1.What is coronary heart disease?
Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease, which refers to the serious atherosclerosis or spasm of the coronary artery DD, the blood vessel supplying nutrients to the heart, making the coronary artery narrowing or blockage, as well as thrombosis causing lumen occlusion, resulting in myocardial ischemia and hypoxia or infarction of a heart disease, also known as ischemic heart disease.
The disease mostly occurs after 40 years old, more men than women, more mental than physical workers, more urban than rural areas, the average prevalence is about 6.49%, and the prevalence increases with age, is the most common cardiovascular disease in the elderly. With the improvement of living standards, the prevalence of coronary heart disease in China is increasing year by year, and the age of the disease tends to be younger. Therefore, in the 21st century, China is facing the challenge of cardiovascular disease, and the key to control the “first killer” that endangers human health is prevention.
2.How to detect coronary heart disease at an early stage?
Early detection, early diagnosis and early treatment are important for the efficacy and prognosis of the disease, and coronary heart disease is no exception. If the following conditions occur, you should seek medical attention to detect coronary heart disease as early as possible so as not to delay the disease.
1.Dull pain behind the sternum or precordial area or tightness-like pain that radiates to the left shoulder and left upper arm during exertion or mental tension, lasting for 3-5 minutes and relieved by itself after rest.
2.Physical activity with chest tightness, palpitation and shortness of breath, which is relieved by itself at rest.
3.Headache, toothache, leg pain related to exercise.
4.People who have chest pain and palpitations when having a full meal, being cold or watching a thriller movie.
5.When sleeping with a low pillow at night, you feel tightness in the chest and feel comfortable when lying on a high pillow; when sleeping or lying down during the day, you suddenly have chest pain, palpitations and difficulty in breathing, which can be relieved by sitting up or standing up immediately.
6, sexual exertion or forceful defecation when there is panic, chest tightness, shortness of breath or chest pain discomfort.
7.Hearing the sound of gongs and drums or other noises in the surrounding area will cause panic and chest tightness.
8.People who repeatedly have irregular pulse, unexplained tachycardia or bradycardia.
3.Dotted clues to track coronary heart disease
The cold weather in winter and spring brings a high rate of recurrence of coronary heart disease, and its fatal complication – myocardial infarction is especially prone to attack. When there is pain in these areas below, you should be alert and seek medical attention in time to prevent accidents.
Headache
Clinicians have found that some coronary heart patients have headaches instead of the traditional anterior heart pain during myocardial infarction attacks. The mystery lies in the fact that after myocardial infarction in these patients, the amount of blood transfusion from the heart decreases dramatically, resulting in reduced blood circulation to the brain, which, together with the change in vascular tone, causes reflex cerebral vasoconstriction, resulting in temporary ischemia and hypoxia and headache.
Toothache
Sudden onset of severe pain, but it is not possible to say which tooth the pain point is. The tooth is intact at the time of examination and there is no sign of inflammation, so the usual painkillers are not effective.
Shoulder pain
The pain in the left shoulder, arm, and three fingers on the inside of the palm of the hand is paroxysmal and is not affected by weather, and should not be mistaken for arthritis.
Abdominal pain
A small number of coronary heart patients show distending pain in the upper abdomen, accompanied by nausea and vomiting. After excluding acute gastroenteritis and gastric neurogenic disorders, coronary heart disease should be considered.
Leg pain
Some patients have no other symptoms when angina attacks, but only pain in the lower limbs, which can be manifested as single leg pain or double leg pain. Any middle-aged or elderly person with a history of coronary heart disease should think of myocardial infarction when leg pain that cannot be explained by leg disease occurs, and take medication or seek medical consultation in time.
4.What methods can be used to confirm the diagnosis of coronary heart disease?
If a patient with coronary heart disease has typical angina pectoris or typical myocardial infarction, the initial diagnosis can be confirmed by combining the medical history and the doctor’s experience. However, in clinical practice, some patients with coronary heart disease do not have obvious symptoms or show painless myocardial infarction, which requires the use of relevant tests to establish the diagnosis.
The following methods are commonly used to diagnose coronary artery disease.
Electrocardiogram.
Electrocardiographic stress test.
Echocardiography.
Dynamic electrocardiogram.
Radionuclide examination.
Selective coronary angiography.
