Coronary heart disease- CHD:
What is coronary heart disease?
Coronary heart disease (CHD) is one of the most common heart disease, coronary heart disease is the myocardial dysfunction caused by coronary artery stenosis, insufficiency, and (or) organic disease, it is also known as ischemic cardiomyopathy. The occurrence of coronary heart disease and coronary atherosclerosis closely related to the degree of stenosis and count, while suffering from diseases such as hypertension, diabetes, and obesity, unhealthy living habits, such as a major factor in inducing the disease.Coronary heart disease is one of the world's highest mortality disease.
Coronary heart disease - OverviewCoronary artery disease coronary atherosclerotic heart disease (coronary artery heart disease ,CHD) referred to as coronary heart disease is caused by myocardial dysfunction due to coronary artery stenosis, insufficiency, and (or) organic disease, it is also known as ischemic heart disease (IHD). CHD is the result of a variety of coronary artery disease, but coronary atherosclerosis accounting for the vast majority of coronary heart disease (95% -99%). Therefore, it is customary to CHD regarded as a synonym for coronary atherosclerotic heart disease (coronary atherosclerotic heart disease).Coronary artery is a branch of the aorta, responsible for supplying blood to the heart. When coronary artery cholesterol or blood clots, coronary artery is blocked, it will lead to cardiac insufficiency, can lead to very serious consequences when serious obstruction of coronary blood.
Coronary heart disease - etiology and pathogenesisCoronary heart disease - causesThe formation of atherosclerotic plaques of coronary heart disease supply the heart itself of coronary artery wall causing vascular stenosis induced heart attack. Due to coronary artery stenosis count and the different levels, their clinical symptoms are also different.Coronary heart disease etiology has not yet entirely clear, but that associated with hypertension, hyperlipidemia, high blood viscosity, diabetes, endocrine dysfunction and older and other factors.1, age and gender: 40 years after coronary heart disease incidence increased incidence of menopausal women less than men, after menopause, and men are equal.Hyperlipidemia: In addition to age, lipid metabolism disorder is the most important predictor of coronary heart disease. There is a close relationship between total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) level and risk of coronary heart disease events. LDLC level is increased by 1%, 2-3% increase in risk of coronary heart disease risk. Triglyceride (TG) is an independent predictor of coronary heart disease, often associated with low HDLC and impaired glucose tolerance, the latter two are also risk factors for CHD.3, the formation of hypertension: hypertension and coronary atherosclerosis and development are closely related. Systolic blood pressure than diastolic blood pressure better predictor of coronary heart disease events, 140-149mmhg systolic blood pressure more than 90-94mmhg, diastolic blood pressure increase the risk of death from coronary heart disease.4 Smoking: Smoking is an important risk factor for coronary heart disease is the single most avoidable cause of death. There is a clear dosage - response relationship between coronary heart disease and smoking.: Coronary heart disease, diabetes is the primary cause of death of the juvenile diabetic patients, coronary heart disease accounted for nearly 80% of all causes of death and hospitalization rates in diabetic patients.Obesity: clear as the primary risk factors for coronary heart disease, can increase coronary heart disease mortality. Obesity is defined as body mass index (BMI = weight (kg) / height squared (m2)) in men and> = 27.8 for women> = 27.3.BMI with TC, TG, increased, decreased HDL-C was positively correlated.7, sedentary lifestyle: people do not love the sport of coronary heart disease incidence and risk of death doubled.8, heredity, alcohol consumption, and environmental factors.Coronary heart disease - pathogenesisCoronary heart disease most of the artery organic stenosis or obstruction caused by coronary artery stenosis mostly the fatty substances caused by accumulation along the vascular wall, a process known as atherosclerosis. Atherosclerosis develops to a certain degree of coronary stenosis gradually increased, limiting blood flow into the myocardium. The heart is not getting enough oxygen supply occurs when the chest discomfort, that is, angina.
