Mr. Wang is 48 years old and an employee of a company. I love sports and have good habits. I am physically strong and rarely catch colds. Therefore, Mr. Wang has always believed that he is very healthy. However, during the company's physical examination in February this year, an electrocardiogram revealed myocardial ischemia symptoms such as ST segment depression and T wave inversion. Therefore, Mr. Wang went to the hospital again for a chest CT scan, which revealed arteriosclerosis of the aorta and coronary arteries, as well as a linear high-density shadow in the left coronary artery pathway. However, as Mr. Wang had never experienced any discomfort such as chest tightness or pain, he did not take it to heart. Until late August, after drinking with a client, there was a feeling of tightness in the precordial area, which was relieved after resting for 3-5 minutes on its own. Considering the previous chest CT results, Mr. Wang underwent coronary CTA examination, which revealed the formation of multiple calcified plaques in the proximal segment of the left anterior descending artery (LAD), resulting in severe stenosis of the lumen (approximately 80%). Mixed plaque formation in the proximal segment of the left circumflex branch (LCX), resulting in moderate stenosis of the lumen. The doctor suggests further coronary angiography to determine the degree of stenosis in the lesion. The results of coronary angiography showed calcification in the LAD with a stenosis of about 40% in the middle segment, and severe stenosis in the middle segment of LCX with a stenosis of about 80%. Surgical treatment is required. Mr. Wang has been diagnosed with coronary heart disease.
What is coronary heart disease?
Coronary heart disease, also known as coronary atherosclerotic heart disease, is mainly due to atherosclerosis in the coronary artery that supplies blood to the heart. Simply put, the heart is like an engine with three oil pipelines, one called the anterior descending branch, one called the circumflex branch (where the anterior descending branch and the circumflex branch merge into the main trunk, called the left main trunk), and one called the right coronary artery, all of which are indispensable. But these oil pipelines will always encounter some "greasy" bad guys called "cholesterol, triglycerides, low-density lipoprotein". These bad guys often break up in groups, forming atherosclerotic plaques in the local blood vessels. Weak ones will cause stenosis, while strong ones will cause blockage.
What are the susceptible populations?
Male over 45 years old, female over 55 years old or postmenopausal, with family genetic history, dyslipidemia, mental workers, hypertension, diabetes, smoking, obesity, gout, and inactivity.
How to detect coronary heart disease early?
When you experience the following phenomena in your daily life, you should be highly vigilant and seek medical attention in a timely manner to detect coronary heart disease early.
1. Sudden pain behind the sternum or in the left chest, accompanied by sweating or radiating to the shoulders, arms, or neck when tired or nervous. 2. During physical labor, there may be palpitations, shortness of breath, fatigue, and difficulty breathing. 3. Feeling palpitations and chest pain during meals and cold weather. 4. When sleeping with a low pillow at night, feeling stuffy and needing a high pillow position. 5. Repeated occurrence of irregular pulse, tachycardia or bradycardia.
How to prevent coronary heart disease?
Coronary heart disease is related to many lifestyles. In addition to age and genetic factors, many risk factors can be altered or even reversed; If blood pressure and blood sugar can be controlled within a reasonable range; Abnormal blood lipids are related to diet. Eating less animal fat and medication can adjust the blood pressure to a normal range; Simultaneously quitting alcohol and smoking, strengthening exercise, controlling weight, maintaining a calm mindset, and managing negative emotions can all lead to a reversal. Medication prevention is the most important part of coronary heart disease, mainly referring to the ABCDE of secondary prevention of coronary heart disease. The so-called secondary prevention refers to the use of medication and non medication interventions to delay or prevent the progression of arteriosclerosis in patients with clear coronary heart disease (including those after coronary stent and bypass surgery). A: Angiotensin converting enzyme inhibitors (ACEIs) and aspirin. B: Beta blockers and blood pressure control. C: Quit smoking and lower cholesterol. D: Rational diet and control of diabetes. E: Sports and Education.
What are the treatment methods?
The treatment methods include drug therapy, interventional therapy, and surgical treatment.
1. Medication therapy: lipid-lowering therapy, including adjustments to diet and lifestyle, and medication therapy such as statins. Regularly apply antihypertensive and hypoglycemic drugs under the guidance of a physician. As long as there are no contraindications, aspirin should be taken for a long time, and those who cannot tolerate aspirin can take clopidogrel. B-receptor blockers can alleviate angina and control arrhythmia, and commonly used drugs include metoprolol sustained-release tablets. All individuals with no contraindications for coronary heart disease should take angiotensin-converting enzyme inhibitors.
2. Interventional therapy: namely percutaneous coronary intervention (PCI), which can significantly alleviate symptoms and improve quality of life. After the lesion is identified by coronary angiography, balloon dilation is performed at the severe stenosis of the coronary artery, and then stents are implanted. Through the mechanical squeezing and stretching of the atheromatous plaque on the coronary artery wall, the coronary artery is unblocked, myocardial ischemia is improved, angina pectoris is alleviated, the risk of coronary heart disease is reduced, and cardiovascular events are reduced. Its greatest advantage is that it is simple, safe, painless, minimally invasive, and has the advantages of rapid postoperative recovery, fewer complications, and less risk.
3. Cardiac bypass surgery is a treatment that establishes a vascular channel between the proximal and distal ends of coronary artery stenosis, allowing blood to bypass the narrowed area and reach the distal end. Cardiac bypass surgery can improve myocardial ischemia, alleviate angina symptoms, improve heart function, and enhance patients' quality of life.