5.The gold standard for the diagnosis of coronary artery disease – coronary angiography
Selective coronary angiography is a cardiovascular imaging method that uses a puncture or incision to selectively insert a special catheter into the left and right coronary artery openings through the right brachial or femoral artery, place the tip of the catheter into the coronary artery openings under X-ray fluoroscopy, and then inject contrast to show the course and lesions of the coronary arteries. It can clearly distinguish whether the coronary artery and its branches are narrowed, the number, location and degree of narrowing, as well as the function of the collateral circulation and left ventricle, and make an accurate diagnosis of coronary heart disease directly. For coronary angioplasty (balloon dilatation) and coronary artery bypass grafting, coronary angiography must be performed before the two procedures to provide accurate information for the diagnosis and treatment of coronary artery disease, and to provide a basis for the selection of surgical indications and the formulation of surgical plans. Therefore, domestic and foreign scholars believe that coronary angiography is the gold standard for the diagnosis of coronary artery disease, which can not only clearly show the extent and location of coronary artery lesions, but also be of great value in determining the condition and prognosis. It can also be used to dilate narrowed coronary arteries, resulting in a one-time solution to the stenosis without surgery.
Coronary angiography is an uncomplicated procedure that requires only local anesthesia, no incisions, no sutures, and one day of postoperative observation before discharge. With the increasing sophistication of equipment and techniques, coronary angiography is a relatively safe and valuable diagnostic measure. It can be divided into three categories: mild, moderate and severe, depending on the number of arteries involved and the degree of stenosis. Stenosis less than 50% of the arterial lumen diameter is considered mild; 50%-80% is considered moderate; 80%-90% is considered severe.
6.What are the treatment methods for coronary heart disease?
At present, there are three kinds of treatment for coronary heart disease, namely, drug treatment, interventional treatment and surgical treatment.
(1) Drug therapy: At present, the more commonly used drugs are musk heart pills and coronary heart sulforaphane pills, which are aromatic and warm, benefit the qi and strengthen the heart. It can be used as both daily prevention and treatment and first aid for patients with coronary heart disease. This kind of medicine treats the disease and pain, and has the function of protecting the heart and improving cardiovascular function.
(2) Interventional treatment: including percutaneous transluminal coronary angioplasty (PTCA), coronary plaque spinotomy, coronary plaque cut and grind, coronary plaque aspiration, percutaneous coronary laser angioplasty, intracoronary stenting and so on. At present, the most widely used interventions are percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stenting.
(3) Surgical treatment: such as coronary artery bypass grafting, i.e. coronary artery bypass grafting. In addition, it has been clinically proven that acupuncture is also effective for certain types of coronary heart disease.
7.What kinds of drugs are commonly used in the treatment of coronary heart disease?
There are many types of drugs used in the treatment of coronary heart disease, and the main ones commonly used are
Nitrate preparations: mainly include nitroglycerin, cardiac pain, sorbitol 5-nitrate, pentoxifylline preparations and long-acting nitroglycerin preparations.
Adrenergic receptor blockers: commonly used preparations include propranolol, indololol, metoprolol, atenolol, vinblastine, nadolol.
Calcium channel blockers: commonly used preparations include verapamil, nifedipine, diltiazem, nicardipine, amlodipine.
Coronary artery dilators: such as disulfiram, amiodarone, dipyridamole. Purine preparations (e.g., aminophylline or dihydroxypropyl theophylline), adenosines (e.g., adenosine triphosphate, cyclic adenosine phosphate) are also often used as coronary artery dilators.
Antiplatelet drugs: such as aspirin, dipyridamole, and ticlopidine.
Lipid-adjusting drugs: such as fenofibrate, gemfibrozil, niacin, pravastatin, lovastatin, simvastatin, etc.
Thrombolytic drugs: such as warfarin, heparin, urokinase, etc.
Chinese herbal medicine: the method of “activating blood circulation and resolving blood stasis” (Danshen, safflower, Chuanxiong, Puhuang, Yujin, etc.) and the method of “aromatic warmth and flux” (Musk Heart Pills, Quick-acting Heart Pills, Suhexiang Pills, Compound Danshen Drops, etc.) are most commonly used.
8, the characteristics and treatment of angina pectoris
(1) Site: The typical site of angina pectoris is behind the sternum, and the pain is fist or palm-sized, and can spread to the precordial area, and often radiates to the left shoulder, the inner side of the left arm up to the ring finger and little finger.
(2) Nature: Crush-like or crunch-like pain, often accompanied by anxiety or fear of dying.
(3) Triggers: Common triggers are physical activity or emotional excitement, full meals, constipation, cold, smoking, tachycardia or bradycardia, high or low blood pressure, shock, etc.
(4) Duration: It often disappears gradually within 3-5 minutes and rarely exceeds 15 minutes. If it exceeds 15 minutes, the possibility of acute myocardial infarction should be considered.
(5) Relief mode: Generally, it can be relieved after stopping the activities that originally induced the symptoms, and sublingual nitroglycerin can also be relieved within 3 minutes.