Coronary heart disease - Clinical manifestationsAsymptomatic coronary artery disease with coronary heart diseaseMany patients have a wide range of coronary artery occlusion did not feel angina, and even some patients with angina, myocardial infarction did not feel. Some patients in the event of sudden cardiac death, myocardial infarction after routine physical examination.ECG ischemic manifestations, some patients with coronary heart disease, the occurrence of arrhythmia, or positive exercise test and coronary angiography before found. Of these patients the chance of sudden cardiac death and myocardial infarction and angina patients, it should pay attention to the usual heart care.Angina in coronary heart diseasePerformance of the sternum after the crushing sense of Fullness sense, accompanied by significant anxiety, for 3-5 minutes, often divergent to the left arm, shoulder, jaw, throat, back, and may radiate to the right arm can sometimes be involving these parts rather than the posterior region of the sternum. force, agitation, chills, a meal called exertional angina attack in the case of increased myocardial oxygen, rest and nitroglycerin alleviate.Sometimes angina is not typical, and can be expressed as a gas tight, syncope, weakness, belching, especially in the elderly. Divided into stable and unstable angina attack frequency and severity of stable angina is angina pectoris attack in January, the attack site, frequency, severity, duration, induce the onset of the size of the labor, the basic stability of the amount of nitroglycerin can relieve pain. Unstable angina refers to the original stable angina attack frequency, duration, severity increased or new onset of exertional angina (incidence less than a month), or heart attack in the resting cramps. Unstable angina is a precursor of acute myocardial infarction, if it is found immediately to the hospital.
Myocardial infarction, coronary artery diseaseOften the prodromal symptoms about a week before the infarction occurred, such as resting and mild physical activity episodes of angina associated with significant discomfort and fatigue. Infarction showed persistent severe pressure, choking sense, even the knife-like pain in the sternum, often spread to the entire chest, to the left side. Some patients can be extended down his left arm ulnar radiation, causing tingling of the left wrist, palm and fingers Ma, some patients may radiate to the upper limbs, shoulders, neck, jaw, to the left. The location of the pain is consistent with previous angina parts, but last longer, heavier pain, rest and nitroglycerin can not be alleviated.Sometimes manifested as upper abdominal pain, easy to be confused with abdominal disease. Accompanied by fever, irritability, sweating and cold sweats, nausea, vomiting, palpitations, dizziness, extreme fatigue, difficulty breathing, sense of impending doom, for 30 minutes or more, often for several hours. Found that this situation should seek medical attention immediately.Ischemic cardiomyopathy, coronary artery diseasePart of the original patients with angina pectoris, after extensive lesions, myocardial extensive fibrosis, angina gradually decreased to disappear, but the performance of the heart failure, such as tight gas, edema, fatigue, etc., as well as a variety of arrhythmias, the performance as heart palpitations. some patients never angina, and direct the performance failure and arrhythmia.Sudden death type of coronary heart diseaseMeans the occurrence of cardiac arrest due to coronary heart disease caused by the unpredictability of sudden death, within six hours after the acute onset of symptoms. Mainly due to ischemia caused by abnormal myocardial cell electrophysiological activity, while the occurrence of severe arrhythmia causes
Coronary heart disease - complicationsPapillary muscle dysfunction of coronary heart disease knowledgeFat cow rate of 50% c shrink small late Kara tone loud, hair-like systolic murmur heard in the incidence 5dJ spoon, apex, serious disorders lead to left heart failure.Papillary muscle ruptureIncidence of 1%, multiple 3d, and high mortality. Apical area heard a loud hair-like systolic murmur, diminished first heart sound, and appear to severe heart failure and (or) cardiogenic shock, and rapid pulmonary edema.Cardiac ruptureRare, the vast majority of ventricular free wall rupture and cause acute hemopericardium and acute pericardial tamponade quenching dead, often occur in about one week after the onset.EmbolusIs a very important complication of myocardial infarction. Seen in the onset of l-2 weeks, fixed ventricular mural thrombus shedding caused by the brain, kidney, spleen, limb artery embolization: deep vein thrombosis shedding resulting in pulmonary embolism.Ventricular aneurysmMainly seen in the left heart empty, fat cow rate of 5% -20%: ECG right pathologic Q waves ST segment has picked up high for more than a month, X-ray, ultrasound heart diagram and radionuclide studies show ventricular wall epilepsy performance.
Coronary heart disease - checkAuscultationGeneral early stage of coronary heart disease without a clear positive signs, heavier may want the circles to the left to expand, the first heart sound weakened, could be heard and premature arrhythmia, atrial fibrillation etc., complicated by heart failure, two lung and wet rales, the apex could be heard, and gallop.
