Is coronary heart disease so serious? What should I pay attention to at ordinary times?

Coronary heart disease (CHD) refers to the disease that yellow waxy plaque accumulates in the coronary artery responsible for providing oxygen-enriched blood to the myocardium. The process of plaque accumulation in arteries is called atherosclerosis, which often lasts for many years.

The cause of disease

It has been found that coronary heart disease begins with coronary endothelial injury caused by risk factors, which include:

1. Smoking;

2. Hyperlipidemia;

3. Hypertension;

4. Hyperglycemia caused by insulin resistance or diabetes;

5. Vascular inflammation.

Plaques begin to grow when coronary arteries are damaged, even in childhood. As time goes on, the plaque will harden or rupture. Sclerosing plaque can narrow the coronary artery and reduce the blood supply to the heart, thus causing angina pectoris (chest pain or chest discomfort). If the plaque ruptures, platelets in the blood will attach to the ruptured plaque and eventually coagulate into thrombus. Thrombosis can make coronary artery narrower and angina pectoris worse. If the thrombus is large enough, it can block the coronary artery mostly or completely, thus causing myocardial infarction. (Add subscription number: yixueleichangshi medical knowledge to learn more exciting content)

clinical picture

Due to the different location, scope and procedure of coronary artery lesions, coronary heart disease can have different clinical characteristics, which are usually divided into five categories:

(1) occult or asymptomatic coronary heart disease: The patient has no clinical symptoms, but has ECG changes of myocardial ischemia. Changes of myocardial disorganization.

(2) Angina pectoris: Paroxysmal retrosternal pain, which is caused by transient myocardial blood supply insufficiency. Most of the myocardium has no morphological changes.

(3) Myocardial infarction: The symptoms are serious and often life-threatening, which is caused by coronary artery occlusion and acute ischemic necrosis of myocardium.

(4) Myocardial fibrosis: namely "ischemic cardiomyopathy", which is gradually caused by long-term myocardial ischemia. Characterized by cardiac enlargement, heart failure and/or arrhythmia.

(5) Sudden death: Death due to cardiac arrest is mostly a serious arrhythmia caused by local electrophysiological disorder of the heart or pacing and conduction dysfunction. (Add subscription number: yixueleichangshi medical knowledge to learn more exciting content)

cheque

Doctors mainly diagnose coronary heart disease according to your medical history, family history, risk factors of coronary heart disease, physical examination and some auxiliary tests. No examination can independently and definitely diagnose coronary heart disease. If your doctor thinks you have coronary heart disease, he will recommend you to have one or more of the following tests:

1. electrocardiogram

Electrocardiogram can simply and painlessly detect and record the electrical activity of the heart, show the frequency and rhythm of the heart beating, and also show the intensity and time limit of the electrical signal passing through the heart. Electrocardiogram examination can find myocardial damage caused by coronary heart disease and ECG manifestations of old or acute myocardial infarction.

2. Load test

When doing a stress test, you need to exercise to make your heart work hard and your heart beat faster, and at the same time, you should monitor your electrocardiogram. If you can't exercise, the doctor may give you some medicine to raise your heart rate. When your heart works hard, it needs more blood and oxygen. Stenosis coronary artery with plaque can't provide enough oxygen-enriched blood flow, so it can't meet the needs of the heart. Stress test can find some possible symptoms and signs of coronary heart disease, such as: ① abnormal changes in heart rate or blood pressure; ② Dyspnea or chest pain; ③ Abnormal heart rhythm or electrical activity. If you can't exercise like normal peers, your heart may not get enough oxygen-enriched blood flow. However, other factors may also affect your exercise time, such as lung disease, anemia or poor health.

Stress test can record the ECG of your heart during exercise and rest, and can reflect the blood supply and pumping of your heart. (Add subscription number: yixueleichangshi medical knowledge to learn more exciting content)

3. Cardiac color Doppler ultrasound

Color Doppler ultrasound of the heart is to obtain the moving image of the heart by ultrasonic waves, which can show the size and shape of the heart and the working state of each chamber and valve of the heart. Color Doppler echocardiography can also find areas of insufficient blood supply, abnormal contraction and old myocardial injury.

4. Chest X-ray examination

Chest X-ray examination can show the organs and structures of the chest, such as the heart, lungs and blood vessels. X-ray examination can find signs of heart failure and lung disease.

5. Hematological examination

Blood lipids, blood glucose and protein can all be detected, and abnormal values may suggest that you are at risk of coronary heart disease.

