Coronary heart disease is the abbreviation for coronary artery disease, which is the most common type of heart disease. It refers to myocardial dysfunction and/or organic lesions caused by coronary artery stenosis and insufficient blood supply, and is also known as ischemic cardiomyopathy. Coronary heart disease is one of the diseases with the highest mortality rate worldwide. According to a report by the World Health Organization, China ranks second in the world in terms of the number of deaths from coronary heart disease. Due to abnormal lipid metabolism, the lipid in the blood is deposited on the originally smooth intima of the artery, and some atherosclerotic lipid substances accumulate in the intima of the artery to form white plaques, which are called atherosclerotic lesions. These plaques gradually increase, causing narrowing of the arterial lumen and obstructing blood flow, leading to heart ischemia and angina pectoris. If plaques on the arterial wall form ulcers or rupture, blood clots will form, completely interrupting blood flow to the entire vessel, leading to acute myocardial infarction and even sudden death. The rare pathogenesis of coronary heart disease is coronary artery spasm (blood vessels may not have atherosclerosis), which produces variant angina pectoris. If the spasm lasts for more than 30 minutes, it will also lead to acute myocardial infarction (even sudden death).
Clinically, according to the degree and number of coronary atherosclerosis stenosis, we should also consider whether the patient has basic diseases such as hypertension and diabetes, as well as factors inducing the disease such as obesity and bad living habits. Coronary heart disease can be divided into 5 types, as follows:
1. Angina pectoris type
manifested as a squeezing and swelling sensation behind the sternum, accompanied by obvious anxiety, lasting for 3 to 5 minutes, often radiating to the left arm, shoulder, jaw, throat, back, and can also radiate to the right arm Sometimes these areas can be affected without affecting the posterior sternum. The onset of exertional angina, characterized by increased myocardial oxygen consumption due to exertion, emotional excitement, exposure to cold, overeating, etc., is relieved by rest and nitroglycerin supplementation. According to the frequency and severity of attacks, angina pectoris can be classified into stable and unstable types Stable angina refers to exertional angina that occurs for more than a month. The location, frequency, severity, duration, intensity of the induced attack, and the amount of nitroglycerin used to relieve pain are generally stable. Unstable angina refers to an increase in the frequency, duration, and severity of previously stable angina attacks, or a new onset of exertional angina (occurring within one month), or angina that occurs at rest.
2. Myocardial infarction type
There are often prodromal symptoms about a week before the infarction occurs, such as angina pectoris that occurs during rest and mild physical activity, accompanied by obvious discomfort and fatigue. During infarction, it presents as a persistent and intense feeling of compression, stuffiness, and even knife like pain, located behind the sternum, often spreading throughout the entire anterior chest, with the left side being the most severe. Some patients may radiate downwards from the ulnar side of the left arm, causing a tingling sensation in the left wrist, palm, and fingers. Some patients may radiate to the upper limbs, shoulders, neck, and lower jaw, mainly on the left side. The pain site is the same as the previous angina site, but it lasts longer and is more severe. Rest and nitroglycerin cannot relieve it.
3. Asymptomatic myocardial ischemia (hidden coronary heart disease)
Many patients have extensive coronary artery occlusion but have not experienced angina, and some patients even do not feel angina during myocardial infarction. Some patients experienced sudden cardiac death, which was only discovered during routine physical examinations after the discovery of myocardial infarction.
4. Heart Failure and Arrhythmia Type
Some patients may have pre-existing angina attacks, but later due to extensive lesions and fibrosis of the myocardium, angina gradually decreases and disappears. However, they may exhibit symptoms of heart failure, such as shortness of breath, edema, fatigue, and various arrhythmias, manifested as palpitations Some patients have never had angina pectoris, but directly present with heart failure and arrhythmia.
5. Sudden death type
refers to unpredictable sudden death caused by coronary heart disease, resulting in cardiac arrest within 6 hours after the onset of acute symptoms. Mainly due to ischemia causing abnormal electrophysiological activity of myocardial cells, resulting in severe arrhythmia.