Coronary heart disease is a common and frequent disease in middle-aged and elderly people. It is mainly a disease caused by spasm or plaque formation in the coronary arteries, resulting in narrowing of the lumen, leading to myocardial ischemia, hypoxia, and even necrosis.
The heart is a powerful pump, pumping more than 10,000 liters of blood per day, requiring a large supply of blood and oxygen. And as activity increases, the more blood supply is needed. Coronary heart patients do not have enough blood to nourish their hearts due to narrowing of coronary arteries, which can cause angina pectoris, arrhythmia (heart beating irregularly), myocardial infarction, and heart pump failure (not being able to pump blood out like normal people).
Due to the above reasons, the heart of patients with coronary heart disease cannot get a good supply of blood flow during life, study and work. Some patients will have angina at work, while some patients will be unable to finish their work or even lose their ability to take care of themselves, so they cannot do physical and mental work like normal people.
In addition, people with acute myocardial infarction, acute heart failure, and certain arrhythmias will not be able to complete the function of pumping blood because the heart cannot complete the function of pumping blood, which will deprive all organs, such as brain, kidney, liver, and lung, of blood supply, and there is a possibility of sudden death.
In addition to the above direct effects on patients with coronary heart disease, coronary heart disease can also cause a considerable financial burden to the patient’s family. Patients with coronary artery disease need to be controlled with medications that require long-term maintenance. In addition, patients who undergo medical interventional stenting and surgical coronary artery bypass grafting will have higher costs.
In conclusion, the impact of coronary artery disease on the patient is enormous, not only in terms of incapacity, but also in terms of sudden death and the financial burden on the patient and his or her family.
What kind of people are prone to coronary heart disease?
According to some foreign related studies, the following factors are considered to be more closely related to the occurrence and development of coronary heart disease.
1, age: the older you are, the greater the risk of coronary heart disease; currently there is a trend of younger age of coronary heart disease onset
2, obesity: people whose weight exceeds the normal range are more likely to suffer from coronary heart disease, especially those with abdominal obesity;
3, smoking: according to large-scale foreign research shows that smoking has an impact on the occurrence, development and treatment of coronary heart disease;
4, diet: often into the high calorie (excessive food), high fat (especially high animal fat), high cholesterol diet susceptible to the disease. At the same time, the diet lacks the necessary vitamins and minerals.
5, family genetic factors: If someone in the family suffers from coronary heart disease, the possibility of other members suffering from coronary heart disease is also higher, and the age of the disease may be younger;
6, hypertension: hypertensive patients are more likely to suffer from coronary heart disease than normal.
7, diabetes: the possibility of coronary heart disease in diabetic patients is also increased, and the treatment effect is also worse than without diabetes;
8, metabolic syndrome: including hyperlipidemia, hyperbilirubinemia, high fibrin, etc., these factors have a huge impact on coronary heart disease;
9, peripheral vascular atherosclerotic disease: refers to the carotid artery, lower limb arteries, upper limb arteries and other arteries of atherosclerotic lesions, causing lumen narrowing;
10, type A personality: the so-called type A personality refers to some people, when encountering some situations, such as the attack of others, some verbal stimulation, and some other specific circumstances, have a tendency to appear aggressive behavior;
11, mental factors: nervousness, fatigue, insomnia, mental anxiety and other signs of mental tension.
In addition to the above factors, there are some other factors that are not yet fully determined, such as blood sedimentation, C-reactive protein, some trace elements, etc. People with these conditions, especially those who are older, need to pay attention to the possibility of coronary heart disease.
What are the clinical manifestations of coronary heart disease?
The main manifestation of coronary heart disease is “angina pectoris”, but the manifestation varies from person to person and the expression varies from person to person. If you have the following symptoms, please pay attention to them. If the following symptoms last for more than 5 minutes, you can call 120 because a myocardial infarction may have occurred.
