Prevention and treatment strategy of patients with coronary heart disease
Expert introduction:
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Li Zhijun
Director of Cardiology, Changji Prefecture People’s Hospital
Member of the Communist Party of China, a bachelor’s degree, chief physician
Member of the Xinjiang Medical Association Hypertension Professional Committee
Chairman of the Cardiovascular Professional Committee of the Xinjiang Medical Association Cardiovascular Professional Committee
He graduated from the Department of Medicine of Shihezi University in 1988 and has been engaged in clinical work in the Department of Internal Medicine at the Changji Prefecture People’s Hospital. He has repeatedly studied and professional studies, and has accumulated rich clinical and teaching experience. He is good at diagnosis and treatment of cardiovascular disease, hypertension, and blood lipid disorders. He has rich clinical experience in the diagnosis and treatment of cardiovascular dysfunction and the rescue of critical patients. Two prizes in the third prize, published more than 10 papers in the provincial core journals. He has been awarded many honors such as the “Baihu Eun Medical Workers of the Autonomous Prefecture”, “State -level Young Jobs”, a top -level talent at the hospital, an advanced communist, an excellent Communist Party member, an excellent middle -level cadre, an excellent teaching teacher.
The heart is a very important organ of the human body. If there is a problem with the heart, it will bring great harm to our body. One of the most likely diseases that the heart is most likely to occur is coronary heart disease. At present, at least 10 million coronary heart disease in my country Patients, 7.7 of each 1,000 people suffer from coronary heart disease, and 986 people died of coronary heart disease every 100,000 people. Coronary heart disease was around us. Therefore, the prevention and treatment of coronary heart disease became very important.
First of all, we need to know what coronary heart disease is. Coronary atherosclerotic heart disease (referred to as coronary heart disease) is the occurrence of motility of motorized lesions in the coronary arteries, causing vascular stenosis, spasm, or obstruction, causing myocardial ischemia, hypoxia, or hypoxia or Heart disease caused by necrosis is often called “coronary heart disease”. However, the scope of coronary heart disease may be wider, and it also includes inflammation and embolism that causes narrow or occlusion of the lumen. The World Health Organization divides coronary heart disease into 5 categories: asymptomatic myocardial ischemia (hidden coronary heart disease), angina pectoris, myocardial infarction, ischemic heart failure (ischemic heart disease) and sudden death. Clinically, it is often divided into stable coronary heart disease and acute coronary artery syndrome.
The general symptoms of coronary heart disease will occur in the back of the sternum or the front area of the heart, and sometimes it will involve the shoulder, the inner side of the left arm, the finger and the pharynx, and the pain can be manifested as burning, sour, tightening or dullness, and will be emotional due to emotions due to emotions. Very fluctuating, strong physical activity, full meals and other pains. Generally, 3-5 minutes can relieve pain. If the attack is frequent and durable for a long time, you need to be alert to “acute myocardial infarction”. Comfortable.
Many patients at work will ask, can coronary heart disease be cured? In fact, coronary heart disease is a disease caused by multiple risk factors, such as age, gender, and genetic factors. These are unchanged, so coronary heart disease is currently irreversible. However, some risk factors can be prevented and changed, such as smoking, hypertension, hyperlipidemia, diabetes, overweight and obesity, insufficient exercise, excessive mental stress, diet and alcohol.
Studies have shown that the first -level prevention effect of coronary heart disease has decreased greater than the relative risk of secondary prevention. Therefore, many experts suggest that the sooner the prevention, the better. The purpose of the first -level prevention of coronary heart disease is to prevent the disease, while the first -level prevention includes the intervention of lifestyle and drug treatment.
First of all, let’s talk about the intervention of lifestyles. The changes in lifestyle can start from several aspects to actively control risk factors:
1. Studies on smoking quitting have found that the incidence and mortality of smokers with coronary heart disease increased by 2-6 times. Although there are many types of coronary heart disease, smoking is a common risk factor for different types of coronary heart disease. Smoking is also an acute myocardial infarction. One of the risk factors, clinical medical experiments show that in the case of the total blood cholesterol concentration of human blood exceeding 5.3 mmol/L, the probability of smoking and the probability of coronary heart disease is a positive correlation. The probability of cardiac disease is 3.87 times that of no smoking group. At the same time, smoking can also increase the mortality of patients with coronary heart disease, an increase of 20%to 70%. Why the first thing to be asked for patients to do is to quit smoking, because smoking can damage arterial endothelial function, promote abnormal lipid metabolism, cause oxidation stress reaction, increase hypertension, interact with drugs, and also affect cardiac qualification nerve functional function Restore, so advise patients to quit smoking early for the health of themselves and their families.