Assistant examinationAn ECG: The ECG is the earliest diagnosis of coronary heart disease the most common and the most basic diagnostic method. Compared with other diagnostic methods, ECG and easy to use, easy to popularize, when changes in the patient's condition can be in time to capture the changes, and continuous dynamic observation and a variety of load test in order to improve the diagnostic sensitivity. Angina or myocardial infarction, typical ECG changes, especially the diagnosis of arrhythmias may have their clinical value, of course, there are also some limitations.
ECG stress test: the exercise stress test and drug test (such as dipyridamole, isoproterenol tests). ECG is a simple method of myocardial ischemia is the most common clinical observation. Angina pectoris, ECG can be recorded to myocardial ischemia, ECG abnormalities. However, many patients with coronary artery disease coronary expansion reserve capacity has decreased, usually static coronary blood flow in the resting state can still be maintained, no myocardial ischemia in the performance of the ECG can be completely normal. Reveal reduce or relatively fixed blood flow through exercise or other methods, the heart of the load-induced myocardial ischemia, and then confirmed the presence of angina. Exercise test is essential for cardiac function after ischemic arrhythmias and myocardial infarction.
3, ambulatory electrocardiography: a long continuous recording and compilation of analysis of cardiac activity and quiet state of ECG changes. This technology be applied first in 1947 by Holter monitoring the electrical activity of the research, also known as Holter monitoring. Resting ECG can only record short only dozens of the cardiac cycle waveforms, dynamic ECG within 24 hours of continuous ECG record up to about 100,000, can improve on the non-persistent ectopic rhythm, especially The detection rate of arrhythmia and transient myocardial ischemic attacks, expanded the scope of clinical application of ECG, and the emergence of time with the patient's activities and symptoms corresponding to.
4, myocardial perfusion imaging: can not be excluded based on history, ECG angina can do this check. Myocardial perfusion imaging can show the ischemic region, clear the location and extent of ischemia in size. Combined with exercise test and then imaging may improve the detection rate.
Coronary angiography: the "gold standard" for diagnosing coronary artery disease. You can clear coronary artery with or without stenosis, stenosis, extent, scope, and can guide further treatment measures to be taken accordingly. At the same time, left ventricular angiography, cardiac function evaluation. The main indications for coronary angiography as follows: 1 under the medical treatment of angina pectoris is still heavier, clear arterial lesions to consider bypass graft surgery; ② chest pain similar to angina but can not be diagnosed.
6, ultrasound, and intravascular ultrasound: cardiac ultrasound on the heart shape, wall motion and left ventricular function to check, is one of the most commonly used means of checking. Aneurysm, intracardiac thrombus, cardiac rupture, papillary muscle function have important diagnostic value. Intravascular ultrasound can clear coronary wall morphology and the degree of stenosis, is a promising new technology.
7, serum creatine kinase check: is one of the important means of diagnosis and differential diagnosis of acute myocardial infarction. Clinically according to the sequence variation of the serum enzyme concentration and specific isozyme increased certainty of enzyme changes can confirm the diagnosis of acute myocardial infarction.
8, blood pool imaging: can be used to observe the ventricular wall contraction and relaxation of dynamic images, has important reference value for the determination of wall motion and cardiac function.
Heart disease - diagnostic criteria
One of the most common diagnostic criteria of coronary heart disease: typical angina pectoris or myocardial infarction, but no severe aortic valve narrow, regurgitation, aortitis, but also the evidence of coronary embolism or cardiomyopathy can be regarded as coronary heart disease.
2, male 40 years old, female patients over the age of 45, resting ECG showing myocardial ischemia manifestations or electrocardiographic exercise stress test positive for other reasons (all kinds of heart disease, autonomic dysfunction, severe anemia, obstructive pulmonary emphysema, digitalis drugs, electrolyte imbalance, etc.) to be investigated, and two of the following three: hypertension, hypercholesterolemia, and diabetes. This is the revised diagnostic criteria of coronary heart disease. The absence of clinical symptoms, can be diagnosed with asymptomatic coronary artery disease.
3, the second point of coronary heart disease diagnostic criteria: patients over 40 years of age, cardiac enlargement or failure, or papillary muscle dysfunction, associated with the performance of significant myocardial ischemia in the resting ECG, but not intentions of myopathy or the other reason to explain, and two of the following three: hypertension, hypercholesterolemia, and diabetes.
Suspicious angina or severe arrhythmia, no other reasons can explain, and two persons in the following three: more than 40 years of age, hypercholesterolemia, rest or exercise ECG suspicious as to the diagnosis of coronary heart disease criteria.