(6) Commonly used drugs for the treatment of angina include: nitroglycerin, cardiac pain relief, Lunan Xinkang, Betalac, Tenel Heart, Aspirin, Musk Heart Pills, Quick-acting Heart Pills, Compound Danshin Drops, etc.
9. Typical clinical manifestations of acute myocardial infarction
Acute myocardial infarction refers to the interruption of blood flow in the coronary arteries on the basis of coronary artery lesions, causing severe and persistent acute ischemia in the corresponding myocardium, which eventually leads to ischemic necrosis of the myocardium. Most of the causes of myocardial infarction are caused by coronary artery plaque or thrombosis on this basis, resulting in blockage of the lumen of the vessel.
Typical clinical symptoms of acute myocardial infarction.
1.Pain
The pain often occurs in quiet or sleep, the pain is difficult to prevent, long duration, oral nitroglycerin tablets still does not work, while cold sweat, restlessness, a sense of fear of dying. 15% to 30% of patients, the pain may not be in the chest, some in the upper abdomen, some in the neck, some in the back, often make a wrong judgment. The acute myocardial infarction of diabetic patients, but often no pain symptoms, the beginning of the performance of shock or acute heart failure.
2, blood pressure drop or shock
Some patients with acute myocardial infarction when the onset of blood pressure drops, shock, the patient is often pale, wet and cold skin, weak and fast pulse, reduced urine, confusion, serious coma.
3. Heart rhythm disturbance
Heart rhythm disturbances occur in 75% to 95% of patients with acute myocardial infarction within 1 to 2 weeks of onset. Ventricular rhythm disturbances are common, especially premature ventricular beats, and can lead to ventricular fibrillation.
4.Heart failure
It is mainly left heart failure, often within the first few days of onset.
5. Nausea, vomiting and epigastric pain.
6.Fever
Appears 1 to 3 days after the disease, with a temperature of 38°C to 38.5°C, sometimes reaching 39°C.
20% to 80% of patients have aura symptoms before myocardial infarction, manifesting as an increase in angina pectoris. Its attack is heavier and lasts longer than before, and the duration is fixed, and nitroglycerin cannot make it relieve. Angina is also accompanied by nausea, vomiting, sweating, arrhythmia and other symptoms or large fluctuations in blood pressure.
10.Promoting factors of acute myocardial infarction
About one-half of the patients with acute myocardial infarction are not found to have any precipitating factors, but the common precipitating factors are mainly the following.
(1) Work exertion, heavy physical labor, etc. can increase the burden on the heart, causing a surge in myocardial oxygen consumption.
(2) mental tension, emotional excitement can occur angina pectoris, or even myocardial infarction.
(3) Full meals, heavy drinking, eating large amounts of fatty substances can trigger the risk of acute myocardial infarction, especially in elderly patients.
(4) Constipation, especially in the elderly, is not uncommon due to forceful breath-holding during defecation, leading to myocardial infarction.
(5) Hemorrhage, major surgery, shock, and severe arrhythmias may trigger atherosclerotic plaque rupture and thrombosis, leading to sustained myocardial ischemia and promoting myocardial infarction.
Cold stimulation.
11.Family first aid for acute myocardial infarction
Many patients with acute myocardial infarction develop after returning home from work or while sleeping. Therefore, as the family members of heart patients, it is necessary to understand the performance of myocardial infarction and the onset of the aura, so that the initial first aid can be carried out in a timely manner. Statistics show that the death rate of patients with acute myocardial infarction is greatly reduced if they are properly treated within one hour of the early onset of the disease.
Initial first aid and treatment of patients presenting with acute myocardial infarction, even if only suspected, should be performed according to the following steps
1, lie flat on the ground, even if they fall on the ground, do not “kindly” have to move to bed.
2. Immediately observe the pulsation of the carotid artery or femoral artery (on the inner side of the wall at the root of the thigh) of the patient. In case of cardiac arrest, the following should be done immediately.
① Give the patient nitroglycerin tablets or sniff isoamyl nitrite.
②Try to call an emergency physician.
If it is difficult or impossible to get an emergency physician, try to transfer the patient to a hospital after quiet rest, when there is no obvious shock, and when the pulse rate and rhythm are normal. Do not make unnecessary moves en route.
④ If you have conditions (such as oxygen bags at home), you should give oxygen first.
Preventive health care
12.Predisposing factors of coronary heart disease
Medical research shows that coronary heart disease is a disease caused by a variety of factors acting on different links. These factors are the susceptibility factors or risk factors, mainly including
Age: The disease is mostly seen in middle-aged people over 40 years old, and progresses faster after 49 years old , and the incidence of myocardial infarction and sudden death from coronary heart disease is proportional to age. In recent years, the incidence of coronary heart disease has a trend of younger.
