1.What is coronary heart disease?
Coronary artery disease is the abbreviation of atherosclerotic heart disease. It is caused by atherosclerosis of the coronary arteries, the blood vessels that supply nutrients to the heart. This atherosclerotic plaque accumulates on the coronary artery intima, and over time, it accumulates more and more, making the coronary artery lumen seriously narrowed or even occluded, just like the water pipe or the spout of the kettle is blocked or narrowed by the water soda that gradually accumulates over the years, which leads to the reduction of blood flow to the heart muscle and insufficient oxygen supply, so that the normal work of the heart is affected to different degrees, resulting in a series of ischemic manifestations, such as chest tightness, breath-holding, angina pectoris, angina pectoris, angina pectoris, angina pectoris and angina pectoris. The result is a series of ischemic manifestations, such as chest tightness, breath-holding, angina pectoris, myocardial infarction and even sudden death. Generally speaking, the degree of coronary stenosis ≥ 50% can be called coronary heart disease.
2.How many types of coronary heart disease are there?
Coronary heart disease is divided into five types.
(1) Asymptomatic coronary heart disease;
(2) Angina pectoris coronary heart disease;
(3) myocardial infarction type coronary heart disease;
(4) Ischemic cardiomyopathy coronary heart disease;
(5) sudden death coronary heart disease;
3.What are the risk factors of coronary heart disease?
Currently, the main risk factors for coronary heart disease in the whole population are traditional risk factors such as hypertension, hypercholesterolemia, smoking, diabetes mellitus and family history, among which hypertension, hypercholesterolemia, diabetes mellitus and smoking are considered to be the most important ones. The development of recent studies suggests some new risk factors associated with coronary heart disease.
(1) Hypertension: Hypertension is considered to be an important risk factor for coronary heart disease. The degree of atherosclerosis is more pronounced in hypertensive patients than in those with normal blood pressure, and the higher the blood pressure level, the more severe the atherosclerosis. Elevated blood pressure not only accelerates atherosclerosis, but also accelerates the hardening of small arteries, so that vascular occlusion and rupture occur about 20 years earlier in hypertensive patients than in normotensive people. Studies have proven that both systolic and diastolic blood pressure are strong predictors of the risk of coronary heart disease.
There is no disagreement about the dangers of severe hypertension, while the role of mild hypertension is controversial. Most experts believe that such patients have lower blood pressure levels and a smaller risk of causing coronary heart disease, but they account for a large proportion of the population and should still not be ignored.
② Hyperlipidemia: High total serum cholesterol has been shown to be a risk factor for coronary heart disease. This is also true in Eastern populations where total serum cholesterol is low. Diet is an important factor affecting serum cholesterol levels and thus also coronary heart disease morbidity and mortality, as confirmed by large autopsy studies and immigration studies. The type of dietary fat is also important; an increase in saturated fatty acids raises serum cholesterol, while an increase in polyunsaturated fatty acids lowers it.
(iii) Smoking: Smoking is an independent risk factor for atherosclerosis. Increased mortality from coronary heart disease due to smoking is mainly due to myocardial infarction and sudden coronary death. The results of epidemiological studies show that: the risk of coronary heart disease due to smoking is proportional to the amount of smoking; the risk of smoking paper cigarettes is greater than that of smoking other types of cigarettes; the results of autopsy studies have found that the degree of atherosclerosis in smokers is much more severe than in nonsmokers; smoking not only affects the occurrence of coronary heart disease, but also has an impact on the prognosis of myocardial infarction; passive smokers suffer the same harm; the younger the age, the higher the relative risk; quitting smoking can make The risk of CHD is reduced by quitting smoking.
④Diabetes and abnormal glucose tolerance: diabetes and abnormal glucose tolerance increase the risk of cardiovascular disease. Hypertension, obesity, insulin resistance, hyperinsulinemia, hypertriglyceridemia, and low HDL-C often co-exist, and all of these factors accelerate atherosclerosis.
⑤ Overweight and obesity: overweight refers to weight gain above a specific standard, usually expressed by body mass index (BMI), i.e., weight kg/(height m)2 ≥ 25 is overweight. Obesity refers to the proportion of body fat is too high, such as men more than 25% of body weight or women more than 30% of body weight. After a large number of epidemiological studies, it is now considered a risk factor for coronary heart disease, mainly by affecting blood pressure and serum cholesterol levels.
