Coronary atherosclerotic heart disease, or CHD for short, is now the “number one killer” of human health. The prevalence of coronary heart disease increases with age, and it is the most common cardiovascular disease among the elderly. The current average prevalence of coronary heart disease in China is about 6.49%. What is alarming is that due to unhealthy living habits, unreasonable dietary structure and increasing work pressure, the incidence of coronary heart disease is on the rise, and even some middle-aged people are suffering from coronary heart disease, which brings misfortune to the originally happy families.
What is coronary heart disease?
Coronary heart disease is caused by atherosclerosis of the coronary arteries. This atherosclerotic plaque accumulates on the intima of coronary arteries, and over time, the coronary artery lumen is severely narrowed or even blocked, resulting in reduced blood flow, insufficient oxygen supply, and reduced nutrient supply to the heart muscle, resulting in a series of ischemic manifestations, such as chest tightness, breath-holding, and angina, which affect the normal work of the heart to varying degrees, and can lead to myocardial infarction or even death in severe cases.
Types of coronary heart disease.
The severity of symptoms of coronary heart disease depends on the degree of myocardial ischemia and damage, and there are mainly the following types.
1, angina pectoris Typically, it is posterior sternal crushing chest pain, or just chest discomfort.
2, myocardial infarction appears angina pectoris more persistent chest pain, laboratory tests can find serum enzymology and electrocardiographic changes.
3.Heart failure: Shortness of breath, easy exertion, and enlarged heart on examination.
4.Arrhythmia Such as premature beats, atrial fibrillation and other types of arrhythmias.
5.Sudden death.
6.Hidden coronary artery disease refers to those who have no obvious symptoms but have ST segment and T wave changes reflecting myocardial ischemia after examination by exercise ECG.
The “gold standard” of coronary heart disease diagnosis
Coronary angiography
Coronary angiography is an interventional diagnostic technique that uses a catheter to perform radiological imaging of the coronary artery anatomy. The purpose of coronary angiography is to examine all branches of the coronary vascular tree to understand its anatomical details, including variations in the origin and distribution of coronary arteries, anatomical and functional abnormalities, as well as inter- and intracoronary collateral traffic, so as to provide reliable anatomical and functional information for the diagnosis of coronary artery disease and to establish a scientific basis for the choice of interventional treatment or coronary artery bypass grafting.
Indications for coronary angiography
Sones’ quote: “Coronary angiography is indicated as long as the operating physician is competent and qualified, the equipment is perfect, the patient can accept its risks, and only showing the coronary arteries will solve the clinical problem.”
Every effort should be made to perform coronary angiography to check for coronary vascular lesions before the onset of clinical symptoms so that revascularization can be performed before myocardial infarction.
Modern indications for coronary angiography
1.Atypical chest pain that is difficult to be diagnosed clinically
2.Patients with typical ischemic angina symptoms, non-invasive tests such as electrocardiogram, exercise test, myocardial tomography and dobutamine stress test have signs of myocardial ischemia
3.Unexplained heart enlargement, arrhythmia and cardiac insufficiency
4.Primary cardiac arrest by cardiopulmonary resuscitation
5.Electrocardiogram shows bundle branch conduction block, T-wave changes, non-specific ST-T changes
6.Recurrent angina pectoris after coronary intervention or CABG
7.Asymptomatic but suspected coronary artery disease and confirmed diagnosis is important for employment (such as pilots, high-altitude work) or insurance career
8.Modern indications for coronary angiography (2)-for therapeutic purposes
9, clinically confirmed coronary artery disease, who want to perform PCI or CABG
10.If there is persistent chest pain within 6 hours of the onset of AMI or more than 6 hours, emergency PCI is proposed
11.Complicated ventricular septal perforation or papillary muscle rupture resulting in cardiogenic shock or pump failure, medical science is ineffective to perform emergency surgery
Post-infarction angina pectoris
1.After myocardial infarction, although asymptomatic, but young, non-invasive examination shows evidence of myocardial ischemia
2.Patients with newly occurred angina pectoris presumed to have new vascular lesions requiring hemodynamic reconstruction
3.Complicated ventricular wall tumor to be operated
4.Recurrence of angina pectoris after hematopoietic reconstructive surgery requiring consideration of hematopoietic reconstructive surgery
5.Patients over 45 years of age with heart valve disease who intend to undergo valve replacement
6.Patients with myocardial ischemia
7.Obstructive hypertrophic cardiomyopathy over 45 years old, with symptoms of chest pain, wanting to perform chemical ablation or before surgery
Other non-cardiovascular diseases, such as major thoracic surgery before and after the need to exclude coronary heart disease
1.Modern indications for coronary angiography (3)-for evaluation purposes
2.Prognostic evaluation (cardiac function, coronary blood flow and collateral circulation after revascularization)
3, clinical treatment regression and follow-up (restenosis, recanalization after thrombolysis, coronary blood flow after heart transplantation)
4.Evaluation of scientific research work (new technology and new products)
5.What are the methods of treating coronary heart disease
6.Drug treatment
7.Heart surgery treatment
8.Interventional treatment of coronary heart disease
What is coronary interventional therapy?
It is a minimally invasive procedure developed in recent years using cardiac catheterization technology to treat coronary heart disease. Unlike open-heart surgery, it requires only local anesthesia, a puncture from the femoral artery or radial artery, and under X-ray fluoroscopy, the narrowed or even occluded coronary artery lumen can be unblocked, thus improving myocardial blood perfusion. These include percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stenting (PCI).
Intracoronary stenting (PCI)
Why does your doctor recommend coronary intervention?