Heart disease - differential diagnosisMyocarditis and coronary heart disease, hypertrophic obstructive cardiomyopathy, pericarditis, pleurisy, etc. to identify:
MyocarditisProdromal symptoms of the disease in the acute phase or sub-acute phase of myocarditis, the patient may have fever, fatigue, sweating, palpitation, dyspnea, precordial dull pain. Examination showed contraction, conduction block and other arrhythmias. Aspartate aminotransferase, creatine phosphokinase increased ESR. ECG, X-ray examination in the diagnosis. Treatment includes resting improve myocardial nutrition, control of ventricular dysfunction and to correct arrhythmias and to prevent secondary infection.
PericarditisPericarditis can be divided into acute pericarditis, chronic pericarditis, constrictive pericarditis, the patient may have fever, night sweats, cough, sore throat, or vomiting, and diarrhea. Pericardial exudation soon a large number of fluid can occur when the symptoms of acute cardiac tamponade, patients with chest pain, dyspnea, cyanosis, pale, and even shock. Also have ascites, hepatomegaly embolism.
PleurisyPleurisy, also known as "pleurisy, inflammation of the pleura. After the inflammation subsided, the pleural recovered to normal, or the occurrence of mutual adhesion of two layers of pleura. By a variety of causes, such as infection, malignancy, connective tissue disease, pulmonary embolism. Tuberculous pleurisy is the most common form. Dry pleurisy, the pleural surface of a small amount of fibrous exudation, manifested as severe chest pain, like acupuncture-like, the check can be found in the pleural friction rub and changes. Exudative pleurisy, pleural cavity exudates increased, chest pain diminished or disappeared, and patients often cough, breathing difficulty. In addition, often fever, weight loss, fatigue, loss of appetite and other systemic symptoms. The check can be found in the performance of the heart, lung compression. When a large number of pleural fluid can be found by chest examination and X-ray examination.
Coronary heart disease - treatmentChoice of calcium channel blockers, nitric acid lipid drug-converting enzyme inhibitor treatment, and rapid heart rate can be selected β-blockers, a release agent as well. Enteric-coated aspirin 100-325mg / day, pay attention to the treatment of coronary heart disease risk factors such as antihypertensive therapy, lipid lowering therapy, treatment of diabetes, smoking cessation, temperance, etc. can be added. You can also use of GIK and nitric acid lipid drug intravenous infusion.
Complicated by heart failure and arrhythmias when added to correct heart failure and antiarrhythmic therapy, if necessary, feasible interventional treatment of coronary heart disease (PTCA and stenting), severe cases can be considered for surgical bypass surgery.
Coronary heart disease - preventionPrevention of common senseCoronary heart disease knowledge, coronary heart disease, should be open-minded, regular inspection, pay attention to changes in condition. Such as angina, acute, and should rest and medication. Such as Guan Xin Su He Pill, heart-protecting musk pill JiuXinWan; or containing of isosorbide dinitrate, nifedipine, nitroglycerin tablets; necessary, oxygen, nervousness service stability and adjuvant therapy.
2, should be the law of life, avoid excessive stress; maintain adequate sleep, develop a variety of fun; to maintain emotional stability and avoid impatient, agitated or depressed.
3, proper physical exercise.
Not only can prevent obesity and improve heart and lung function, and enhance the response capabilities; also to reduce hyperlipidemia, diabetes, hypertension, hyperviscosity and thrombus formation. Exercise varies from person to person, generally, tai chi, walking, Qigong exercise is appropriate.
4, a reasonable diet, good health habits to prevent the development and progression of coronary heart disease have an important role.
Vegetarian, vegetables, fruits as the main diet will not only reduce blood cholesterol, elevated lipoprotein; vegetable oil, peanut oil, corn oil, help reduce blood cholesterol levels, should increase consumption. Develop good bowel habits, maintain defecate unobstructed; bath water should be warm should not be hot, not a large pool.
In addition, to avoid psychological stress and emotional, as soon as possible to quit smoking, daily alcohol should not exceed 25ml.
, Angina treated continued remission, and determined the tightness of the former District, choking sensations, sweating more than should tracings of ECG and ultrasound echocardiography, if confirmed acute myocardial infarction should be taken immediately in Integrative Medicine First Aid to prevent the occurrence of ventricular fibrillation, cardiogenic shock.