6. Electron beam CT scanning

Electron beam CT scan (EBCT) can detect coronary artery calcification. Coronary artery calcification is the early manifestation of coronary heart disease. This test helps to determine whether your risk of myocardial infarction or other heart diseases increases before symptoms and signs appear. Electron beam CT scanning is usually not used to diagnose coronary heart disease because its accuracy is not clear.

7. Coronary angiography and cardiac catheterization

If other tests show that you may have coronary heart disease, your doctor may suggest that you have a coronary angiography. This examination uses contrast media and X-rays to show the inside of the coronary artery. In order to get the contrast agent into the coronary artery, your doctor needs to do a cardiac catheterization. The doctor will implant a catheter from your arm, groin or neck, and position the catheter at the opening of the coronary artery so as to inject the contrast agent into the coronary artery.

When the contrast agent passes through the coronary artery, X-ray and contrast agent can help doctors judge the condition of heart blood vessels. Cardiac catheterization is usually performed in hospitals. You were awake during the whole examination. Except for some pain when the catheter is implanted, you will only have slight pain or even no pain at other times.

treat cordially

The treatment of coronary heart disease includes lifestyle change, drug therapy and surgical treatment. (Add subscription number: yixueleichangshi medical knowledge to learn more exciting content)

First, the purpose of treatment

1. Relieve symptoms;

2. Reduce risk factors, slow down, stop or even reverse the growth of plaque;

3. Reduce the risk of thrombosis (thrombosis can cause myocardial infarction);

4. Open occluded coronary artery (dilation or bypass);

5. Prevent complications of coronary heart disease.

Second, change your lifestyle.

Changing lifestyle is usually helpful to prevent or treat coronary heart disease. Sometimes, a healthy lifestyle is the only treatment some patients need.

1. Healthy eating

A healthy diet is the main component of a healthy lifestyle. A healthy diet can prevent or reduce hypertension and hyperlipidemia and maintain an ideal weight. If you want to know more about healthy eating, you can visit the website of American Heart, Lung and Blood Institute, which provides some practical skills for healthy eating, physical exercise and weight control.

2. Treatment of lifestyle changes

If your blood lipids are high, your doctor may suggest that you change your lifestyle. Therapeutic lifestyle changes include three parts: healthy diet, physical exercise and weight management.

(1) The daily energy from saturated fat should be less than 7%. Saturated fat exists in some meats, dairy products, chocolates, baked goods, fried and processed foods. The daily energy from all fats such as saturated fat, trans fat, monounsaturated fat and polyunsaturated fat should not exceed 25% ~ 35%. Your daily cholesterol intake should be less than 200mg. The nutrition label indicates the cholesterol content and all kinds of fat content of pre-processed food. Foods rich in soluble fiber are also part of a healthy diet, which can reduce the absorption of cholesterol in the digestive tract. This kind of food includes: ① whole grains such as oats and oat bran; 2 apples, bananas, oranges, pears, plums and other fruits; 3 beans such as green beans, lentils, chickpeas, black-eyed beans and Lima beans. A diet rich in fruits and vegetables can increase cholesterol-lowering substances in the diet, which are called plant cholesterol or plant steroids, and their effects are similar to soluble fiber. A healthy diet should also include certain fish, such as salmon, tuna (canned or fresh) and mackerel. These fish are the source of omega-3 fatty acids, which can help the heart prevent thrombosis, resist inflammation and reduce the risk of myocardial infarction. It is recommended to eat fish twice a week. Try to reduce the intake of salt. You can choose low-salt or salt-free foods and condiments. The nutrition label of food is marked with the salt content. 6. Limit the intake of alcoholic beverages. Excessive drinking will increase your blood pressure and triglyceride levels; Drinking alcohol will also increase the extra energy intake, leading to weight gain. Men should not drink more than 2 units per day, and women should not drink more than 1 unit per day. 1 unit is relative to 1 glass of wine, beer or a small amount of spirits. (Add subscription number: yixueleichangshi medical knowledge to learn more exciting content)

(2) Termination of diet therapy for hypertension (DASH) If you have high blood pressure, the doctor may recommend you to adopt DASH diet. DASH's diet plan focuses on eating fruits, vegetables, whole grains and other foods that are good for heart health and low in fat, cholesterol and salt. DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry and nuts. DASH diet plans to reduce the intake of red meat (including lean meat), candy, sweetened and sugary drinks. DASH diet is rich in nutrition, protein and fiber. Even for those who don't have high blood pressure, the DASH diet plan is a good healthy diet plan.

