Coronary heart disease, the full name of which is coronary atherosclerotic heart disease, includes heart-induced diseases such as myocardial infarction, myocardial ischemia and premature beats. Hypertension is mainly caused by the increase of diastolic blood pressure or systolic blood pressure. People with coronary heart disease may not have high blood pressure, which has nothing to do with blood pressure. People with hypertension may not have coronary heart disease. These two diseases are not the same.
Coronary heart disease generally refers to coronary atherosclerotic heart disease.
Coronary atherosclerotic heart disease is a kind of heart disease caused by coronary artery stenosis or obstruction, resulting in myocardial ischemia, hypoxia or necrosis, which is often called "coronary heart disease". However, the scope of coronary heart disease may be wider, including inflammation, embolism and other causes of lumen stenosis or occlusion. The World Health Organization classifies coronary heart disease into five categories: silent myocardial ischemia (occult 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 syndrome.
hypertension refers to a clinical syndrome characterized by the increase of systemic arterial blood pressure (systolic pressure and/or diastolic pressure) (systolic pressure ≥14 mm Hg, diastolic pressure ≥9 mm Hg), which may be accompanied by functional or organic damage of heart, brain, kidney and other organs. Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. The blood pressure of normal people fluctuates within a certain range with the changes of internal and external environment. In the whole population, blood pressure level gradually increases with age, especially systolic blood pressure, but after 5 years old, diastolic blood pressure shows a downward trend, and pulse pressure also increases. In recent years, people's understanding of the role of multiple risk factors of cardiovascular disease and the protection of heart, brain and kidney target organs has been deepened, and the diagnostic criteria of hypertension have been constantly adjusted. At present, it is believed that patients with the same blood pressure level have different risks of cardiovascular disease, so the concept of blood pressure stratification has emerged, that is, patients with different risks of cardiovascular disease should have different appropriate blood pressure levels. The evaluation of blood pressure and risk factors is the main basis for diagnosis and treatment of hypertension. Different patients have different goals of hypertension management. When facing patients, doctors should judge the most suitable blood pressure range according to their specific conditions and adopt targeted treatment measures on the basis of reference standards. On the basis of improving lifestyle, it is recommended to use 24-hour long-acting antihypertensive drugs to control blood pressure. In addition to evaluating the blood pressure in the clinic, patients should also pay attention to the monitoring and management of family blood pressure in the morning to control blood pressure and reduce the incidence of cardiovascular and cerebrovascular events.
second, what are the clinical symptoms of hypertension
The symptoms of hypertension vary from person to person. There may be no symptoms or obvious symptoms in the early stage, and the common ones are dizziness, headache, stiff neck, fatigue and palpitation. Blood pressure only rises after fatigue, mental stress and mood swings, and returns to normal after rest. With the prolongation of the course of the disease, the blood pressure increases obviously and continuously, and various symptoms will appear gradually. At this time, it is called progressive hypertension. The common clinical symptoms of progressive hypertension include headache, dizziness, inattention, hypomnesis, numbness of limbs, nocturia, palpitation, chest tightness, fatigue and so on. The symptoms of hypertension are related to the blood pressure level. Most of the symptoms can be aggravated after being nervous or tired, and the blood pressure can rise rapidly after morning activities, resulting in early morning hypertension, which leads to cardiovascular and cerebrovascular events mostly occurring in the morning.
When blood pressure suddenly rises to a certain level, symptoms such as severe headache, vomiting, palpitation and dizziness may occur, and in severe cases, unconsciousness and convulsions may occur, which are classified as acute hypertension and hypertensive crisis, and serious damage and pathological changes to heart, brain, kidney and other organs, such as stroke, myocardial infarction and renal failure, may occur in a short period of time. There is no consistent relationship between symptoms and elevated blood pressure.
The clinical manifestations of secondary hypertension are mainly related to the symptoms and signs of the primary disease, and hypertension is only one of its symptoms. The increase of blood pressure in patients with secondary hypertension can have its own characteristics, such as hypertension caused by coarctation of aorta can be limited to upper limbs; The increase of blood pressure caused by pheochromocytoma is paroxysmal.
