method to open the paralysis is the aromatic smell, blood circulation, warmth and good ventilation of the medicine can achieve the purpose of quick pain relief. In recent years, many Chinese patent medicines have been developed and produced in China, such as Guanxin Suhe pill, quick-acting heart saving pill, heart saving dan, Su Bing drip pill, broad chest aerosol, etc. The medicines are taken from ice chips, Suhe Xiang, sandalwood, ginger, pseudostellaria, and descending incense, etc., which are aromatic and open the orifice, promote the chest Yang, and have the effect of quick-acting pain relief. Clinical also see some patients, angina attack with sublingual nitrate drug effect is not good, taking such drugs or combined with such drugs to treat, can achieve good results.
Angina pectoris in remission: Chinese medicine treatment should be aimed at reducing or preventing the recurrence of angina pectoris and improving the long-term prognosis of patients. At present, the clinical treatment of angina pectoris in coronary artery disease is mostly based on the rule of activating blood circulation and resolving blood stasis, or using the formula of activating blood circulation and resolving blood stasis alone, or combining it with the method of regulating qi, benefiting qi, warming yang, resolving phlegm, etc., all of which have shown certain efficacy.
On this basis, clinical treatment should also be combined with different types of angina pectoris and characteristics of the onset of coronary heart disease, in order to achieve better results.
9.Is ischemic heart disease and coronary heart disease the same thing?
Ischemic heart disease refers to myocardial damage caused by imbalance between coronary blood flow and myocardial demand due to changes in coronary circulation. Its most common cause is subcoronary artery and occlusion caused by coronary atherosclerosis. Therefore, ischemic heart disease is often used as a synonym for coronary atherosclerotic heart disease, or coronary heart disease. Broadly speaking, ischemic heart disease also includes coronary artery disorders other than coronary atherosclerosis, such as coronary artery entrapment aneurysm, calcium deposition, intimal hyperplasia, lupus, rheumatic fever, syphilis, viral infection, etc. involving coronary artery opening, coronary artery embolism caused by emboli formed by atheromatous plaque fragments, bacterial endocarditis redundancy shedding, etc.
10.Is myocardial ischemia equal to coronary heart disease?
In a demonstration of cardiac intervention, four patients with myocardial ischemia who were repeatedly hospitalized in various hospitals under the name of “coronary artery disease” due to chest tightness and precordial discomfort and ECG suggesting myocardial ischemia were diagnosed with coronary artery disease after coronary angiography, only one of them was diagnosed with coronary artery disease and underwent After coronary angiography, only one of them was diagnosed with coronary artery disease and underwent stent implantation, while the other three were “uncapped” and the patients and their families were very happy. It seems that “myocardial ischemia” on ECG alone is not equal to “coronary heart disease”.
There are many causes of myocardial ischemia. Coronary heart disease is the main cause of myocardial ischemia, but not the only cause, other diseases can also cause myocardial ischemia.
In an outpatient clinic, an electrocardiogram is usually the initial method of diagnosing heart disease. In a normal ECG, the T wave is “upright”, while in patients with chronic myocardial ischemia, the T wave may show a “low” or “inverted” pattern. However, the diagnosis of myocardial ischemia is not the same as coronary artery disease. In middle-aged women, sympathetic arousal due to anxiety, hypertension, satiety, myocarditis, atrial fibrillation, and rapid heart rate can cause T-wave changes on the ECG. The high incidence of coronary heart disease in women is after menopause. Women with normal menstruation before menopause, without a family history of coronary heart disease or high cholesterol, are less likely to develop coronary heart disease due to the protective effect of estrogen on coronary arteries. Epidemiological surveys show that the incidence of coronary heart disease in women gradually equals that of men at the age of 65 to 70. Therefore, when the electrocardiogram indicates T-wave changes, it should not be automatically associated with coronary artery disease, but should be further examined by the cardiology department.