(6) Lack of physical activity: Most of the information now available on the relationship between exercise and death from coronary heart disease are observational studies that fail to draw a causal relationship. a 1987 review summarized the results of 43 epidemiological studies and concluded that moderate or vigorous physical activity reduces the risk of coronary heart disease. the CDC evaluation concluded that epidemiological, clinical and laboratory arguments have affirmed the association between physical activity and prevention of However, for those who are not normally accustomed to exercise, intense physical activity may trigger acute myocardial infarction episodes in those at risk for coronary heart disease.
Regular activity over a longer period of time, with a short interval each time, can protect people from coronary heart disease or from triggering myocardial infarction with heavy exertion; on the other hand, strenuous activity in inactive people, especially those known to have coronary heart disease or to be at risk for coronary heart disease, may pose a risk to patients. Frequent physical activity in daily life can protect patients from or against myocardial infarction due to strong physical activity. Therefore it is also important to take this into consideration when conducting outreach.
(7) Behavior type and mental stress: It has been found that men with type A behavior have twice the risk of angina pectoris and myocardial infarction than those with type B. The same association exists in women. The concept of coronary vulnerability includes physical and emotional reactivity when under stress (including anger, cynicism, doubt, manifested and suppressed hatred).
(8) Coagulation risk factor: GPIIIa is the major platelet integrin, which is a transmembrane glycoprotein complex. Its role is to act as a receptor that mediates fibrinogen binding to the platelet surface and subsequent platelet aggregation. A case-control study in the United States observed an association between the PIA2 polymorphism of the GPIIIa gene (substitution of leucine-33 by proline) and acute thrombosis, with a predictive significance over and above known coronary risk factors such as hypertension, smoking, hypercholesterolemia or diabetes mellitus.
9 Homocysteine: Homocysteine (Hey) is a sulfur-containing amino acid produced during methionine metabolism, and several case-control studies have reflected a high prevalence of coronary heart disease in those with high plasma Hcy levels. The European Collaborative Action Plan further confirmed it as an independent risk factor.
Lipoprotein(a): Lipoprotein(a) [LP(a)] has a lipid composition similar to that of LDL, and the apo(a) portion of the protein has a multi-kringle structure and is highly homologous to fibrinogen. It can interact directly with fibrin and inhibit the fibrinolytic effect of fibrinogen. Structurally, it has thrombogenic and atherogenic potential.
Atherogenic lipoprotein profile (ALP): Atherogenic lipoprotein profile (ALP) is a combination of several metabolic abnormalities with a certain genetic basis. The main manifestations are increased low-density lipoprotein (LDL2) with small and dense particles that are highly AS-causing, hypertriglyceridemia (TG), and low HDL levels. It is often accompanied by a metabolic syndrome based on insulin resistance (syndrome X proposed by Reaven). Preliminary results from the German PROCAM study suggest that high triglycerides combined with low HDL-C represent the most undesirable type of lipoprotein, which can greatly increase the risk of coronary heart disease.
4.What is the prognosis of coronary heart disease?
The prognosis of coronary artery disease depends on the severity and stability of the lesion, i.e. the more severe and extensive the myocardial ischemia and the more frequent the episodes, the greater the likelihood of infarction and death. Patients are also at increased risk after a myocardial infarction. Active interventions have been proven to significantly reduce infarction and death in coronary heart patients, so adhering to strict standardized treatment and improving coronary lesions and myocardial ischemia can prolong life and improve quality of life.
5.What should be noted in the diet of coronary heart disease patients?
(1) Control total calories and maintain normal body weight.
The proportion of sugar in the total calories should be controlled at 60%~70%. It is advisable to eat more coarse grains to increase the content of complex sugars, fiber and vitamins. Monosaccharides and disaccharides, etc. should be controlled appropriately, especially for hyperlipidemia and obese people.
(2) Limit fat.
Fat intake should be limited to less than 30% of total calories, with vegetable fat as the main source. Eat lean meat, poultry and fish appropriately. According to epidemiological survey data, Europeans and Americans have a high incidence of coronary heart disease, while the Japanese in Asia have a low incidence of coronary heart disease. China’s Zhoushan fishermen and the Arctic Eskimos almost do not suffer from coronary heart disease. Europeans and Americans eat an average of 20 grams of fish per day, the Japanese eat 100 grams of fish per day, Zhoushan and Eskimos eat 300 grams to 400 grams of fish per day. Scientists have found that the fat of sea fish contains polyunsaturated fatty acids, which can affect human lipid metabolism, reduce serum cholesterol and serum triglycerides and low-density lipoprotein and very low-density lipoprotein, thus protecting cardiovascular and preventing coronary heart disease.
