In clinical practice, many people often mention coronary heart disease , angina pectoris, and myocardial infarction, which brings many people the misunderstanding of "coronary heart disease = angina pectoris + myocardial infarction".
In fact, angina pectoris and myocardial infarction are both clinical types of coronary heart disease. According to different types, coronary heart disease can be divided into occult coronary heart disease, angina pectoris, myocardial infarction, ischemic cardiomyopathy , and sudden cardiac death. Here are the explanations for each type.
Type 1: Hidden coronary heart disease
1. Concept
Coronary artery stenosis is mild, myocardial ischemia is mild, the blood supply is insufficient or there is good collateral circulation, and there is no clinical symptoms of the heart, that is, asymptomatic myocardial ischemia , which is called Hidden coronary heart disease.
2. Clinical manifestations
does not have any clinical symptoms of myocardial ischemia, and patients with higher pain threshold have no pain.
3.Assisted examination
electrocardiogram has a transient ST segment (elevation or depression) or T wave (low flat or inverted) changes, radionuclide myocardial imaging, or echocardiography shows myocardial ischemia.
4. Treatment
Appropriately reduce work and avoid fatigue. Follow the doctor's instructions to use nitrate preparations, beta blockers, and calcium channel blockers for treatment, and have regular physical examinations.
Type 2: Angina
1. Concept
Coronary artery stenosis, insufficient blood supply, myocardial ischemia and hypoxia worsen, and the heart shows characteristic symptoms, that is, angina.
2. Clinical manifestations
paroxysmal and compressive pain occurred in the posterior part of the sternum, even the anterior heart and the left upper limb. The frequency of attack is 3~5 min/time, and it may occur once or several times a day, and disappear after taking nitrate preparations.
3.Assisted examination
(1) When angiography occurs, the lead mainly in the R wave can be seen with the ST segment depressed, the T wave flat or inverted, and it will recover within a few minutes after the onset. When the electrocardiogram has no change, a load test can be considered. If the attack is atypical and the electrocardiogram cannot be confirmed, multiple reviews of the electrocardiogram, electrocardiogram load test or 24 h dynamic electrocardiogram continuous monitoring.
(2) Intracoronary ultrasound examination can show tube wall lesions, which is also helpful for diagnosis.
(3) According to the specific circumstances, coronary angiography is selected for .
4. The treatment of angina pectoris can be divided into drug treatment and surgical treatment. Drug treatment mainly uses nitrate preparations (isosorbitol nitrate, long-acting nitroglycerin preparations), beta blockers (propranolol, aprolol, tendolor, metoprolol), calcium channel blockers ( verapamil , nifedipine , amlodipine ), coronary artery dilators ( amiodarone , aminophyline), etc., among which nitroglycerin is more used. In particularly severe cases, surgical treatment can be performed as directed by the doctor. It should be noted that coronary angiography is required before the operation.
Type 3: Myocardial infarction
1. Overview
Myocardial infarction is myocardial necrosis caused by persistent ischemia and hypoxia in the coronary artery.
2. Clinical manifestations
Clinically, patients often have severe and long-lasting poststernum pain, and rest and taking nitrate drugs cannot completely relieve it. When the infarction area is greater than 40%, the cardiac blood volume of is reduced sharply, which can cause cardiogenic shock; when the systolic blood pressure of is less than 80 mmHg (1 mmHg=0.133 kPa), the patient will have pale complexion, damp and cold skin, irritability, indifference, heart rate increase, and reduced urine volume (less than 20 ml/h). It can also cause arrhythmia , shock or heart failure , which may often endanger life. It should be noted that if the elderly suffer from sudden heart failure, shock or severe arrhythmia, the possibility of myocardial infarction/ acute myocardial infarction should be considered.
3. Auxiliary examination
(1) The electrocardiogram is manifested as ST segment elevation, which can be diagnosed as ST segment elevation myocardial infarction; the electrocardiogram has no ST segment elevation, which can be diagnosed as non-ST segment elevation myocardial infarction.
(2) Follow the doctor's instructions to perform myocardial necrosis serum biomarker detection, and use cardiotroponin I, myoglobin , and creatine kinase isozyme , which can be used as a rapid auxiliary diagnosis in myocardial infarction bursts.
4. When treating acute attack of myocardial infarction with
, patients need to take aspirin, beta blockers or statins. In addition to general treatment, morphine, dulcidine and diazepam are also used for sedation and pain relief. At the same time, reperfusion treatment is required (including coronary interventional treatment and thrombolytic treatment) within 12 hours of the onset, with the purpose of reducing the area of myocardial infarction.
Type 4: ischemic cardiomyopathy
1. Overview
ischemic cardiomyopathy refers to a pathological state in which the blood perfusion of the heart is reduced, resulting in a decrease in the heart's oxygen supply, abnormal myocardial energy metabolism, and cannot support the normal functioning of the heart. It is more common in elderly patients, and is often accompanied by chronic diseases such as hypertension, diabetes , and hyperlipidemia.
2. Clinical manifestations
Clinical symptoms are concomitant angina pectoris and myocardial infarction, including chest tightness , fatigue, dizziness, dyspnea, and paroxysmal and pressing pain in the posterior sternum.
3.Assisted examination
(1) Previous history of angina pectoris, even myocardial infarction, or abnormal Q waves on the electrocardiogram, is crucial to differentiating ischemic cardiomyopathy.