1. Pain or discomfort in the upper body, including the upper extremities, left shoulder, back, neck, jaw (throat), and stomach;
2. difficulty breathing or shortness of breath;
3.Heavy or cold sweat;
4, indigestion or choking (may manifest as heartburn);
5, nausea, vomiting;
6, dizziness, dizziness, extreme weakness or irritability;
7, rapid or irregular heartbeat.
It should be further noted that there are some people who have coronary artery disease but have no symptoms. These patients may have a more serious condition. Therefore, middle-aged and elderly people who have risk factors for coronary heart disease need to have regular checkups to see if they have coronary heart disease.
Acute myocardial infarction manifestation and treatment
Acute myocardial infarction refers to the occlusion of coronary arteries or branches due to coronary atherosclerosis, thrombosis or persistent spasm of coronary arteries, resulting in necrosis of the myocardium due to persistent ischemia and hypoxia.
Predisposed population: The most common are people with a history of hypertension or hypertension before the onset of the disease, nearly half of the patients have angina pectoris, followed by people who smoke, obesity, diabetes and lack of physical activity are more susceptible to the disease.
Season of onset: mostly in spring and winter, related to the cold climate and temperature changes; most of the onset of the disease without obvious causes, often in quiet and sleep onset, some patients are in strenuous physical labor, mental stress or after a full meal, or even force bowel movement onset. In addition, shock, bleeding and tachycardia can trigger the disease.
The most prominent symptom is pain, whose nature, duration of attack, accompanying sensations and sensitivity to nitroglycerin differ greatly from previous angina pectoris. Other symptoms include systemic symptoms such as fever, malaise and sweating, gastrointestinal symptoms such as nausea, vomiting and epigastric distension, as well as arrhythmias, hypotension, shock and heart failure.
Because of the high mortality rate of patients with acute myocardial infarction, patients suspected of having acute myocardial infarction should be immediately treated on site and call 120.
The measures for on-site self-rescue mainly include
1, immediate bed rest, absolute prohibition of all kinds of activities, avoid all interference, minimize noise, and maintain a quiet environment. Those who are in a position to do so should immediately inhale oxygen.
2, the typical patient should be immediately to give pain relief, reduce tension and excess emotion, such as carrying a first aid kit, that is, oral Valium tablets, nitroglycerin tablets or inhalation of isoamyl nitrite nebulizer. If there are conditions, immediately give morphine or dulcolax is better.
3, before the arrival of medical personnel, if the patient has a sudden convulsion and loss of consciousness, then immediately perform chest compressions and mouth-to-mouth breathing.
Coronary heart disease related tests
If you have some symptoms that could be coronary heart disease or have risk factors for coronary heart disease, then you need further tests. These tests mainly include.
1.Electrocardiogram: The best time to have an electrocardiogram is when you have a symptomatic attack;
2.Heart ultrasound (heart Doppler, echocardiography): mainly to observe the movement of the heart and reflect whether there is myocardial ischemia;
3.Exercise test: The symptoms are induced by increasing the blood displacement of the heart through exercise or drugs, and recorded by ECG. However, this test must be performed under the condition of professional guidance and supervision to ensure the safety of patients. And this method can detect asymptomatic coronary heart disease;
4.Coronary angiography: This is the most reliable test for the diagnosis of coronary artery disease, but it is invasive, but it is necessary when deciding further treatment;
5.Radionuclide test: This test can help to diagnose coronary heart disease, but it is more expensive;
6.CT, MRI: It can help to diagnose and is less invasive.
If you suspect that you have coronary heart disease, please determine whether you need further tests under the guidance of your doctor.
Treatment of coronary heart disease
There are four main treatments regarding coronary artery disease as follows.
1. Internal interventional stenting: This is a method of making small incisions in the lower extremities (in the groin, at the femoral artery), dilating the narrowed part of the coronary artery through a guide wire and other devices, and putting in a stent for treatment. It is suitable for lesions with a small number of branches and requires long-term medication and follow-up after surgery;
2.Surgical coronary artery bypass grafting: This is a surgical procedure that uses the patient’s own blood vessels to cross the narrowed part of the coronary artery to regain the blood supply to the ischemic myocardium. This method is the most effective treatment for multiple coronary artery lesions and left main artery lesions, although it is invasive and has a large scar. It also requires long-term medication and follow-up after surgery. In addition, there are also non-invasive surgical treatments, but they are relatively rare in China, lack of experience, and have certain indications;
3, drug treatment: drug treatment is the basis of all treatment, but also necessary! Mainly includes the following drugs.
