Written by: Zhao Wanyu, Dong Xiaoli, Zhang Jun Editor: Xu Min Have you ever had this experience - you have had a coronary stent or coronary artery bypass surgery to open the diseased blood vessel, but your chest pain symptoms still have not improved? Are you not suitable for coro

2024/11/0522:07:33 regimen 1600

Writers: Zhao Wanyu, Dong Xiaoli, Zhang Jun Editor: Xu Min

Have you ever had such an experience - you have had a coronary stent or coronary artery bypass surgery to open the diseased blood vessel, but your chest pain symptoms still have not improved? Are you not suitable for coronary stent and coronary artery bypass grafting treatments due to various reasons, but cannot improve myocardial blood supply with current medical and surgical methods? Did you do coronary angiography and no coronary artery blockage was found, but you always feel chest pain? The worries and worries caused by refractory angina pectoris seriously affect the quality of life...

All these problems can be improved through a myocardial vascular regeneration therapy. This therapy is called "extracorporeal cardiac shock wave", and in this issue we will learn about it together.

Extracorporeal cardiac shock wave therapy (CSWT) uses ultrasound positioning technology to release shock waves to the determined myocardial ischemia site. Shock waves can induce the synthesis of local myocardial nitric oxide through a series of mechanisms, promote capillary regeneration in ischemic areas and the reconstruction of local microcirculation, increase myocardial coronary flow, and reduce the symptoms of angina pectoris. This therapy is non-invasive, painless, safe and effective, and can improve patient clinical prognosis.

At present, Yunnan Fuwai Cardiovascular Disease Hospital cardiac rehabilitation ward team and ultrasound department team have put into use this equipment, and have completed a course of treatment for many patients with chest pain and myocardial ischemia. Most of the patients have obvious chest pain symptoms. Relief, exercise tolerance improved, and symptoms of myocardial ischemia were also improved compared with before treatment.

Which patients are suitable for extracorporeal cardiac shock wave? What are the taboos?

Indications: 1. Patients with coronary artery stenosis confirmed by coronary angiography and still develop angina after coronary stent or bypass (including those who are unwilling or unconditional to undergo revascularization); 2. Cardiac ultrasound strain and myocardial infarction Radionuclide imaging can locate the exact myocardial ischemic area, and the stress test confirms the existence of viable myocardium (hibernating or stunned myocardium); 3. heart failure caused by any reason: such as ischemic cardiomyopathy, dilated myocardium Heart disease.

Absolute contraindications: 1.After heart transplant; 2.After mechanical valve replacement; 3. Intracardiac thrombosis; 4. Severe and uncontrollable heart failure and hemodynamics instability ; 5. Severe arrhythmia ; 6. infective endocarditis ; 7. Severe chronic obstructive disease and pulmonary bullae; 8. Pregnant women; 9. After prosthetic breast implantation; 10. Within 5 years after malignant tumor or tumor resection; ventricular turbulence or heart rate 40 beats/min or 120 beats/min; 11. LVEF 30%; 12. Severe skin ulceration, eczema or infection in the treatment area. Relative contraindications: 1. Aortic aneurysm far away from the treatment area; 2. Thrombocytopenia or bleeding tendency.

At present, the extracorporeal cardiac shock wave therapy system of Fuwai Hospital in Yunnan Province is mainly widely used in people with chronic coronary heart disease, coronary microvascular disease and heart failure. The technology is also used in acute myocardial infarction , cardiomyopathy and other fields. It has been carried out gradually, and the cost of the examination has been included in the medical insurance.

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