I always have chest pain at night. What may be the causes?

A piece of information about how to deal with chest pain has been circulated repeatedly in the circle of friends, appearing again and again like a catwalk. As a cardiologist, I also receive inquiries time and time again from classmates, relatives, and friends. Is this true?

I have chest pain at night, what should I do?

This is really a rumor, I want to vomit. In the end, it was simplified directly into one sentence: "Why don't you lie down? And you insist on never lying down? What should I do? Prepare to sit up and ascend to heaven? Do you have to take an ambulance and a hospital?"

After vomiting out , we still need to take this rumor seriously.

There is never a fixed pattern in the treatment of disease. Everyone is an independent and specific individual. Rushing to use overall "experience" to set up each case will only harm others and yourself.

Nighttime chest pain, especially chest pain during sleep, is really mostly caused by coronary heart disease. Generally speaking, the reasons are as follows: 1. Drugs used daily to treat coronary heart disease may cause symptoms if they are taken during the day and the drug metabolism is completed at night; 2. The tension of the vagus nerve increases at night and the blood vessels constrict, causing the blood supply of the originally narrow blood vessels to further decrease. However, patients with different underlying diseases who have chest pain symptoms at night must not take medicine casually to avoid delaying subsequent treatment or even aggravating the condition.

Let’s analyze what kind of patients should do if they have chest pain?

1. First, there are patients with a high probability of coronary heart disease.

In fact, the original meaning is the same. The core of coronary heart disease is that the coronary arteries are narrowed and the blood supply cannot meet the oxygen demand of the heart itself. Myocardial cells are hypoxic and produce inflammatory transmitters, which stimulate nerves and cause pain. The degree of pain is usually related to the severity of the lesion. Short-term insufficient blood supply is called angina, and complete occlusion of blood vessels is called myocardial infarction.

So "severe pain can wake you up", indicating that myocardial infarction may have occurred. What to do at this time? The correct answer is to first obtain the patient's vital signs. Almost all patients with a history of heart disease have their own blood pressure monitor. At this time, the blood pressure and pulse frequency of both upper limbs need to be measured (the key point, must be both sides) and recorded. If your blood pressure is higher than 90/60mmHg, you can take 1-2 nitroglycerin tablets and isosorbide dinitrate tablets sublingually. (Nitroglycerine needs to be stored in a sealed environment away from light. No matter how much is left after 3 months of use, it needs to be replaced with a new drug. In order to save money, the efficacy cannot be delayed.) And quickly call 120 for help.

While waiting for emergency personnel to arrive, comfort the patient, try to stay supine or seated, and reduce movement. At the same time, collect and organize the patient's past medical history (hypertension, diabetes, cerebral infarction, etc.). ) and medicines you take on a daily basis (both packaging and instructions are acceptable). If you have been hospitalized before (any illness is acceptable), having a complete copy of your medical records will be of great help. And record the onset time. If possible, measure the patient's blood pressure every 5 minutes (regardless of which side the measurement is higher). until emergency personnel arrive.

2. According to probability calculation, he is a patient with normal hypertension. The greatest harm caused by high blood pressure to the body is systemic arteriosclerosis. From the thickest aorta, which is directly connected to the heart, to the capillaries, the vascular endothelium can become "hard and brittle" due to excessive pressure. But if the pressure is too great, the brittle parts can easily break and tear. In some cases, there is a "sandwich" between the blood entering the intima and the middle layer of the blood vessel, and in some cases, the entire blood vessel wall can rupture and bleed.

Patients with hypertension usually experience chest pain at night. The first thing to do is to measure the blood pressure of both upper limbs. If the blood pressure difference between the two sides is large (>40mmHg is a clear indication), aortic dissection is highly suspected. After dialing 120, the patient still needs to maintain a comfortable position (preferably lying flat) to reduce activity, and can take short-acting antihypertensive drugs (such as captopril, nitrendipine). At the same time, the patient's medical history, medications, and past medical information are compiled and waited for the arrival of emergency personnel.

3. Two relatively rare types of patients, including pulmonary embolism, spontaneous pneumothorax and even more rare digestive system symptoms. Let’s mainly talk about the first two.

Pulmonary embolism, also called pulmonary embolism, has a very clear meaning. Some emboli (mostly venous thrombosis in the lower limbs) block the pulmonary artery, preventing the blood from carrying out gas exchange smoothly. This disease mainly manifests as chest tightness and shortness of breath, and some patients may also experience chest pain.

If a patient usually has a history of varicose veins in the lower limbs, edema of the lower limbs, or even malignant tumors, and suddenly has chest pain at night, all the family can do at this time is to call 120, measure vital signs, understand the medical history, and take medication. Diagnosis must be checked.

