Mr. Zhang was sent to the emergency room due to sudden chest pain at the beginning of this year and was diagnosed with "acute extensive anterior wall myocardial infarction". After resuscitation and rescue, he underwent emergency coronary angiography and placed stent . After comprehensive treatment, the doctor reviewed his heart ultrasound before discharge, and the results showed that his heart's ability to pump blood was only about half of that of his normal peers. The index of "left ventricular ejaculation fraction (LVEF)" in ultrasound was only 30%, and it was considered that there was "post-myocardial infarction heart failure". Uncle Zhang was still scared of this onset experience that was "like passing the gates of hell". After being discharged from the hospital, he tried hard to follow the doctor's instructions, quit smoking and drinking, take medicine regularly, and improve his eating habits. He lost 10 kilograms in half a year, and his physical strength was gradually recovered, and he was effortless when walking and doing exercises. Half a year later, he came to the cardiology clinic for a follow-up examination. His heart ultrasound showed that the ejaculation fraction of had increased to 48%, which made great progress. While happy, Uncle Zhang gradually relaxed his requirements for himself. In addition to taking medicine on time, he even "picked" the cigarettes; no longer restricted the diet, but also drank alcohol and various beverages; exercise activities were reduced, and he gained 8 kilograms in weight within 2 months. As a result, from the third month after "release", Mr. Zhang felt that his physical strength was getting worse, and he was short of breath and panic after taking two steps, and he also developed swelling in his calf. So he came to the hospital for a review again. The heart ultrasound showed that the ejaculation fraction dropped to 32% again, accompanied by heart enlargement ; in biochemical examination, blood lipid , blood sugar and other indicators were also "red in the whole line". Mr. Zhang was both frustrated and puzzled: "Didn't the result of the last review and review, saying that my heart function had improved? I didn't stop the medication, so why did it worse again?"
(Picture source: Tencent Medical Dictionary)
Mr. Zhang's condition changes in the first half of the year are clinically called "ejaculation fraction improved heart failure". It means that in cardiac ultrasound examination, the left ventricular ejaculation fraction (LVEF) at the baseline level is ≤40%, and the LVEF increase after at least 3-6 months' interval exceeds the baseline ≥10%, or LVEF >40%. This type of heart failure is often seen in: (1) the direct cause of heart failure is actively corrected or fully controlled; (2) After effective lifestyle control, drug and device treatment, the structure, function and metabolic level of heart tissue are continuously improved. For Mr. Zhang, the acute myocardial infarction surgery opened the blocked coronary blood vessels, effectively controlling the development of the cause; within the second half of myocardial infarction, standardized comprehensive treatment was adhered to further protecting the structure and function of the heart, which was why he made significant progress in his symptoms and cardiac ultrasound review results, which was consistent with the characteristics of "improving ejaculation fraction heart failure", and confirmed that Mr. Zhang's treatment in the first half of the year was sufficient and effective.
But why did his condition recur again later? According to the current medical research results, diseases like " heart failure " are not easy to achieve "complete cure", but they can achieve "clinical remission" through long-term comprehensive treatment mode. The reason is that under the action of various causes, the heart tissue has undergone irreversible structural damage and metabolic function damage from the cellular level; but in the course of the disease, the continuous progress of the cause can be effectively intercepted through surgery, drugs, devices and other treatment methods; and then through long-term drug protection and various cardiac rehabilitation treatment measures, the structural changes of damaged myocardial tissue are controlled, and the undamaged myocardium can be promoted to realize the potential of maintaining and improving the heart structure and function under the "full-process treatment mode". It can be seen that "improvement" does not mean "recovery and cure"; to achieve clinical improvement of heart failure, it is neither possible to go once and for all, nor will it be achieved overnight; the joint cooperation of surgery/instrument/drug + comprehensive rehabilitation models can determine the trend of heart failure prognosis.
(Picture source: Tencent Medical Dictionary)
So, in response to Mr. Zhang’s problem, the cardiologist once again adjusted his comprehensive treatment prescription: after raising the dose of some drugs to improve cardiac function and anti- myocardial ischemia , he was required to come to the hospital regularly for follow-up, actively lower lipids and sugars to meet the standards, and ensure smooth coronary blood circulation; under the premise of taking medicine regularly, he should quit smoking and alcohol as soon as possible. If you are not bad, drink less sugary drinks; change your diet and drinking habits, eat small amounts in a single time, in batches, and avoid overeating to reduce the burden on the heart; in terms of diet structure, you should focus on rich vegetables and fiber-rich cereal staple foods, maintain the necessary high-quality protein intake such as milk and eggs, and reasonably control meat intake to help lose weight; you should also insist on restoring aerobic exercise, proceed step by step, and gradually increase your cardiopulmonary capacity. I hope that after this experience, Mr. Zhang can truly understand and receive the key points of treatment for heart failure, seize the opportunity of "improvement" again, and regain his "heart"!