(3) Increasing physical exercise Daily physical exercise can reduce the risk factors of coronary heart disease, including low-density lipoprotein ("bad") cholesterol, hypertension and overweight. Physical exercise can also reduce the risk of diabetes and increase your HDL cholesterol level. High density lipoprotein cholesterol is "good" cholesterol, which helps to prevent coronary heart disease. Before you start a new exercise program, you should discuss with your doctor what kind of exercise and how much exercise is safe for you. We can benefit from 60 minutes of moderate-intensity aerobic exercise every week. The more exercise, the greater the benefit.

(4) Maintaining a healthy weight can reduce the risk of coronary heart disease. Our overall goal is to keep the body mass index below 25. The formula for calculating the body mass index is weight/height 2(kg/m2), which can estimate the total body fat. You can use NHLBI's online BMI calculator to calculate your BMI, or your doctor can help you calculate it.

Body mass index 25 ~ 29.9 is overweight and 30 is obese. Body mass index 25 is the goal of preventing and treating coronary heart disease. Your doctor or other medical personnel can help you set an appropriate target body mass index.

(5) Quit smoking If you smoke, please quit smoking. Smoking can increase the risk of coronary heart disease and myocardial infarction and worsen the risk factors of coronary heart disease. Discuss your smoking cessation plan and products with your doctor. In addition, try to avoid second-hand smoke. If you have difficulty quitting smoking by yourself, you can consider joining a quit smoking group. Many hospitals, workplaces and community groups offer courses to help people quit smoking. (Add subscription number: yixueleichangshi medical knowledge to learn more exciting content)

(6) Management stress research shows that emotional excitement is the most common trigger of myocardial infarction, especially anger. In addition, some people's ways of coping with stress, such as drinking, smoking or overeating, are unhealthy. Learning how to cope with stress and relax can improve your physical and mental health. In life, sharing your feelings or doubts with your friends and relatives can help relieve stress. Physical exercise, drugs and relaxation therapy can also help relieve stress. You can also consider taking some stress management training.

Third, medication.

If lifestyle changes are not enough to treat coronary heart disease, you may need drugs to treat coronary heart disease. Drug treatment includes:

1. Reduce the burden on the heart and relieve the symptoms of coronary heart disease;

2. Reduce the risk of myocardial infarction or sudden death;

3. Reduce cholesterol and blood pressure;

4. Prevent thrombosis;

5. Prevent or delay surgical treatment (such as angioplasty or coronary artery bypass grafting).

The drugs for treating coronary heart disease include antiplatelet drugs such as aspirin, angiotensin receptor antagonists, β -receptor blockers, calcium antagonists, statins, nitroglycerin, fish oil and other supplements rich in omega-3 fatty acids.

The purpose is to relieve symptoms and reduce angina pectoris and myocardial infarction. Delaying the development of coronary atherosclerosis and reducing the death of coronary heart disease. Standardized drug therapy can effectively reduce the mortality and ischemic events of patients with coronary heart disease and improve their clinical symptoms. For some patients with severe vascular diseases or even complete obstruction, vascular reconstruction therapy can further reduce the mortality of patients on the basis of drug treatment.

Fourth, surgical treatment.

You may need surgery to treat coronary heart disease. Angioplasty and coronary artery bypass grafting are used to treat blocked coronary arteries. You can discuss with your doctor which treatment is best for you.

The prevention of coronary heart disease should start from children, teenagers and young people.

1. No smoking.

2. Keep the blood pressure normal and stable, and the ideal blood pressure is 120/80mmHg. The prevention and treatment measures of hypertension include maintaining normal weight, limiting the intake of ethanol and salt, maintaining the appropriate intake of potassium, calcium and magnesium, and taking antihypertensive drugs under the guidance of doctors.

3. Maintain normal blood lipids and prevent hyperlipidemia. High-risk groups should have regular checkups, a low-fat diet, exercise and take lipid-lowering drugs.

4. Avoid mental stress.

5. Lifestyle with too little exercise is an important risk factor for coronary heart disease. Regular exercise helps to maintain weight and reduce the incidence of hyperlipidemia, hypertension and coronary heart disease.

6. Maintain normal blood sugar and prevent diabetes.

7. For high-risk patients with coronary heart disease risk factors (hypertension, diabetes, hyperlipidemia, etc.). ), it is recommended to take Xinxuekang for a long time to prevent coronary heart disease.