Gender: In China, the incidence and mortality ratio of coronary heart disease in men and women is 2:1, but the incidence of coronary heart disease in women increases significantly after menopause. Some data show that after the age of 60, the incidence rate of women is greater than that of men.
Occupation: mental workers are more prone to the disease than physical workers, and jobs with a constant sense of urgency are more prone to the disease.
Diet: people who often eat a higher-calorie diet, more animal fat and cholesterol are prone to the disease, as well as those who eat large amounts of food. Experts say that to control the incidence of coronary heart disease, in addition to controlling the intake of high-fat diet, you must also pay attention to control the amount of food.
Blood lipids: Increased total cholesterol, triglycerides, LDL and VLDL, and decreased HDL, predispose to this disease.
Blood pressure: elevated blood pressure is an independent risk factor for the development of coronary heart disease. Elevated blood pressure is most likely to cause atherosclerosis of coronary arteries. About 70% of patients with atherosclerosis of coronary arteries have hypertension. Patients with hypertension are four times more likely to suffer from this disease than those with normal blood pressure.
Smoking: Smoking is the main risk factor for coronary heart disease. The morbidity and mortality of the disease is 2-6 times higher in smokers compared to nonsmokers, and is proportional to the number of cigarettes smoked per day.
Obesity: People who are over the standard weight are susceptible to this disease, especially those who gain weight rapidly. Prospective studies have shown that centripetal obesity is a greater risk.
Diabetes: It has been shown that the incidence of the disease is twice as high in diabetic patients as in non-diabetic patients.
Heredity: family has in the young susceptible to this disease, its close relatives can be 5 times the chance of disease than the family without this family situation.
13.Life of patients with coronary heart disease
1, get up, wash face For patients who have angina when quiet, make the room warm in advance in the morning or take nitroglycerin tablets in bed first to prevent sudden attacks when getting up.
2.Eating and drinking As the abdomen is full after meals, it is easy to trigger angina, so do not eat too much, and do not work immediately after meals.
3.Defecation
Since straining during defecation can increase the heart rate and blood pressure, thus increasing the possibility of inducing coronary artery spasm, constipation should be prevented. For patients with frequent constipation, consider using laxatives. In order to reduce the number of urination at night, limit water consumption before bedtime.
4, bath The appropriate temperature for bathing is about 40 ℃, blood pressure and pulse without significant changes is appropriate, and the time should not exceed 10 minutes.
5.Sex life should be moderated, but not absolutely forbidden. Mainly according to the patient’s body after sex without discomfort for the degree.
6, smoking Nicotine in tobacco can cause angina attack, so you should resolutely quit smoking.
7. Work The intensity of daily work and activity should follow the doctor’s instruction. If your condition permits, you can gradually increase the working hours consciously, so that your body can adapt to the environment and adjust your mental and psychological state.
14.Canceling the blessing DD full meal
The fullness of the mouth, a full meal is a beautiful thing for us such mortals. However, for coronary heart patients, this beauty is “no blessing”. It has been reported that a full meal is an important cause of stroke death, and more than half of the stroke deaths are caused by a full meal.
In humans, the catecholamines in the blood increase after a full meal, and this substance is very easy to induce spasm of coronary arteries, so that coronary blood flow decreases sharply, causing angina pectoris and even myocardial infarction.
Therefore, experts recommend that: coronary heart patients, especially in the case of angina attack, should avoid violent times of overeating. To prevent the occurrence of angina, myocardial infarction and sudden death.
15, move to prevent coronary heart
It is often said that life lies in sports. Participate in a certain amount of physical labor and physical activity, to prevent obesity, exercise the function of the circulatory system and adjust the lipid metabolism are beneficial, is a positive measure to prevent coronary heart disease.
Exercise can not only accelerate the metabolism, increase the oxidative consumption of lipids, so that blood lipids fall, reduce and avoid the deposition of lipids on the inner wall of blood vessels, which is conducive to preventing the production of atherosclerosis. Studies have found that obese hypertensive patients with a weight loss of 1 kg can reduce systolic blood pressure by 2.5 mmHg and diastolic blood pressure by 1.7 mmHg.
