Introduction to coronary heart disease

Description: Coronary heart disease is a heart disease caused by myocardial ischemia or hypoxia (angina) or myocardial necrosis (myocardial infarction) caused by coronary artery atherosclerosis (atherosclerosis or dynamic vasospasm) stenosis or obstruction. Ischemic heart disease. Etiology: Supply of the heart of the coronary artery wall to form atheromatous plaques caused by vascular stenosis caused by heart disease. The clinical symptoms vary depending on the number and extent of coronary stenosis. The etiology of this disease has not yet been fully understood, but it is thought to be related to hypertension, hyperlipidemia, hyperviscosity, diabetes, endocrine function and age. 1. Age and gender: The incidence of coronary heart disease is higher after 40 years of age. The premenopausal incidence rate of women is lower than that of men, and it is equal to men after menopause. 2, 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) levels and the risk of coronary heart disease events. For every 1% increase in LDLC levels, the risk of coronary heart disease increases by 2-3%. Triglyceride (TG) is an independent predictor of coronary heart disease, often accompanied by low HDLC and impaired glucose tolerance, the latter two are also crowns Risk factors for heart disease. 3. Hypertension: Hypertension is closely related to the formation and development of coronary atherosclerosis. Systolic blood pressure is more predictive of coronary heart disease than diastolic blood pressure. The systolic blood pressure of 140-149 mmhg is more likely to increase the risk of death from coronary heart disease than the diastolic blood pressure of 90-94 mmhg. 4. Smoking: Smoking is an important risk factor for coronary heart disease and is the single most avoidable cause of death. There is a significant dose-response relationship between coronary heart disease and smoking. 5. Diabetes: Coronary heart disease is the leading cause of death in underage diabetic patients. Coronary heart disease accounts for nearly 80% of all death causes and hospitalization rates of diabetic patients. 6, obesity: has been identified as the primary risk factor for coronary heart disease, can increase coronary heart disease mortality. Obesity was defined as body mass index (BMI = weight (kg) / height square (m2)) in men >= 27.8, women >= 27.3. BMI was positively correlated with TC, TG, and HDL-C decline. 7, sedentary lifestyle: people who do not love sports, the risk of coronary heart disease and death will double. 8, there are still inheritance, drinking, environmental factors and so on. Symptoms: First, clinical symptoms: According to its clinical symptoms, coronary heart disease can be divided into 5 types: 1, angina type: manifested as the feeling of crushing behind the sternum, swell feeling, accompanied by obvious anxiety, lasting 3 to 5 minutes, Often spread to the left arm, shoulder, lower jaw, throat, back, but also to the right arm. Sometimes these parts can be affected without affecting the posterior sternal area. Exercising, emotional, cold, full meal, etc., increased the onset of myocardial oxygen consumption called labor angina, rest and nitroglycerin relief. Sometimes angina is not typical, it can be expressed as tightness, syncope, weakness, belching, especially in the elderly. According to the frequency and severity of the attack, it is divided into stable and unstable angina. Stable angina refers to exertional angina pectoris with more than one month of attack. The location, frequency, severity, duration of the attack, the amount of labor that induces the attack, and the amount of nitroglycerin that can relieve pain are basically stable. Unstable angina refers to the frequency, duration, and severity of the original stable angina pectoris, or new onset of exertional angina (within 1 month), or angina at rest. Unstable angina is a precursor to acute myocardial infarction, so go to the hospital immediately if you find it. 2, myocardial infarction type: a week before the infarction often have prodromal symptoms, such as resting and mild physical activity when the onset of angina, accompanied by obvious discomfort and fatigue. Infarction manifests as persistent intense pressure, suffocation, and even knife-like pain. It is located behind the sternum and often spreads throughout the chest, with the left side as the weight. Some patients can extend the left arm to the ulnar side, causing tingling in the left wrist, palm and fingers. Some patients can radiate to the upper limbs, shoulders, neck, and lower jaw, mainly to the left. The pain site is consistent with the previous angina pectoris, but lasts longer, the pain is heavier, and rest and nitroglycerin do not relieve. Sometimes it manifests as pain in the upper abdomen and is easily confused with abdominal diseases. Accompanied by low fever, irritability, sweating and cold sweat, nausea, vomiting, palpitations, dizziness, extreme fatigue, difficulty breathing, sudden death, lasting more than 30 minutes, often for several hours. If you find this condition, you should see a doctor immediately. 3, asymptomatic myocardial ischemia: Many patients have extensive coronary artery occlusion but did not feel angina, and even some patients did not feel angina in myocardial infarction. Some patients have sudden cardiac death, which was discovered after a myocardial infarction was found during routine physical examination. Some patients have arrhythmia due to an ischemic manifestation of the electrocardiogram, or coronary angiography because of a positive exercise test. This type of patient has the same chance of sudden cardiac death and myocardial infarction as patients with angina, so you should pay attention to your usual heart health. 4, heart failure and arrhythmia type: some patients have angina pectoris, after the extensive lesions, extensive myocardial fibrosis, angina gradually reduced to disappear, but the appearance of heart failure, such as tightness, edema, fatigue, etc. A variety of arrhythmia, manifested as palpitations. Some patients have never had angina, but directly manifested as heart failure and arrhythmia. 