Treatment principles of coronary heart disease: In addition to the basic treatment of coronary heart disease, the treatment focuses on improving coronary artery blood supply and reducing myocardial oxygen consumption, stopping the onset of angina pectoris and preventing its recurrence.
I. Basic treatment of coronary heart disease
1.Rational diet Total calories should not be too high to prevent overweight, and excessive animal fat and cholesterol-rich food should be avoided, such as fatty meat, cream, liver, brain, kidney and other offal, bone marrow, fish roe, egg yolk, coconut oil, etc. Overweight people should reduce their total daily calories and limit sugar foods. The diet should be light, with more vitamin-rich vegetables, fruits and protein-rich foods, such as lean meat, beans and their products, and as much as possible, soybean oil, vegetable oil, sesame oil or corn oil as cooking oil. Li Song, cardiovascular disease specialist, Guangdong Provincial Hospital of Traditional Chinese Medicine
2, adhere to the appropriate amount of physical activity physical activity according to the original physical condition, to be gradual, should not be forced to make strenuous exercise, the elderly advocate walking to do health care gymnastics and taijiquan, etc..
3.Rational arrangement of work and life Pay attention to the combination of work and rest, regular life, and keep a happy mood.
4, other advocate non-smoking, can drink a small amount of alcohol.
5.Control susceptibility factors If you have diabetes, you should control blood sugar in time, including diet control. The glucose-lowering drugs for type II diabetes should not cause hyperinsulinemia; if you have hypertension, you should give antihypertensive drugs to lower the blood pressure to the appropriate level, and if you have high blood cholesterol, you should control high cholesterol and give lipid-lowering drugs appropriately.
Second, terminate the angina attack
The activity should be stopped immediately, sublingual nitroglycerin 0.3-0.6mg 1-2 minutes can be relieved; containing isosorbide dinitrate 5-10mg, then 5 minutes effective; side effects are dizziness, red face, palpitations, occasional drop in blood pressure, so the first time the drug, should lie down for a moment, if necessary, oxygen, glaucoma is contraindicated.
III. Seizure prevention
Commonly used drugs are nitrate, beta-blockers and calcium blockers.
1, nitrate preparations The main effect is to dilate the veins to reduce the amount of return blood, reduce the preload of the heart, myocardial oxygen consumption is reduced; dilate the coronary arteries, improve the myocardial blood supply in the ischemic area. Half an hour before the activity expected to induce angina, sublingual nitroglycerin 0.3-0.6mg can prevent angina attack. 1-2% nitroglycerin ointment applied to the skin is gradually absorbed, suitable for nighttime attacks of angina, applied before bedtime can prevent attacks.
2, beta-blockers anti-angina effect is mainly through the weakening of myocardial contraction, slowing the heart rate, thereby reducing myocardial oxygen consumption, for exertional angina, but should not be used for patients with variant angina, because it can induce spontaneous angina.
3.Calcium antagonist The dilating and antispasmodic effect on coronary artery is stronger and longer than nitroglycerin, which is the most effective in controlling spontaneous angina pectoris.
4.Other drugs Other coronary artery dilators can improve myocardial blood supply, anti-platelet aggregation drugs can reduce the risk rate of vascular death and myocardial infarction.
5.Chinese medicine mainly uses aromatic warming, blood circulation, blood stasis, Qi and pain management.
IV. Interventional treatment
Patients with stable or unstable angina with coronary artery stenosis of 75% or more and lumen occlusion of <15mm, normal left ventricular systolic function, positive exercise test and short history can be treated with percutaneous transluminal coronary angioplasty (PTCA). PTCA is performed by inserting a special catheter with a balloon into the stenosis site and squeezing the plaque through the mechanical pressure of the balloon. The mechanical pressure of the balloon will cause the plaque to break up, the tissue of the diseased vessel wall will stretch and lengthen, the internal diameter of the vessel will increase, the blood flow will increase, and the angina attacks will be reduced or disappeared, with good results in the near future. Stents can be implanted to maintain the therapeutic effect.
V. Etiological treatment
Seek treatment for the causes and diseases that trigger and may aggravate angina attacks, such as hypertension, anemia, hyperthyroidism, etc. Control susceptibility factors, reduce weight in obese people, and quit smoking in smokers. Avoid full meals, anger and emotional stress. Stable angina pectoris with good cardiac function can be appropriate physical activity.
Sixth, surgical treatment
If angina cannot be controlled by active medical treatment, aortic-coronary artery bypass (or bypass) surgery can be considered, in which the saphenous vein is commonly used to anastomose with the distal part of the aortic root and coronary artery stenosis to connect the blood flow, and most of the angina is relieved or significantly reduced after surgery. The surgical mortality rate is condition dependent and is generally less than 5%.
Conclusion: Each patient’s condition is different, and medication must be taken according to medical advice.