(2) Enhanced cardiovascular magnetic resonance imaging detection can better display the patient's internal heart condition and can be used as a powerful means to diagnose ischemic cardiomyopathy.
(3) can also perform ventricular nuclide imaging as directed by the doctor.
4. Treatment
for drug treatment as prescribed by the doctor. Commonly used drugs include angiotensin converting enzyme inhibitors, beta blockers, digitalis and other inotropic drugs. In severe cases, surgical treatment can be taken, such as percutaneous coronary artery endovascular surgery and heart transplantation.
Type 5: Sudden cardiac death
1. Overview
Sudden cardiac death is an unforeseeable natural death caused by cardiac causes, accounting for about 80% of the sudden death of , and the disease occurs urgently.
2. Clinical manifestations
(1) There may be pioneering symptoms before sudden cardiac death, such as chest pain , shortness of breath, fatigue, weakness, persistent angina pectoris, arrhythmia, heart failure and other symptoms.
(2) In acute attack, severe chest pain, acute dyspnea, sudden palpitations, or vertigo.
(3) When cardiac arrest occurs, it is manifested as sudden loss of consciousness or convulsions (can be accompanied by convulsions ), disappearance of large artery pulsation (especially carotid artery, femoral artery), inability to palpate pulse, blood pressure measurement, disappearance of heart sound during auscultation, sigh-like breathing or breathing stop accompanied by cyanosis, and dilated pupils.
3. Auxiliary examination
(1) Laboratory examination may cause metabolic acidosis caused by hypoxia, decreased blood pH, and increased blood sugar and amylase.
(2) There are three types of ECG examination, including: ① Ventricular fibrillation/flutter, showing ventricular fibrillation waves or flutter waves (the success rate of resuscitation is higher); ② Ventricular arrest ECG is straight or only atrial waves; ③ Although the ECG-mechanical separatory ECG has slow and wide QRS waves, it cannot produce effective cardiac mechanical contraction (usually, the success rate of ventricular pause and electromechanical separation resuscitation is lower).
(3)EEG shows low and flat brain waves.
4. Treatment of
(1) Basic life support is required, including open airways, artificial respiration, and chest compression. If necessary, artificial respiration and chest compression need to be performed simultaneously.After admission to the hospital, it is recommended to give the patient artificial respirator , establish intravenous access, perform ECG monitoring and electrocardiogram, and anti-arrhythmic treatment. The treatment of arrhythmia mainly includes drugs ( lidocaine , adrenaline , isopropylene , procaineamide, atropine, etc.), electric shock resection and artificial cardiac pace. After resuscitation, effective circulation and effective breathing are required, and low-temperature therapy to prevent and treat brain hypoxia and cerebral edema (physical cooling and the use of artificial hibernation drugs such as chlorpromazine , finagren, etc.) and dehydration therapy (20% mannitol 250 ml or 25% sorbitol 250 ml intravenous rapid infusion, dripping within 20~30 min).
(4) Some super-emergency moments can be rescued using implantable cardiac rhythm reversal defibrillator, which has supporting pacing and anti-tachycardia pacing, low-energy cardiac reversal and high-energy defibrillation.
In short, there are many causes of coronary heart disease, and more attention should be paid to prevention, especially in cases of heavy physical activity, emotional excitement, overeating, infection, arrhythmia, etc.
Daily patients should regularly monitor their blood pressure and blood lipids, and maintain appropriate degree of exercise habits for a long time. Exercise ability can be evaluated by cardiopulmonary exercise tests, flat panel exercises, 6 min walking tests, 30 m round trip exercise tests, etc.
References
[1] Wang Lisheng. Coronary heart disease is the root cause of angina pectoris and myocardial infarction [J]. 2022, 01 (7): 2-3.
[2] Peng Yongqiang. These symptoms often occur, and coronary heart disease is checked as soon as possible [J]. Health Monthly, 2022, 43 (2): 2.
[3] Cardiovascular Professional Committee of Beijing Nursing Society. Expert consensus on prescription nursing in cardiac rehabilitation health education for patients with coronary heart disease [J]. Chinese Modern Nursing Journal , 2022, 28 (9): 1121-1127.
[4] Shen Xiaocheng, Hu Na, Fu Quanshui, et al. Research on the diagnostic value of application of enhanced cardiovascular magnetic resonance imaging on ischemic cardiomyopathy [J]. Chinese Journal of CT and MRI , 2021, 19 (3): 3.
[5] Fan Shuaiwei, Zhao Gang. A case of ischemic cardiomyopathy that is easily misdiagnosed [J/OL]. China Clinical Case Results Database, 2021, 03 (1): E010-E010.
[6] Deng Wei, Yin Yanyan, Li Yiling, et al. A case of successful rescue of sudden ventricular fibrillation and acute myocardial infarction during occult coronary heart disease [J/OL]. Journal of Clinical Anesthesiology , 2018, 34 (10): 1039-1040.
[7] Xie Yajuan, Wang Cheng. The clinical value of exercise-load electrocardiogram and dynamic electrocardiogram in the diagnosis of occult coronary heart disease [J]. Modern Journal of Integrated Traditional Chinese and Western Medicine , 2017, 26 (30): 3.
Articles: Fu Yujie