5, sudden death type: refers to the unpredictable sudden death caused by coronary heart disease, caused by cardiac arrest within 6 hours after the onset of acute symptoms. Mainly due to ischemia caused myocardial cell electrophysiological activity abnormalities, resulting in severe arrhythmia. Second, physical signs: generally no clear positive signs in the early stage, the heavier ones may have the heart to the left to expand, the first heart sounds weakened, there may be arrhythmia when you can hear premature beats, atrial fibrillation, etc., combined with heart failure, two lungs can be Smell the wet rales, the apex can be heard and galloping. Diagnosis: Coronary heart disease is a common and frequently-occurring disease in middle-aged and elderly people. In daily life, if you have any of the following conditions, you should seek medical advice promptly and find coronary heart disease as soon as possible. (1) When tired or mentally stressed, there is pain in the back of the sternum or in the anterior region, or contraction-like pain, and radiate to the left shoulder and left upper arm for 3-5 minutes. (2) Chest tightness, palpitations, shortness of breath, and self-relief during rest. (3) There are headaches, toothaches, and leg pains related to exercise. (4) Chest pain and heart palpitations when eating a meal, being cold, or watching a thriller. (5) When the sleep pillow is low at night, feel chest tightness and suffocation, need to be comfortable in the high lying position; when sleeping, or when lying down in the daytime, suddenly chest pain, palpitations, difficulty breathing, need to sit up or stand immediately to relieve. (6) Pain, chest tightness, shortness of breath or chest pain discomfort during sexual life or forced bowel movements. (7) Hearing noise can cause palpitation and chest tightness. (8) Repeated pulse irregularities, unexplained tachycardia or slow. It should be differentiated from myocarditis, hypertrophic obstructive cardiomyopathy, pericarditis, pleurisy, etc. 1. Myocarditis Myocarditis refers to acute, subacute or chronic inflammatory lesions in the myocardium that are localized or diffuse. The relative incidence of viral myocarditis has increased in recent years. The severity of the disease is different, the performance is very different, the infants and young children are more severe, the adults are lighter, the lighter can have no obvious symptoms, and the severe ones can be complicated by severe arrhythmia, cardiac insufficiency or even sudden death. For the prodromal symptoms of acute or subacute myocarditis, the patient may have fever, fatigue, sweating, palpitation, shortness of breath, and pain in the precordial area. Check for arrhythmias such as contraction and conduction block before the visible period. Aspartate aminotransferase, creatine phosphokinase increased, and erythrocyte sedimentation rate increased. Electrocardiogram and X-ray examination are helpful for diagnosis. Treatment includes rest, improving myocardial nutrition, controlling cardiac insufficiency and correcting arrhythmia, and preventing secondary infections. 2, pericarditis pericarditis can be divided into acute pericarditis, chronic pericarditis, constrictive pericarditis, patients may have fever, night sweats, cough, sore throat, or vomiting, diarrhea. Acute heart tamponade can occur when the pericardium quickly exudes a large amount of fluid. The patient has chest pain, difficulty breathing, cyanosis, pale complexion, and even shock. There may also be ascites, hepatomegaly and other symptoms. 3, pleurisy pleurisy, also known as "pleural inflammation", is inflammation of the pleura. After the inflammation subsides, the pleura can return to normal, or two layers of pleura adhere to each other. Caused by a variety of causes, such as infections, malignant tumors, connective tissue disease, pulmonary embolism. Tuberculous pleurisy is the most common type. In dry pleurisy, a small amount of fiber exudation appears on the surface of the pleura, which is characterized by severe chest pain, which is like a needle-like shape. Examination can reveal changes in pleural friction. In exudative pleurisy, with the increase of exudate in the pleural cavity, chest pain is weakened or disappeared, and patients often have cough and may have difficulty breathing. In addition, there are often systemic symptoms such as fever, weight loss, fatigue, and loss of appetite. Examination can reveal the performance of heart and lung compression. In the case of a large amount of pleural fluid, it can be found by chest examination and X-ray examination. The treatment of tuberculous pleurisy mainly includes tuberculosis drug treatment; accelerate the absorption of pleural fluid, and if necessary, pumping treatment; prevent and reduce pleural thickening and adhesion, and use adrenal cortex hormone. Pleuritis is inflammation of the pleural wall and visceral layers caused by various causes. Most of them are lesions secondary to the lungs and chest, and can also be local manifestations of systemic diseases. There are many types of clinical pleurisy, most common with tuberculous pleurisy. There is a special quantitative differential diagnosis method for hyperthyroidism, rheumatic heart disease and coronary heart disease: hyperthyroidism (referred to as hyperthyroidism), rheumatic heart disease (referred to as rheumatic heart disease), coronary atherosclerotic heart disease (referred to as coronary heart disease) is Three different types of heart disease, but in a certain period of disease, their performance is quite similar, which is easy to cause misdiagnosis and mistreatment. Complications: 1. Papillary muscle dysfunction rate of cattle up to 50% c on the onset of 5dJ scoop, apical area heard contraction of small late clicks and loud hairy systolic murmur, severe disorders leading to left heart failure. 2. The incidence of papillary muscle rupture is 1%, multiple within 3 days, and the mortality rate is high. The apical area hears a loud squeezing murmur, the first heart sounds weakened, severe heart failure and/or cardiogenic shock, and pulmonary edema can occur rapidly. 3. Cardiac rupture is rare, and most of them are ruptured free wall of the ventricle. Causes acute pericardial hemorrhage, acute pericardial tamponade and quenching, often occurs about 1 week after onset. Read more...