However, exercise should not be too blind, scientific exercise requirements, exercise intensity for exercise per minute maximum heart rate plus age to 170-180. exercise frequency for 3-5 times a week, each lasting 20-60 minutes. According to the physical condition, age, the functional state of the heart to determine, in order not to increase the burden on the heart and do not cause discomfort. Exercise should be done in an aerobic way, such as walking, jogging, cycling, tai chi, health exercises, etc. Try to avoid activities with breath-holding action, such as weight lifting, etc. Activities and exercise should be gradual, regular and persistent. Not suitable for strenuous activities, strenuous activities can cause a variety of cardiac arrhythmias. Before exercise should be 5 ~ 10 minutes of preparatory activities, can do some regular repetitive light activities, in order to make the pulse rate gradually increased to the pulse rate at the time of exercise, after exercise should also be 5 ~ 10 minutes of recovery activities, in order to make the extremities blood gradually return to the central circulation.
16, get out of bed at night “three and a half”, a day to maintain health “three and a half”
The medical profession believes that cardiovascular diseases can be effectively prevented.
National cardiovascular disease prevention and treatment of scientific research leadership group, deputy composition of the Chinese Cardiovascular Society, member of the Chinese Hypertension Alliance executive director Professor Hong Zhaoguang pointed out: if effective preventive measures can be taken, at least 1/2 of the cardiovascular and cerebrovascular patients can be saved from sudden death! One of the measures is the simple and easy to implement “three and a half minutes”.
The “three and a half minutes” is to wake up at night, open your eyes, continue to lie flat for half a minute, then sit in bed for half a minute, then sit with your legs down on the edge of the bed for half a minute, and finally move down to the floor.
Professor Hong, who has been engaged in the clinical work of cardiovascular diseases for many years, introduced that clinically, cerebral thrombosis, cerebral hemorrhage, sudden cardiac death, etc. often occur at night. 24-hour ambulatory ECG monitoring shows that many patients’ heartbeats are stable during the day, but only at night there are several large fluctuations, mostly occurring at night when they get up to go to the toilet. This is mainly due to the sudden change of body position, resulting in insufficient blood supply to the heart and brain, especially in the elderly, who are more prone to danger due to slow neural regulation. He reminded people with cardiovascular and cerebrovascular diseases, the most effective and reliable way to prevent problems at night is to do “three and a half minutes”. The “three and a half hours” refers to a half-hour walk in the morning, a half-hour walk after dinner, and a half-hour nap at noon.
Swedish medical scientists on the statistical results of the two populations show that coronary heart disease patients adhere to the daily nap half an hour than patients who do not nap 30% reduction in mortality. The World Health Organization has also been in the international sleep conference to emphasize the benefits of napping.
17, those dietary factors can trigger cardiovascular disease?
Over the past few decades, a large amount of epidemiological data worldwide has proved that: dietary habits and the occurrence of cardiovascular and cerebrovascular diseases, the development of a close relationship between people who love to eat high-fat, high cholesterol food, the incidence of cardiovascular and cerebrovascular disease is higher. High cholesterol is an important factor causing atherosclerotic lesions, therefore, reducing the intake of cholesterol can reduce the incidence of atherosclerosis. Some people are accustomed to a high-salt diet, which is also one of the dietary factors causing hypertensive disease. Studies on metabolism show that the daily sodium requirement for healthy growth is only 200 mg (equivalent to 0.5 grams of salt), while we consume about 15 grams of salt per day. Therefore, from the point of view of early prevention of cardiovascular and cerebrovascular diseases, should start from children and even infants, to develop less salt, light eating habits.
18, nap can prevent coronary heart disease
According to medical scientists, 30 minutes of napping every day, the incidence of coronary heart disease can be reduced by 30%. But napping must also pay attention to the following points.
Do not eat greasy food before going to bed, do not eat too full.
It is not appropriate to lie down immediately after lunch, should generally rest 20 minutes after eating.
Sleeping position should take the head high feet low, right side lying.
People with high blood pressure, do not take blood pressure medication before going to bed.
Nap time to about 1 hour is appropriate. After getting up, first in bed for light activity, slowly sit up, used in the precordial area, chest for 5-10 minutes massage, and then get out of bed and drink a glass of water.
19.The relationship between blood lipids and the development of coronary heart disease
A lot of clinical data show that blood cholesterol, triglycerides, LDL, VLDL, etc. are closely related to the onset of coronary heart disease. The incidence of coronary heart disease also increases with the increase of such lipids, and the magnitude of lipid elevation is correlated with the incidence of coronary heart disease, death rate and severity of lesions.
Recent studies have shown that some patients with coronary heart disease do not have hyperlipidemia, but have a significant reduction in HDL-cholesterol, which is known as the “anti-atherosclerotic lipoprotein” and is known as the “intravascular scavenger”. The deficiency indicates that such people are less able to remove cholesterol from the arterial wall, so they are also prone to atherosclerosis.