III. What are the typical symptoms of coronary heart disease
1. Symptoms
(1) Typical chest pain is caused by physical activity and emotional excitement, and sudden pain in the precordial area, mostly paroxysmal colic or squeezing pain, or a feeling of oppression. The pain starts from the posterior sternum or precordial region and radiates upward to the left shoulder, arm and even the little finger and ring finger, which can be relieved by rest or taking nitroglycerin. The site of chest pain can also involve neck, jaw, teeth, abdomen and so on. Chest pain can also occur in quiet state or at night, caused by coronary spasm, also known as variant angina pectoris. If the nature of chest pain changes, such as the recent progressive chest pain, the pain threshold gradually decreases, and even a little physical activity or emotional excitement can occur even when resting or sleeping. The pain is getting worse, the frequency is changing, the duration is prolonged, and it cannot be relieved by removing the inducement or taking nitroglycerin. At this time, unstable angina pectoris is often suspected.
classification of angina pectoris: CCSC Canadian Cardiovascular Association classification method is generally adopted internationally.
class I: daily activities, such as walking and climbing stairs, without angina pectoris.
grade ⅱ: daily activities are slightly limited due to angina pectoris.
grade ⅲ: daily activities were obviously limited due to angina pectoris.
grade ⅳ: any physical activity can lead to angina pectoris.
When myocardial infarction occurs, chest pain is severe and lasts for a long time (often more than half an hour). Nitroglycerin can't relieve it, and there may be nausea, vomiting, sweating, fever and even cyanosis, blood pressure drop, shock and heart failure.
(2) It should be noted that some patients' symptoms are not typical, only manifested as precordial discomfort, palpitation or fatigue, or mainly gastrointestinal symptoms. Some patients may have no pain, such as the elderly and diabetics.
(3) About 1/3 of the patients with sudden death first suffered from coronary heart disease.
(4) Other patients with systemic symptoms and heart failure may appear.
2. Signs
There is nothing special in patients with angina pectoris before the attack. Patients may have weakened heart sounds and pericardial fricative sounds. Patients complicated with ventricular septal perforation and papillary muscle insufficiency can hear murmurs in the corresponding parts. When arrhythmia occurs, auscultate irregular rhythm.
IV. What are the treatments for coronary heart disease
The treatments for coronary heart disease include: ① changes in living habits: quitting smoking and alcohol, eating a low-fat and low-salt diet, proper physical exercise, weight control, etc. ② Drug therapy: antithrombotic (antiplatelet, anticoagulant), reducing myocardial oxygen consumption (beta blockers), relieving angina pectoris (nitrates), regulating blood lipid and stabilizing plaque (statins); ③ revascularization therapy: including interventional therapy (endovascular balloon angioplasty and stent implantation) and surgical coronary artery bypass grafting. Drug therapy is the basis of all treatments. Long-term standard drug therapy should also be adhered to after interventional and surgical treatment. For the same patient, at a certain stage of the disease, drugs can be ideally controlled, while at another stage, drugs alone are often ineffective, so drugs need to be combined with interventional therapy or surgery.
1. The purpose of drug therapy
is to relieve symptoms and reduce the attack of angina pectoris and myocardial infarction; Delaying the development of coronary atherosclerosis and reducing the death of coronary heart disease. Standardized drug therapy can effectively reduce the mortality and the occurrence of ischemic events in patients with coronary heart disease, and improve the clinical symptoms of patients. For some patients with severe vascular diseases or even complete obstruction, on the basis of drug treatment, vascular reconstruction therapy can further reduce the mortality of patients.
(1) Nitrate drugs: nitroglycerin, isosorbide dinitrate (isosorbide dinitrate), isosorbide 5-mononitrate, and long-acting nitroglycerin preparation (nitroglycerin ointment or plaster patch). Nitrates are commonly used in patients with stable angina pectoris. When angina pectoris occurs, nitroglycerin can be taken sublingually or nitroglycerin aerosol can be used. For patients with acute myocardial infarction and unstable angina pectoris, the drug should be given intravenously first. After the condition is stable and the symptoms improve, it should be taken orally or by skin patch. After the pain symptoms completely disappear, the drug can be stopped. Continuous use of nitrates can lead to drug resistance, and the effectiveness will decrease. The nitrates can be taken at intervals of 8-12 hours to reduce drug resistance.