6, more than tea, according to statistics, do not drink tea with coronary heart disease incidence rate of 3.1% reduced to 2.3% occasionally drink tea, regular tea (drink more than three years) is only 1.4%. In addition, the increased coronary heart disease, coronary insufficiency and thrombus formation. Continuously formed by oxidation of catechins in the tea polyphenols and tea and more of this phenol in the boiling process, tea pigment, the animal in vitro experiments suggest a significant anticoagulant, promote fibrinolysis, and antithrombotic and other effects.
7, no smoking, alcohol: tobacco allows the contraction of the arterial wall, promoting atherosclerosis; and alcohol abuse is very emotional, high blood pressure.
8, positive prevention and treatment of elderly patients with chronic diseases: hypertension, high cholesterol, diabetes, closely related to these diseases and coronary heart disease.
9, positive buck to pay close attention to symptoms of myocardial ischemia. The very old elderly (> 80 years), antihypertensive therapy can reduce stroke risk, but whether it can reduce the CAD is not sure.
Control and PreventionPrevention is the key control of coronary heart disease. Although coronary heart disease is a common and frequently-occurring disease of the elderly, but its pathological basis of atherosclerosis origin in children of extremely valuable opportunity for preventive work in the intervening decades. Primary prevention, to prevent the occurrence of coronary atherosclerosis, the eradication of coronary heart disease in the bud; secondary prevention, early detection rate of community-wide coronary heart disease, intensive therapy to prevent disease development and to seek its reversal; tertiary prevention, timely control of complications and improve patient quality of life, extend a patient's life.
Coronary heart disease - the incidence of
Coronary heart disease incidence of cardiovascular disease as a hazard to human health "killer", has affected the whole world, the major disasters of many rich countries. World War I, the main clinical types of myocardial infarction, coronary heart disease is very rare, but in 1940, coronary heart disease has become the United States and some industrialized countries the leading causes of death. There are certain difficulties in the diagnosis of certain types of coronary heart disease, it is usually to the morbidity and mortality of acute myocardial infarction on behalf of coronary heart disease morbidity and mortality, including mortality is more commonly used.
According to the 11 countries the information released by the World Health Organization 1990, 30 to 69 years with coronary heart disease mortality in Northern Ireland, the highest, Finland, followed by Japan, the lowest. In the United States, coronary heart disease mortality over 30 years ago, fell by 40 percent, but continued to hold the first of the American cause of death.
1988 U.S. National Center for Health Statistics released by the United States in 1987 the number of deaths and causes of death overall data indicate that 35% of heart disease, the total cause of death, including coronary heart disease deaths accounted for 24.1 percent, ranking first in the top 10 causes of death.
Coronary heart disease - how early detection of coronary heart disease?
Coronary heart disease is a common and frequently-occurring disease of the elderly people in this age, in their daily lives, if the following conditions, to timely medical treatment, early detection of coronary heart disease.
(1) fatigue and mental stress occurs when substernal or precordial dull pain, or contraction-like pain and left shoulder, left arm radiation, for 3-5 minutes after the break and relieve itself.
(2) physical activity, chest tightness, heart palpitations, shortness of breath, rest and relieve itself.
(3) of sports-related headache, toothache, leg pain.
(4) meal, cold or watch a thrilling movie, chest pain, palpitations.
(5) night sleep pillows, feel chest tightness, suffocation, need a high pillow lying side comfort; sleeping or daytime supine sudden chest pain, heart palpitations, breathing difficulties, in order to ease the need to immediately sit or stand.
(6) sexual life or defecation, palpitation, chest tightness, shortness of breath or chest discomfort.
(7) to hear the noise they cause palpitation, chest tightness.
(8) recurring pulse arrhythmia, unexplained tachycardia or bradycardia.
For the early detection of coronary heart disease, people over the age of 40 should be regularly do the following test:
If test results are abnormal or at risk of coronary heart disease risk factors, it should be every five years for one or more times the blood cholesterol laboratory.
Undergo an annual blood pressure check.
Blood glucose testing once a year.
If you belong to high risk of coronary heart disease, we should ask the doctor to see if in need of ECG. If you need further examination, the doctor will do an exercise test to measure the ECG step on a fixed bicycle or step on the treadmill machine.
Coronary angiography is the most certain method of diagnosing coronary artery disease.
