☆ When initially determining whether it is coronary heart disease, what are the main aspects to look for? Typical angina symptoms have the following characteristics: 1. location: usually located in the posterior sternum or left anterior chest, a few can be located in the pharynx, upper abdomen, jaw and other parts, the site of each attack is usually constant; 2. nature: usually heavy pressure-like, squeezing sensation, tightness, band feeling and other dull pain nature, some patients show choking sensation, generally will not be pinprick-like, knife-like, burning-like sharp pain; 3. duration If the typical symptoms last for more than 15 minutes, myocardial infarction should be excluded; 4. Radiating site: the discomfort can be felt in the left shoulder, left back, left upper limb at the same time as the onset of chest discomfort; 7. The symptoms of myocardial infarction are similar in nature to angina pectoris but much more intense and persist without relief, and can be accompanied by sweating, nausea, and a sense of near death ECG: The typical ECG manifestation of myocardial ischemia is horizontal or downward sloping downward shift of the ST segment and inversion of the T wave during the onset of symptoms, which rapidly returns to normal after the symptoms are relieved. The key point is that ECG changes are closely related to the symptoms. If there are “ST-T changes” in the ECG on physical examination but they are not related to the symptoms and there is no long-term dynamic change, then there is no diagnostic value. Risk factors: The diagnostic accuracy is higher if the person is a high-risk group with typical symptoms ☆ Who are the main high-risk groups? What is the age of people with symptoms that should be considered for coronary heart disease? Risk factors for coronary heart disease include: middle-aged men and older, postmenopausal women, hypertension, lipid metabolism disorders, diabetes, obesity, low physical activity, smoking, family history of early onset of atherosclerosis (before the age of 55 for men and 65 for women in the immediate family), and hyperhomocysteinemia. High-risk groups are people who have multiple risk factors at the same time. Coronary artery disease should be considered except for men over 45 years of age and women over 55 years of age with corresponding symptoms. ☆ If young people in their 20s or 30s develop typical symptoms of coronary heart disease, should coronary heart disease be considered? Nowadays, it is not uncommon for young people to have coronary heart disease or even acute myocardial infarction, and the youngest coronary heart disease patient I have seen is 15 years old for men and 23 years old for women. Therefore, as long as the typical symptoms are present, we should consider excluding the possibility of coronary heart disease. ☆ What are the main aspects of past medical history to focus on? Hypertension, hypercholesterolemia, diabetes mellitus, history of myocardial infarction, stroke, peripheral vascular atherosclerosis, history of heart failure, etc. ☆ Do coronary heart patients always have changes in lipids, blood sugar and blood pressure? Although hypertension, lipid metabolism disorders and diabetes are risk factors for coronary heart disease, it does not mean that all patients with coronary heart disease have these factors present. In fact, it is not uncommon for people who do not find any risk factors to have coronary heart disease or even acute heart attack. This is because the causes of coronary heart disease are still far from being clearly studied by current medicine. ☆ Is it necessary to screen for coronary heart disease in people who have not been found to have three highs but have symptoms such as angina and shortness of breath? Of course it is needed, for the same reasons as above. ☆ What are the typical symptoms of coronary heart disease? Is angina pectoris the key to judgment? The typical symptoms of angina pectoris in coronary heart disease are chest tightness at the time of activity, relieved by rest for a few minutes after stopping activity, and recurrence of symptoms under the same amount of activity. The symptoms of acute heart attack are similar in nature to those of angina but are more severe and last for several hours without relief, and can be triggered by satiety, emotional excitement, heavy smoking, or no obvious trigger. Many patients do not have a history of significant angina attacks before the infarction, so the absence of previous angina cannot be used as evidence to rule out an infarction. ☆ How does angina really hurt? Angina pectoris is a discomfort caused by the accumulation of local acidic metabolites in the myocardium in a state of ischemia that stimulates the nerves because the blood supplied to the myocardium by the coronary arteries cannot meet the needs of myocardial metabolism. In medical terms, “angina” usually refers to pain caused by ischemia. ☆ Is there a relationship between the severity of symptoms and the severity of coronary artery disease? There is no absolute correspondence between the severity of symptoms and the severity of coronary artery disease. In general, the symptoms of myocardial infarction are much more severe than angina pectoris, but there are some patients (mainly elderly and diabetic patients) who do not have any pain at the time of infarction but present to the clinic with symptoms of heart failure after the secondary heart failure. On the other hand, the sensitivity of pain sensation varies from patient to patient, so it should not be assumed that the condition is severe if the pain is severe. ☆ What do the atypical symptoms of coronary heart disease mean and what do they include? Are they easily mistaken for other diseases? Atypical symptoms of angina pectoris refer to atypical pain in terms of location, nature, duration and trigger. It can be manifested as toothache, sore throat, abdominal pain, etc., and may be mistaken for dental disease, acute abdomen, etc. ☆ Is there any asymptomatic coronary heart disease? Yes, there is a clinical classification of coronary artery disease called occult coronary artery disease, also called asymptomatic myocardial ischemia, which is manifested when patients have no angina symptoms but evidence of myocardial ischemia is found in objective tests such as exercise electrocardiogram. ☆ How to achieve early detection of coronary artery disease with atypical or asymptomatic symptoms? Coronary heart disease with atypical symptoms can usually be diagnosed promptly by consulting an experienced physician in the Department of Cardiology as long as the symptoms are closely related to physical activity. Coronary heart disease that is completely asymptomatic is more difficult to diagnose early, and high-risk groups can go to the cardiology department of a large hospital for regular checkups. ☆ Are there any cases that look like coronary heart disease but are not actually coronary heart disease at all? How should people differentiate? There are too many. Aortic stenosis and hypertrophic obstructive cardiomyopathy can have typical myocardial ischemic manifestations, but this ischemia is not due to coronary causes, so they cannot be diagnosed as coronary artery disease. Cardiac neurosis, anxiety and depression, and menopausal syndrome can all have clinical manifestations that look like coronary artery disease, and need to be diagnosed by a doctor in the cardiology department.