1) anti-embolism drugs: aspirin, effervescent, bamil, etc.
2) Nitrate drugs: nitroglycerin, cardiac pain, etc.
3) beta-blockers: betalactam, canco, etc.
4) Lipid-regulating therapy: Sulforaphane, Cinco, etc.
4) Treatment for the risk factors of coronary heart disease to achieve the purpose of prevention. This includes the treatment of hypertension, diabetes, hyperlipidemia and other diseases. Moreover, patients should pay attention to quit smoking, lose weight and exercise moderately in daily life.
In addition, patients should regularly visit outpatient clinics for review of changes in their condition for further treatment and prevention of some complications.
Diet for patients with coronary heart disease
The general principles of diet for patients with coronary heart disease are: reduce and control dietary energy intake to control body weight; reduce total fat and intake of saturated fatty acids and cholesterol; limit the intake of monosaccharides and disaccharides; supply appropriate amount of minerals and vitamins.
1, energy in the diet: standard weight (kg) = height (cm) – 105; if the actual weight exceeds the standard weight: over 30 years old > 15% for overweight, under 30 years old > 10% for overweight, > 20% of the standard weight for obese. If there is overweight, the supply of energy should be reduced to reduce body weight, or increase physical work appropriately.
2.Eat complex carbohydrates, and eat less or no simple carbohydrates such as sucrose or glucose.
3.Appropriately increase dietary fiber intake: dietary fiber can adsorb cholesterol, prevent cholesterol from being absorbed by the body, and promote bile acid excretion from feces to reduce the in vivo production of cholesterol, so it can lower blood cholesterol. You can eat some coarse grains, vegetables, fruits and other foods with high fiber content.
4, control the intake of fat: the amount of fat accounted for 20% of the total energy, should not exceed 25%. Use more vegetable oil, as a preventive diet, the ratio of polyunsaturated fatty acids to saturated fatty acids should be >1; for the therapeutic diet, the polyunsaturated fatty acids should be 15-20g/d, and the P/S ratio should be >2.0; foods high in animal fat should be prohibited. In addition, cholesterol intake should be controlled, limited to less than 300mg/d in the preventive diet and less than 200mg/d in the therapeutic diet; high cholesterol foods are prohibited.
5, protein: protein according to the labor intensity supply, coronary heart disease diet protein should account for 15% of the total energy, or by 2g/kg supply. Try to use more soybean and its products, such as tofu, dried beans, hundred pages, etc.; river fish or sea fish, most of which contain low cholesterol, such as mackerel, grass carp, carp, snapper, yellowtail, pomfret, striped bass, etc. cholesterol content <100mg%, so eat 250g of fish per day, its cholesterol content <300mg/d; milk fat and cholesterol make people worry, but milk contains cholesterol synthesis inhibition factor, each 1 bottle Milk contains only 9g of fat, 30mg of cholesterol, so patients with coronary heart disease do not need to ban milk; healthy people increase 1 egg per day, does not affect the blood cholesterol, in fact, moderate amount of eggs are beneficial, but should not eat more.
6, supply sufficient vitamins and minerals: such as eating more fresh green leafy vegetables, fruits, seaweed and other foods.
7, reduce the intake of sodium, in terms of sodium chloride, the intake of each person should first strive to reach 6 grams / day or less.
8, avoid smoking, do not drink or a small amount of alcohol (< 30 g / day), and should not use foods that excite the nervous system and promote vasospasm, such as strong tea, coffee, strong alcohol, strong condiments (mustard, onions, garlic, mushrooms, etc.).