2. A large number of high blood pressure studies have shown that hypertension can damage arterial endothelials and cause atherosclerosis, and accelerate the process of atherosclerosis. The higher the level of blood pressure, the heavier the degree of arteriosclerosis, and the higher the risk of death at coronary heart disease.
Similarly, hypertension can cause myocardial infarction. When the coronary pathogens are existed, the increase in blood pressure may trigger the rupture of porridge hardrobe plaque, thrombosis, blocking coronary veins, and cause acute myocardial infarction. Therefore, good control of hypertension can prevent coronary heart disease, reduce the seizures of coronary heart disease and prevent accidents from occurring.
3. Potal cholesterol, triglyceride, low -density lipoprotein (LDA) or extremely low density lipoprotein, high density lipoprotein and lipoprotein A, and increased lipoprotein are risk factors for coronary heart disease. High cholesterol hemorrhine can damage arterial endothelial cells, swell and exfoliative endothelial cells, increase vascular permeability, hyperplasia in the middle layer of smooth muscle cells, cholesterol can be deposited in the endometrium through the endometrium of the damage, becoming a slightly bulging lesion. The endometrial fibrous tissue hyperplasia, surrounds and fix the lesion, forms porridge plaques. The deep layers of the plaques can soften and ulcer, forming yellow porridge -like substances. Fiber caps are wrapped in a large amount of lipids (lipid nucleus) and extended to the middle membrane of the tube wall when the volume of the plaques increased to the tube wall, which can destroy the muscle fiber and elastic fiber of the tube wall, and replace the connective tissue and hyperplasia of the newborn capillaries. The surface of the plaque may occur, and its rough surface is prone to cause blood thrombus. The formation of wall thrombus can cause the lumen to narrow or occlude. Fiber caps with thin and large liposuction are unstable plaques, which are easily ruptured and acute formation of thrombosis. Hypersemipermia is not only one of the causes of atherosclerosis, but also a risk factor that promotes the increase in platelet activity and the formation of thrombosis. Blood lipids increase, the incidence of coronary heart disease has also increased, and the increase in blood lipids is positively correlated with the incidence of coronary heart disease, mortality, and severity of the disease. Patients with high cholesterol hemophilia have increased by 5 times that their coronary heart disease risks are normal than those with normal blood lipids. It is also critical to actively control blood lipids. 4. Diabetes coronary heart disease and diabetes are complementary. Coronary heart disease is a complication of diabetes, and diabetes is also a prone factor for coronary heart disease. The chance of coronary heart disease in diabetic patients is 4 times that of non -diabetic patients. When diabetes is often severe, the latter is severe, the prognosis is poor, and the mortality rate is high. Sample sclerosis and stenosis are also heavier; painless myocardial infarction in patients with diabetes is more common, which is about twice as much as non -diabetes combined with coronary heart disease. Such patients have no chest pain due to myocardial infarction and are easily misdiagnosed; diabetes after myocardial infarction with myocardial infarction The area of the infarction is generally large, and it is prone to severe cardiac insufficiency. Heartogenic shock, heart rupture, sudden death and severe arrhythmia. Therefore, for patients with diabetes, in addition to actively controlling blood sugar, we must also actively control other controllable risk factors.
5. Obesity and overweight large amounts of data show that the average weight of patients with coronary heart disease is higher than those of non -coronary heart disease, and the incidence of coronary heart disease in obese people is higher, especially in the short term or severe obesity. This is because the obese people have too much calories. While the weight gain, the heart load and blood pressure increased, which increases myocardial oxygen consumption. Excessive dietary calorie has increased cholesterol, triple fat, and increased blood pressure, promoting the formation and aggravation of coronary atherosclerosis. At the same time, the physical activity of obese people gradually became less, which prevented the formation of coronary atherosclerotic sidewalk circulation. Moreover, obese people often weaken the biological effects of insulin, and the body of the obese people resists insulin, which is easy to form diabetes. Diabetes, hyperlipidemia, and hyperfibin ledmia are all risk factors for atherosclerosis, so coronary heart disease is also prone to.