Spontaneous pneumothorax is more common in patients who are slim, thin, or obese and have a history of respiratory diseases such as bullae, emphysema, and chronic obstructive pulmonary disease. The chest pain of pneumothorax is shallow, obviously related to respiratory activity, and is often accompanied by shortness of breath, cyanosis, etc. The family can do the same at this time as they would with a pulmonary embolism. Diagnosis also requires physical examination and auxiliary examinations.

Finally, be careful to refute rumors and try to eliminate barbs.

Let’s talk about two major principles first. If your blood pressure is low, not only lower than 90/60mmHg, but even if it is much lower than usual, you cannot take nitroglycerin; if you have aortic dissection, taking aspirin may cause a major bleeding disaster.

1. You said that patients with coronary heart disease account for the majority. After the ambulance arrives, they will listen to their blood pressure, do an electrocardiogram, and chew aspirin. Wouldn't it be more advantageous if I gave it first? The reality is this. Even in hospitals with "chest pain center" qualifications, there is still a possibility of misdiagnosis in the differential diagnosis of chest pain. And chewing aspirin works by destroying the intestinal membrane of the tablet, allowing it to be released as quickly as possible. The fastest it takes is about 2 hours. Currently, first aid capabilities can be reached in about 15 minutes in the middle of the night. It will be much more practical to administer medication once you have a certain foundation for the exam.

2. Even if I unfortunately get dissection, can't you just do emergency surgery? Yes, but it takes time to transfer to another hospital, re-examine, confirm the diagnosis, talk about surgery, and prepare for surgery. There are a lot of people who refuse to accept the aspirin sandwich break. Who can guarantee that God will take such good care of you and that you can persist until the surgery begins after taking that load of aspirin?

3. How about Salvia miltiorrhiza dropping pills? How many pills can I take? No problem, but not very helpful. How about Suxiao Jiuxin Pill? The name is so naughty, why didn’t you mention it? Indeed, a good name does not necessarily mean that the medicine is effective. The "refreshing" feeling when taking these two drugs will indeed make patients feel more comfortable, but this is the effect of the "borneol" in the ingredients. Moreover, there is an article in the instruction manual of nb Suxiao Jiuxin Pill, the excerpt is as follows: 4. If angina attacks persist during treatment, nitrate drugs should be added.

So why not just take nitrates for better results?

4. Let’s call 120 for a small matter. Don’t we want to avoid troublesome doctors and family members? If you take medicine, it won't hurt. Can't you go see it the next day? Sudden chest pain at night is usually critical. Even if the symptoms have eased by the time you get to the hospital, you cannot take it lightly. The emergency department will do some tests to evaluate your condition. If you need to stay for observation or be hospitalized, we will communicate with you repeatedly. Fighting the disease or insisting on refusing further testing may mean you are on the road to no return.

I believe that many people with angina pectoris should know this, that is, the frequency of angina pectoris attacks is often higher at night than during the day, which makes many patients wonder why angina pectoris is more likely to occur at night. How to prevent angina pectoris at night? Angina patients should read this article. These methods are very effective. Learn quickly!

Why do heart attacks and angina pectoris tend to occur at night? It is related to these three factors

Why does angina pectoris tend to attack at night?

First, angina pectoris is easy to attack at night, because Chinese families usually have a big dinner, and there are a lot of things in the stomach after the meal, which makes people feel difficult to breathe. For people to digest so much food, they must have more blood to supply the digestive system for related operations. This not only increases the burden on the heart, but also reduces the blood supply to the coronary arteries, easily causing angina or myocardial infarction.

Second, people often watch TV in the evening to entertain themselves. Many scenes during watching TV will make people extremely excited, which will excite the body, keep blood pressure rising, and cause coronary artery spasm, causing myocardial ischemia, which will naturally lead to a higher incidence of angina pectoris.

Third, after a person falls asleep at night, the body's blood pressure will be about 20% lower than during the day. Some patients will take antihypertensive drugs before going to bed, so the blood pressure will be further reduced and the blood flow will be particularly slow. , the heart is prone to insufficient blood supply, so it is normal for the frequency of angina pectoris to be particularly high.

How to prevent angina pectoris at night?

First, when people sleep at night, try not to be stimulated and have too much mood swings.

Second, don’t eat too much when eating, especially don’t go to bed immediately after eating.

Because if you sleep after eating, the blood will be concentrated in the digestive tract, and the blood in other parts will be relatively reduced, which can easily cause angina pectoris.

Third, people should drink a cup of hot milk before going to bed, which can not only supplement the nutrients needed by the body, but also help people fall asleep quickly. In addition, the most important thing is to reduce blood viscosity so that angina will not occur.

For diseases such as angina pectoris, people must pay attention to taking good care of themselves in daily life, and pay special attention at night, because attacks at night are really a great threat to their lives.