(2) Antithrombotic drugs include antiplatelet drugs and anticoagulant drugs. Antiplatelet drugs mainly include aspirin, clopidogrel and tirofiban, which can inhibit platelet aggregation and prevent thrombosis from blocking blood vessels. Aspirin is the first choice, and the maintenance dose is 75 ~ 1 mg per day. All patients with coronary heart disease should take it for a long time without contraindications. The side effect of aspirin is irritation to gastrointestinal tract, so patients with gastrointestinal ulcer should use it with caution. After percutaneous coronary intervention, clopidogrel should be taken orally every day, usually for half a year to one year.
Anticoagulant drugs include ordinary heparin, low molecular weight heparin, sodium fondaparinux and bivalirudin. It is usually used in the acute phase of unstable angina pectoris and myocardial infarction, as well as in interventional therapy.
(3) Fibrinolytic drugs Thrombolytic drugs mainly include streptokinase, urokinase, tissue plasminogen activator, etc., which can dissolve thrombus formed in coronary artery occlusion, open blood vessels and restore blood flow, and are used in acute myocardial infarction.
(4) β -blockers can not only prevent angina pectoris, but also prevent arrhythmia. In the absence of obvious contraindications, beta blockers are the first-line drugs for coronary heart disease. Commonly used drugs are: metoprolol, atenolol, bisoprolol, carvedilol and arolol (Almar), etc. The dosage should be to reduce the heart rate to the target range. The contraindications and cautious use of beta blockers include asthma, chronic bronchitis and peripheral vascular diseases.
(5) Calcium channel blockers can be used to treat stable angina pectoris and angina pectoris caused by coronary spasm. Commonly used drugs are: verapamil, nifedipine controlled release agent, amlodipine, diltiazem and so on. Short-acting calcium channel blockers, such as nifedipine tablets, are not recommended.
(6) Renin angiotensin system inhibitors include angiotensin converting enzyme inhibitor (ACEI), angiotensin 2 receptor antagonist (ARB) and aldosterone antagonist. For patients with acute myocardial infarction or recent myocardial infarction complicated with cardiac insufficiency, such drugs should be used especially. Commonly used ACEI drugs include enalapril, benazepril, ramipril and fosinopril. If there are obvious side effects of dry cough, angiotensin 2 receptor antagonists can be used instead. ARB includes valsartan, telmisartan, irbesartan, losartan, etc. Attention should be paid to prevent low blood pressure during medication.
(7) Lipid-regulating therapy is suitable for all patients with coronary heart disease. Statins are given to coronary heart disease on the basis of changing living habits. Statins mainly reduce low-density lipoprotein cholesterol, and the treatment goal is to reduce it to 8mg/dl. Commonly used drugs are lovastatin, pravastatin, simvastatin, fluvastatin and atorvastatin. Recent studies have shown that statins can reduce mortality and morbidity.
2. Percutaneous coronary intervention (PCI)
Percutaneous transluminal coronary angioplasty (PTCA) uses a special catheter with a balloon, which is sent to the coronary stenosis through the peripheral artery (femoral artery or radial artery). Filling the balloon can dilate the narrow lumen, improve blood flow, and place a stent at the dilated stenosis to prevent restenosis. It can also be combined with thrombus aspiration and rotational grinding. It is suitable for patients with stable angina pectoris, unstable angina pectoris and myocardial infarction with poor drug control. Emergency interventional therapy is the first choice for acute myocardial infarction. Time is very important, and the sooner the better.
3. Coronary artery bypass grafting (CABG)
Coronary artery bypass grafting can relieve chest pain and ischemia, improve patients' quality of life and prolong patients' life by restoring myocardial blood perfusion. It is suitable for patients with severe coronary artery disease, patients who cannot receive interventional therapy or relapse after treatment, angina pectoris after myocardial infarction, or complications such as ventricular aneurysm, mitral regurgitation and ventricular septal perforation. Coronary artery bypass grafting should be performed while treating complications. The choice of operation should be decided by the cardiac surgeon and the patient.