6. Insufficient exercise has shown that regular and appropriate exercise can reduce the risk of coronary heart disease. The study of the incidence of different occupations shows that professional personnel who have been sitting for a long time have become potential people with high coronary heart disease. Compared with active activities, the relatively risks of coronary heart disease increased by 1.9. The crowd of crowds engaged in secondary sports activities is one -third reduced than those with less activity. The lack of physical activity is a very important independent risk factor that leads to coronary heart disease, and each patient can change this factor and play a role that can not play medicine. Less physical activity, gain weight, and lipid metabolism disorders; long -term sitting can easily cause endocrine disorders, increased levels of catecholamine and corticosteroids, increased blood pressure, coronary endothelial cell damage; long -term meditation will cause coronary arteries to relax function Negative Effects. Therefore, proper participation in sports can effectively reduce blood sugar, reduce “bad” cholesterol content, increase “good” cholesterol content, effectively delay the process of coronary atherosclerosis, and reduce the risk of cardiovascular disease death.
7. Excessive pressure of the survey, a study of 200 middle-aged people aged 46-55 shows that negative psychological emotions such as depression, anxiety and resentment will cause damage to the heart. Each of these factors rose 1 point, the risk of angina pectoris increased by 5 percentage points. Negative emotions bring a pathogenic chemical -inflammatory protein. Inflammatory protein can cause damage to vascular endothelial cells, induces the synthesis and release of adhesion molecules and inflammatory factors, aggravate the response of vascular inflammation, and induce endothelial cell apoptosis. Vascular endothelial damage is not only the beginning of atherosclerosis, and it is also a variety of hearts. The basis of the occurrence and deterioration of vascular disease. Medical experts analyze that in those who have negative emotions, higher inflammatory protein content can be found. This continuous inflammation involving the entire cardiac system has an important impact on the induced angina pectoris of coronary heart disease.
8. The diet with a good diet is the golden key to open the door of health. According to the 2016 dietary guide, whether it is patients with coronary heart disease or ordinary public, they must be diverse. Eat fruits and vegetables, milk, soybeans, eat fish, poultry, eggs, lean meat, and less salt and less oily. It is easy to induce acute heart incidents. Patients with coronary heart disease should not drink alcohol. If you drink alcohol, it is necessary to drink an appropriate amount. Men do not exceed 25 grams of alcohol per day, and women do not exceed 15 grams.
Adhere to the appropriate amount of exercise, quit smoking and restriction, control weight, scientific diet is the prerequisite for therapy of coronary heart disease. In addition to lifestyle intervention, patients with coronary heart disease also need to actively cooperate with drug treatment, because once patients with coronary heart disease are diagnosed, drug treatment needs Maintain for life. Commonly used drugs include the following categories: antiplatelet preparations, such as aspirin, clopidogrera, etc., Bloodylidaic drugs, such as Atorvanda, Sippedin, etc.; ? -D receptor blockers, commonly used as Metolol, Betholol, etc. Vascular tensional converting enzymes/dynasties, such as Fushezuli, Pelich, Elyshadam, oscearta, etc. Calcium channel blockers, such as Dilozozo.
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In daily work, many patients do not understand his drugs very well. Here we will simply share it. He is a kind of cholesterol biological synthetic enzyme inhibitor, which can reduce the synthesis of cholesterol in the liver, reduce “bad” cholesterol, make soft plagues Hard -stiff, the hard spot is smaller, relieves the symptoms of angina pectoris, and reduce the occurrence of cardiovascular disease is a cornerstone drug to reduce the risk of coronary heart disease. Studies have confirmed that for patients with coronary heart disease, taking a sufficient amount of Heine 4.9 years will not only significantly reduce cardiovascular incidents, but also reduce the risk of stroke. The effect of lipids in his lipids is related to dose. Coronary heart disease patients can obtain a powerful blood vessel protection effect in sufficient use of statins. Compared with lower intensity, high -strength statins (such as Atropine 40mg/day) are treated. A summary of the 58 Bestein Studies, it was found that the decrease in myocardial infarction and cerebral infarction is related to the length of the treatment time for his treatment. The longer the treatment time of his treatment, the greater the proportion of myocardial infarction and cerebral infarction. ,long. Similarly, a large number of research and real world data show that Hisatin has good liver, kidney and muscle safety.
There are many ways to prevent coronary heart disease, but not all coronary heart disease prevention methods are effective for anyone, mainly because everyone’s physical fitness is different, the merging disease is different, and the individual differences are large. It determines that the treatment of patients with coronary heart disease is different. Only by combining the actual situation of the patient’s itself, effective risk control can be determined to determine personalized treatment solutions. Patients need to actively cooperate with medical staff, timely treatment, prevent deterioration, extend life, and improve life treatment.
The above is the introduction of coronary heart disease content. There are many ways to prevent coronary heart disease. Coronary heart disease is greater than treatment, so everyone must pay attention to the prevention of coronary heart disease. The above are some personal views, for reference only.
