Treatment of coronary heart disease

  The principle of treatment of coronary heart disease is to improve the blood supply to the coronary arteries and reduce the oxygen consumption of the heart muscle, as well as to treat and prevent the development of atherosclerosis.  Treatment methods include drug therapy, reperfusion therapy, and heart transplantation. Specific therapeutic measures should be tailored to the patient’s specific situation and different treatment methods should be selected.  Drug therapy: The aim is to improve the blood supply to the coronary arteries and reduce the oxygen consumption of the heart muscle. It mainly refers to the treatment with single or combined application of drugs under the guidance of physicians according to the patient’s condition.  1, angina attack treatment: the attack should be rapidly dilated coronary arteries, increase myocardial blood supply, improve the status of myocardial ischemia, to prevent myocardial necrosis due to ischemia.  Take nitroglycerin: 1 piece of nitroglycerin (0.3-0.5 mg per piece) chewed and taken under the tongue, angina can be relieved after 1 to 2 minutes, if the pain is still not relieved after 5 minutes, take 1 more piece.  Take cardiac pain: It can treat and prevent angina attacks and anti-arrhythmic effects. Use 1 to 2 tablets each time, and change to 1 tablet 3 times a day after the symptoms are relieved.  2.Conventional drug treatment: treatment in remission.  a) Dilate the coronary arteries with nitrates and herbal combinations, etc.  b) Apply calcium antagonists and β-receptor organizers to relieve coronary spasm and reduce myocardial oxygen consumption.  c) Application of ACEI class to reduce cardiac afterload.  Reperfusion therapy: i.e., take methods to recanalize the occluded coronary arteries, restore myocardial perfusion, salvage ischemic myocardium and reduce the infarct area, thus improving hemodynamics and restoring blood supply to the heart. There are three main methods.  1.Tethering treatment: It is to dissolve the thrombus by intravenous injection of thrombolytic drugs to achieve the purpose of recanalization of infarct-related vessels. This method is mainly applied within 12 hours of the onset of the disease, and the cost is lower than that of interventional therapy, but the revascularization rate is slightly lower and there is a certain risk of bleeding.  2.Interventional therapy: The basic principle of interventional therapy is to place a balloon catheter through a vascular puncture into the narrowed vessel and expand the balloon under pressure outside of the body to open the narrowed vessel wall, so that the diseased vessel can be restored to flow. This technique is applied to the human coronary arteries to ensure the patency of the coronary arteries, increase the blood supply to the heart muscle, and reduce the rate of death caused by myocardial infarction and other diseases.  3.Coronary artery bypass surgery (CABG): The main principle of CABG is to use its own blood vessels (internal mammary artery, radial artery, right gastroretinal artery, saphenous vein) to establish a bypass (“bridge”) between the aorta and the diseased coronary artery so that the blood in the aorta is directly perfused across the narrowed part of the vessel to the distal end of the stenosis, thus restoring blood supply to the heart muscle.  4.Heart transplantation: If coronary artery disease is advanced and drug treatment is ineffective; if surgical or interventional treatment cannot correct, repair or relieve the disease; if recurrent heart failure or arrhythmia occurs, which is life-threatening and the risk of death is estimated to be very high within one year, heart transplantation should be performed as early as possible. Basic normal function of other organs will ensure or improve the success rate of the procedure.