Previously, I introduced to you the most common clinical manifestation of coronary heart disease - angina pectoris. However, many patients think that the chest pain is angina pectoris, or some patients have coronary heart disease but do not have angina pectoris, which are asymptomatic coronary heart disease patients. So what examinations can we do to determine whether we are coronary heart disease and what the severity of coronary heart disease is.
laboratory examination. blood routine , blood lipid , blood sugar, coagulation function and other tests can understand the risk factors of coronary heart disease. If chest pain is obvious, you need to check myocardial enzyme and troponin , which is of great importance for diagnosing myocardial infarction, especially heart-specific troponin, which can be elevated after 23 hours of acute myocardial infarction and can last for 1 to 2 weeks.
ECG examination. In addition to typical clinical symptoms, the most commonly used, simplest and most convenient method of examination is electrocardiogram.
ordinary electrocardiogram. The ECG abnormality should occur when the angina pectoris occurs, but about half of the patients with angina pectoris are normal, indicating that the ECG diagnosis is insensitive. In addition, 60% of the elderly have abnormal electrocardiograms regardless of whether they have angina pectoris or not, while less than 30% can be used as a basis for diagnosing coronary heart disease.
ECG load test. allows patients to exercise ( bike , tablet test, etc.) or drugs to induce changes in myocardial ischemia. The accuracy rate of coronary heart disease diagnosis can be increased to about 75%, but the side effects are relatively large. Some elderly patients with bedridden, mental illness, and drug allergies cannot complete the trial.
Dynamic ECG . is also known as Holter. All electrocardiograms in patients within 24 to 48 hours can be continuously recorded. Whether it is myocardial ischemia or arrhythmia , whether it is persistent or paroxysmal attacks, they can be found through this examination. In addition, dynamic ECG can also record the patient's ECG in various states, such as eating, going upstairs, resting, running, etc., to facilitate the analysis of the patient's heart reserve function and reactivity in various states. The causes of discomfort can also be identified by combining electrocardiogram with symptoms. The disadvantages are that the results are slow, some patients are not able to adapt to the back of their bodies, and myocardial ischemia cannot be accurately located.
Multi-slice spiral CT coronary artery imaging (CTA). performs coronary artery two-dimensional or three-dimensional reconstruction. It is used to judge the degree of stenosis of the lumen of coronary artery and the calcification of the tube wall, and it has certain significance for judging the distribution range and properties of plaques in the tube wall. The disadvantage is that there are still certain limits in the judgment of the degree of stenosis, especially when calcification exists, it will significantly affect the judgment.
echocardiography. echocardiography on patients with myocardial infarction or severe myocardial ischemia can find that the ventricular wall is thinner and the movement is weakened, and the scope and nature of the lesions are clarified; the patient's heart function is measured to judge the effect of the lesions on overall heart function; complications of coronary heart disease can be diagnosed, such as: ventricular wall tumor , pericardial effusion , ventricular septum perforation , etc.; and differential diagnosis of other angina pectoris, such as obstructive hypertrophic cardiomyopathy, abnormal coronary artery origin, subaortic aortic stenosis, etc., but the disadvantage is that it is meaningless for patients with coronary heart disease who do not have myocardial ischemia in a quiet state.
radionuclide examination.
nuclide myocardial imaging. Nucleol is quickly ingested by normal cardiomyocytes with coronary blood flow. When resting, the perfusion defect is mainly seen in the scar area after myocardial infarction. When the coronary artery is insufficient after exercise, obvious coronary defects and myocardial ischemia areas can be seen.
radionuclide heart cavity contrast. uses radionuclide for in vivo red blood cells to obtain the development of the blood pool in the heart cavity. By analyzing the development image of different phases in cardiac cycle , the left ventricular ejection fraction can be determined and local motion disorders in the ventricular wall of myocardial ischemia are displayed.
positron emission tomography myocardial imaging (PET). uses a positron-emitting nuclide tracer for myocardial imaging. In addition to judging myocardial blood flow perfusion, it can also understand the myocardial metabolism. Through matching analysis of myocardial blood flow perfusion and metabolic imaging, myocardial vitality can be accurately evaluated.
Coronary angiography-the gold standard for diagnosing coronary heart disease.
Inject contrast agent into the opening of the coronary artery with a special-shaped cardiac catheter to develop the coronary artery to understand the shape of the coronary artery and the size of the lumen. It can identify all blood vessels with multi-grade branches of the coronary artery circulation as small as 0.2mm in diameter, and clarify whether the coronary artery has stenosis, degree, range, etc., thereby providing reliable anatomical and functional data for the diagnosis and treatment of coronary heart disease.
intracoronary ultrasound imaging. has high resolution and clear images. It is used to examine coronary lesions and can distinguish the inner, middle and outer layers of the blood vessel wall. The diameter of the coronary artery, the area of the lumen, the shape of the tube wall and the degree of stenosis, the presence or absence of atherosclerotic plaques and plaque distribution, and the presence or absence of thrombosis and endarteral tear in the coronary artery can be evaluated, providing an important basis for further treatment.
(Updated tomorrow: Comprehensive understanding of coronary heart disease: Diagnostic standards)
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