Patients with coronary heart disease with hyperlipidemia should pay attention to lipid control under the guidance of a doctor and regularly review lipids and other conditions to understand the effect of treatment.
The foods that are available, restricted, and cannot be consumed in large quantities regularly by patients with coronary artery disease are as follows.
1. Available foods: grains, beans and their products, soy milk, vegetables, fruits, sour milk, skim milk, egg whites, fish, skinless chicken, veal, wild birds and lean pork. Fresh mushrooms, shiitake mushrooms, soy protein, soy milk, soy products, adzuki beans, mung beans, peas, mao beans, vegetable beans, pomfret, yellow croaker, scallions, leeks, kelp, celery, eggplant, black fungus, walnuts, sesame seeds, etc. all have lipid-lowering effects.
2.Restricted foods : beef and lamb with visible fat removed and ham, shellfish except small shrimp and egg yolk, etc.
3, minimize or do not use food: food containing high animal fat, such as fatty pork, fatty lamb, fatty goose, fatty duck, minced meat; high cholesterol food, such as pig skin, pig claws, skinned hooves, liver, kidney, lung, brain, fish roe, crab yolk, full fat cream, salami; food containing high energy and high carbohydrate, such as ice cream, chocolate, cane sugar, shortening sweet snacks, honey, a variety of fruit sugar, etc., are Small volume of high heat production food; stimulating food, such as chili, mustard, pepper, curry, strong coffee, etc.
Exercise precautions for patients with coronary heart disease
Moderate physical exercise has great benefits for both the general population and patients with coronary artery disease, and is also beneficial for those with old myocardial infarction, post-coronary bypass surgery, and post-percutaneous coronary balloon dilation. However, not all patients with coronary heart disease are suitable to participate in physical exercise, and there are some points to note when patients with coronary heart disease participate in physical exercise.
1.Physical exercise for patients with coronary heart disease should be allowed by the doctor and should be carried out after following his instructions.
2, in general, stable coronary heart disease (including old myocardial infarction, stable angina), occult coronary heart disease, coronary artery bypass surgery, after percutaneous coronary balloon dilation patients are more suitable for physical exercise. Unstable angina, acute myocardial infarction and other patients are not suitable.
3, coronary heart disease patients should avoid exercising alone, it is best to be accompanied by someone, and carry first aid drugs or first aid kit. Exercise should pay attention to the monitoring of blood pressure, heart rate and other conditions, if the precordial pain, left upper limb and stomach pain and other conditions should stop exercise in a timely manner.
4, adhere to long-term physical exercise, step by step, and regular review to test the effect of exercise and disease progress.
5, exercise should avoid bad weather, such as cold, windy, hot, dry, rainy and excessive temperature. Exercise time should not be too early, preferably around 10:00 am. Exercise before not smoking and drinking alcohol; avoid emotional excitement; exercise 2 hours before and 1 hour after exercise should avoid drinking strong tea, coffee and other stimulating drinks; avoid taking a hot bath or hot shower immediately after exercise, at least 15 minutes after rest, and control the water temperature at 40 ℃ or less.
6, exercise in the form of aerobic training, including walking, cycling, swimming, playing gateball, playing table tennis and badminton, etc. Rhythmic dance, traditional Chinese boxing exercises, etc. are also appropriate forms of exercise.
7, exercise intensity: wake up in the morning feeling comfortable and fatigue-free. The total amount of exercise per week should be equivalent to walking 10 to 20 kilometers. The amount of exercise is composed of three elements: intensity, time and frequency. The easiest way to determine whether the intensity of exercise is appropriate is to sweat slightly while exercising, and to breathe lightly faster but without affecting the conversation. Exercise time is the time it takes to reach training intensity each time, usually 10 to 30 minutes. Training frequency refers to the number of times per week training, generally 3 to 5 times per week exercise is enough. Preparatory activities should be performed before exercise, and finishing activities (5-10 minutes each) should be performed after exercise.
All in all, patients with coronary heart disease should exercise under the guidance of a doctor and must do so according to their ability.