Coronary intervention should be considered if you are experiencing
1.Angina has failed to stabilize after aggressive drug treatment.
2, Although the angina symptoms are mild, there is clear objective evidence of myocardial ischemia and significant stenotic lesions.
3.After interventional treatment or heart bypass surgery, angina recurs and the coronary artery lumen is restenosed.
4.Acute myocardial infarction.
Process of coronary intervention – preoperative
Routine examination: blood routine, urine routine, stool routine, biochemistry, blood clotting time, ECG, chest X-ray, etc.
If necessary, UCG, DCG, ECT, exercise test, etc.
Check the patient’s bilateral femoral artery and radial artery to select the access path
Skin preparation in the operation area (bilateral)
Penicillin skin test
Pre-operative informed consent
Preoperative training (psychological, defecation, intraoperative cooperation)
Establishment of venous access
Procedure of coronary intervention – intraoperative
Fasting in the morning of surgery
Transfer to the catheterization room (in the DSA room of the imaging building)
Prior to arterial puncture, local anesthesia will be applied to the puncture site so that the procedure is painless and remains awake at all times
The site of arterial puncture is mostly chosen from the right femoral artery, but also from the brachial and radial arteries
Coronary angiography puncture route
1.Femoral artery puncture (most commonly used)
2. radial artery puncture (gradually increasing)
Procedure of coronary intervention – postoperative
Cardiac monitoring for 24 hours, and 24-48 hours of observation in CCU for PCI. For imaging, return to the ward to remove the sheath, 500 gram sand bag local compression at the puncture site for 6-8 hours, then, that side of the limb is braked for 4 hours. for PCI, keep the sheath at the puncture site for more than 4 hours or overnight.
Treatment was continued as appropriate.
Outpatient follow-up at 1, 3 and 6 months after the procedure to develop further treatment plans.
What are the advantages of coronary intervention?
Currently, PCI has become an important tool in the treatment of coronary artery disease. It has revolutionized the treatment of coronary artery disease with the advantages of significant efficacy, minimal trauma, low risk, and short post-operative recovery time.
Why does restenosis of stent vessels occur after coronary stent placement?
Successful stent placement can reduce the stenotic lumen to less than 20% to 50%, eliminate or significantly reduce angina, and result in significant electrocardiographic changes. However, the stent itself can stimulate the proliferation of endothelial and smooth muscle cells, and the cells will accumulate in the endothelium and the stimulated area, resulting in restenosis of the lumen in the stent. Restenosis is about 20% within six months after stent placement. Patients with diabetes, multiple stents or long stents are also major risk factors for lumen restenosis. When multiple risk factors are present, the restenosis rate is as high as 59%.
Is it possible to prevent restenosis at the original site after stent implantation?
Drug-coated stents are available to prevent restenosis at the site of stent implantation. Unlike ordinary metal stents, drug-coated stent systems are coated with drugs such as “rapamycin” and “paclitaxel”.
”Rapamycin and paclitaxel are cytostatic agents that inhibit cell division and growth, smooth muscle cell proliferation, and inflammatory responses.
Drug-coated stents are coated with drugs either directly or mixed with a polymer matrix on the surface of the stent, making the stent a local drug release system. This can increase the local concentration and duration of action of the therapeutic drug on the one hand, and avoid the side effects associated with systemic drug administration on the other.
Can drug-eluting stents completely treat coronary artery disease?
The clinical efficacy of stents in treating coronary artery disease is well known, but it also has the disadvantage that in-stent restenosis can occur 6 to 8 months after stent implantation, which means that reocclusion can occur in the stent. The incidence of restenosis in the early years of bare metal stents was about 20% (15%-40%); now the incidence of restenosis in the era of drug stents has dropped to about 9%. The implantation of drug stents only locally inhibits the proliferation of vascular endothelial cells and inflammatory response, reducing the pain and harm caused by angina pectoris and myocardial infarction due to stenosis, but it does not mean that the coronary heart disease is cured.
Why is it necessary to have clinical and imaging follow-up after implantation of drug stents?
Coronary artery disease is a lifelong disease. If we do not insist on drug prevention and clinical follow-up, other vessels are likely to develop atherosclerosis and even thrombosis in the stent. If a coronary angiography review is performed six months to eight months after surgery and no in-stent restenosis occurs, generally speaking, restenosis will rarely occur in the future.
Therefore, coronary angiography review after stenting is very necessary to determine the effectiveness of drug-eluting stent therapy and also to observe other untreated vascular lesions for relevant management.
What is the secondary prevention of coronary artery disease?
Secondary prevention after coronary intervention is of great importance!
One week after the operation, you can do some light physical activities, such as walking, doing radio exercises, etc. Try to avoid strenuous exercises, such as cycling, running, carrying heavy objects, etc.
Strictly follow the doctor’s prescription, take anti-platelet coagulation drugs, and regularly recheck blood routine, clotting time, liver function and electrocardiogram. Continue to take other medications for coronary heart disease as prescribed by the doctor.
Specific measures for secondary prevention of coronary heart disease.
Reasonable arrangement of work and study, regular life, maintain optimism, happy mood, pay attention to the combination of work and rest.
Control diet: change bad eating habits, avoid frequent consumption of fatty meat, animal offal, cream products, egg yolk, etc., advocate a light diet, eat more malt, corn, beans, fruits and vegetables. Binge drinking and overeating are strictly prohibited.
Make efforts to quit smoking and refrain from drinking strong alcohol.
Diseases related to coronary heart disease should also be actively treated: for example, control blood pressure and blood lipids, and actively treat diabetes.
Learn more about coronary heart disease.