This shows that eating more sea fish is beneficial to the prevention and treatment of coronary heart disease. Dietary intake of cholesterol should be controlled, cholesterol intake should be less than 300 mg per day, the cholesterol in an egg is close to 300 mg, when suffering from coronary heart disease, the intake of eggs should be controlled, should be half an egg per day or an egg every two days. Do not eat several eggs a day. To limit the offal of animals, brain, etc.
(3) Moderate amount of protein.
Protein is an essential nutrient to maintain the heart and can enhance resistance, but excessive protein intake is not good for coronary heart disease. Because protein is not easy to digest, it can speed up the metabolism and increase the burden on the heart. Some scholars have observed that excessive intake of animal protein can increase the incidence of coronary heart disease. So protein should be moderate. The daily content of protein in food should not exceed 1 gram per kilogram of body weight, and milk, yogurt, fish and soybean products should be used, which is beneficial to the prevention and treatment of coronary heart disease.
(4) Diet should be light and low in salt.
It is especially important for people with combined hypertension, and the salt intake should be controlled at less than 5 grams per day. It can be increased or decreased according to the seasonal activity. For example, in summer, when sweating is more frequent and outdoor activities are more frequent, salt intake can be increased appropriately. In winter, when sweating is less and activity is reduced accordingly, salt intake should be controlled.
(5) To eat more protective foods.
Such as onion, garlic, purple flower, alfalfa, fungus, kelp, shiitake mushroom and purple cabbage. Researchers have found that garlic and onions contain essential oils, which are effective ingredients in the prevention and treatment of atherosclerosis. Essential oil is a mixture of sulfur-containing compounds, mainly allyl disulfide and diallyl disulfide. If you eat raw garlic at a rate of 1 gram per kilogram of body weight or raw onions at a rate of 2 grams per kilogram of body weight, you can play a role in preventing coronary heart disease. Moderate consumption of tea can prevent coronary heart disease. Tea has the effect of anti-coagulation and promote fibrinolysis. Tea polyphenols in tea, can improve the permeability of the microvascular wall, can effectively enhance the elasticity and resistance of the heart muscle and blood vessel wall, reduce the degree of atherosclerosis. Caffeine and theophylline in tea can directly excite the heart, dilate the coronary arteries and enhance the function of the heart muscle.
(6) Supply sufficient vitamins, inorganic salts and trace elements.
The diet should pay attention to eat more food containing magnesium, chromium, zinc, calcium, selenium elements. Magnesium-rich foods are millet, corn, beans and soy products, wolfberry, cinnamon, etc. Magnesium can affect lipid metabolism and thrombosis, promote fibrinolysis, inhibit coagulation or platelet stabilization, prevent platelet coagulation. Chromium-rich foods, such as yeast, beef, liver, whole grains, cheese, brown sugar, etc. Chromium can increase the breakdown and excretion of cholesterol.
6.How to carry out regular coronary heart disease drug treatment?
How to use the medication reasonably after getting coronary heart disease is the most concerned issue for patients and their families. Generally speaking, if the following 4 basic medication principles can be adhered to, the occurrence of acute coronary events can be greatly reduced, so that the incidence of unstable angina pectoris, acute myocardial infarction, serious fatal arrhythmias such as ventricular tachycardia and ventricular fibrillation can be significantly reduced, thus achieving the purpose of reducing the disease, improving symptoms and prolonging life. Since the first letters at the beginning of these 4 basic medication methods are A, B, C and D, let’s call it ABCD program for the sake of memorization.
A. Includes 3 A’s.
①Aspirin (Aspirin): long-term daily oral 50 to 100 mg enteric aspirin has the effect of counteracting and inhibiting platelet aggregation, which can reduce the formation of thrombus in the coronary arteries and keep them open.
②Anti-Angina: If a coronary patient has an angina attack, he should immediately take 1 to 2 tablets of nitroglycerin under the tongue, which can not only stop the pain but also relieve the condition. If the chest pain is still not relieved after the above treatment, the patient should go to hospital immediately.
Angiotensin-converting enzyme inhibitors (ACEI): commonly used such as captopril, enalapril, ramipril, etc. These drugs can not only treat hypertension, but also improve cardiac function, reduce cardiac remodeling, and have a protective effect on the heart, as to the usage and dosage should be decided by the doctor according to the condition.
B. Including 2 Bs.
① Application of beta-adrenergic receptor blocker (Beta blocker): such as metoprolol, carvedilol, atenolol, bisoprolol, etc. It is currently believed that beta blockers should be used routinely in coronary artery disease as long as there are no contraindications, because these drugs can not only lower blood pressure and reduce the burden on the heart, but also treat exertional angina, reduce arrhythmias, It can also prevent myocardial infarction and improve cardiac function.
Blood pressure control (Blood pressure): Hypertension is an important risk factor for coronary heart disease, so it is especially important to control blood pressure in coronary heart patients. It is best to control blood pressure below 130/85mmHg, which not only can reduce the occurrence of acute coronary events, but also can reduce the complications of hypertension itself, such as stroke, cardiac hypertrophy, cardiac and renal insufficiency and fundus lesions.
C. Includes 2 Cs.
①Lower cholesterol (Cholestero1): It is well known that hypercholesterolemia is the most important risk factor for coronary heart disease. To lower cholesterol, first of all, we have to control our mouth, eat less cholesterol-rich foods such as animal offal, egg yolk and fatty meat, and try to bring down the excessive cholesterol; if the serum cholesterol still cannot be lowered to normal level after dietary control, then we must take lipid-regulating drugs. The most commonly used drugs are statin lipid regulators, such as simvastatin, pravastatin, atorvastatin, etc. Try to lower the serum cholesterol to below 4.6mmol/L (180 mg/dL), which can not only lower cholesterol, but also stabilize atheromatous plaque and reduce the incidence of acute coronary events.
② Quit smoking (Cigarettes): Quit smoking can not only reduce the incidence of chronic bronchitis, emphysema, pulmonary heart disease and lung cancer, but also reduce the damage to the endothelium of the blood vessels, so as to prevent and treat coronary heart disease. Smoking has a hundred hazards but no benefit, advise the majority of smokers to take care of themselves.
D. Including 2 Ds.
① Prevention and control of diabetes (Diabetes): diabetes not only increases blood sugar, but also often accompanied by disorders of lipid metabolism, which is another risk factor for coronary heart disease. The recurrence rate of coronary heart disease can be greatly reduced by controlling diet, applying hypoglycemic drugs and lipid regulating drugs to control blood glucose at around 6 mmol/L and serum cholesterol at below 4.6 mmol/L.
②Control diet (Diet): In a sense, coronary heart disease is eaten out! Therefore, in addition to eating less cholesterol-rich food, it is the best way to maintain health for coronary heart disease patients to eat eight minutes full and avoid overeating.
In short, coronary heart patients as long as under the guidance of doctors adhere to the four ABCD basic medication principles and preventive and curative measures, then coronary heart disease can be controlled.
7, coronary heart disease patient’s sex life should pay attention to what?
Sexual life is a circumstance of excitement process, can make the heart rate breathing accelerated, blood pressure, muscle tension, oxygen consumption increased. Therefore, this is extremely detrimental to patients suffering from severe hypertension, coronary heart disease, angina pectoris, especially myocardial infarction, cardiac insufficiency.
It has been found that during sexual intercourse after myocardial infarction, the peak heart rate averaged 107 to 118 beats/min, and about 20% had severe arrhythmias or a significant shift in the ST segment. These changes are the result of mental excitement, which affects post-infarction myocardial oxygen consumption and electrical stability through neurohumoral factors. In fact, during sex, sudden myocardial infarction, cerebrovascular accidents and even sudden death occur in a large number of people.
For patients with severe hypertension, coronary heart disease unstable angina, myocardial infarction, cardiac insufficiency and cerebrovascular disease should abstain from sex. However, abstaining from sex does not mean absolutely no sex life for couples, but to have moderation, to be carried out slowly on the basis of adequate preparation, any party such as dizziness, palpitations, mental trance, should immediately stop sex.
For patients with coronary heart disease, angina, 10 minutes before sexual intercourse, containing nitroglycerin tablets to prevent angina attacks. It is also proposed that the cardiac function is suitable for sexual intercourse only after 1 to 2 months after the occurrence of myocardial infarction, or if you can go up one floor before discharge from hospital, or if you can complete a single-fold amount of second-stage exercise test.