Correctly understand coronary heart disease, hypertension, myocardial ischemia and angina pectoris

There are many kinds of cardiovascular diseases, which seriously endanger people's health. Usually some patients after hospitalization, especially elderly patients, always find that not only high blood pressure, but also coronary heart disease or diabetes, etc., these diseases harm the patient's body at the same time like sisters. Then, why do these diseases appear one after another? Let us correctly understand the diseases of coronary heart disease, hypertension, myocardial ischemia and angina pectoris.

No.1 Are hypertension and coronary heart disease sister diseases?

If you have been to the elderly cardiovascular ward, you will find that many patients are diagnosed as "coronary heart disease" and "hypertension" at the same time, and the two are linked together. Hypertension is often accompanied by coronary heart disease, and the morbidity and mortality of coronary heart disease increase with the increase of blood pressure. The incidence of myocardial infarction in hypertensive patients is twice that of normal blood pressure patients. More than 70% of people with coronary heart disease in my country have hypertension. Hypertension accelerates the formation and development of atherosclerosis and coronary heart disease.

There are two reasons for hypertension-induced coronary heart disease:

1. In hypertension, high-level nerve center activity is impaired, and the cerebral cortex is in a state of excitement for a long time, causing sympathetic nerve excitement and excessive release of catecholamines. An increase in catecholamines can directly damage the walls of arteries and can also cause coronary artery spasm. At the same time, the sensitivity of the cardiovascular system to catecholamines increases, thereby accelerating the process of coronary atherosclerosis.

2. In hypertension, the lateral pressure of blood flow on the arterial wall increases, and lipids in the blood easily invade the arterial wall; increased vascular tension causes excessive stretching of the arterial intima and breakage of elastic fibers, resulting in intimal damage and thrombosis; The capillaries in the arterial wall rupture, causing subintimal hemorrhage and thrombosis, causing the proliferation of intimal fibrous tissue, and ultimately leading to atherosclerosis.

No.2 Are coronary heart disease and diabetes sister diseases?

Data show that the risk of diabetic patients with coronary heart disease is 2 to 3 times higher than that of ordinary people. If diabetic patients are also accompanied by high blood pressure, then the possibility of coronary heart disease will be greater. Compared with non-diabetic coronary heart disease, diabetes complicated by coronary heart disease is more serious, mainly manifested as: high prevalence, high mortality, early age of onset, and high incidence of myocardial infarction. In addition, people with diabetes are prone to complications such as painless acute myocardial infarction, shock and heart failure after coronary heart disease. Diabetes is a disorder of sugar, protein and lipid metabolism with hyperglycemia as the main manifestation.

Diabetes is prone to complicated by coronary heart disease due to the following 5 aspects:

1. Diabetes patients are often accompanied by lipid metabolism disorders and hyperlipidemia. The latter is an important factor in the occurrence of atherosclerosis and coronary heart disease.

2. Insulin deficiency in diabetic patients or a decrease in the number of insulin receptors can reduce the uptake of glucose by myocardial cells, resulting in insufficient myocardial energy supply and weakened myocardial contractility.

3. Diabetes patients have higher blood glucose concentration and increased glycosylated hemoglobin, which reduces the oxygen-carrying capacity of red blood cells, and the myocardium is prone to hypoxia.

4. Diabetes patients with high blood pressure are 4 times higher than non-diabetic patients, and hypertension is a risk factor for coronary heart disease.

5. The adhesion and aggregation of platelets in diabetic patients increase, blood viscosity increases, red blood cell deformability decreases, and thrombosis is prone to occur.

Therefore, in addition to checking blood sugar and urine sugar regularly, and actively treating, people with diabetes should also regularly measure blood pressure, check the fundus, electrocardiogram, and perform heart function tests when necessary. This is good for early detection and prevention of coronary heart disease.

No.3 What does asymptomatic coronary heart disease refer to?

Asymptomatic coronary heart disease, also known as "hidden coronary heart disease". Although patients with recessive coronary heart disease have the pathological basis of coronary heart disease, they do not have to show symptoms on weekdays, and they do not know that they are already sick, but when running, drinking, overwork, agitation, excessive smoking, severe insomnia, sudden rain , Long-distance travel, and frequent sexual intercourse can induce coronary artery spasm, causing myocardial ischemia, hypoxia, leading to local electrophysiological disorders, severe arrhythmia, or even cardiac arrest, or on this basis, causing coronary embolism. Cause a large area of ​​myocardial necrosis.

Recessive coronary heart disease is the enemy of "healthy people" and can often cause sudden death of "healthy people". Recessive coronary heart disease usually has no discomfort, but some clues are often revealed during physical examination. For example, the resting or stress test ECG has symptoms of myocardial ischemia such as low ST-segment voltage and T-wave inversion. In order to make the disease be detected as soon as possible and get timely For treatment, it is recommended that middle-aged and elderly people at the age of high incidence of coronary heart disease should go to the hospital for cardiac examinations on a regular basis. For people with high risk factors for coronary heart disease, such as middle-aged and elderly men over 40, postmenopausal women, people with hyperlipidemia, high blood pressure, excessive smoking, diabetes, or a family history of coronary heart disease, in addition to routine heart examinations, Exercise tests should also be conducted for detection and screening.

No.4 How to recognize angina pectoris?

Angina pectoris is a clinical syndrome caused by temporary myocardial ischemia and hypoxia. The main clinical manifestations are squeezing or contraction-like pain or chest discomfort in the upper or middle part of the sternal body. It can spread to the precordial area.

No.5 Is ischemic heart disease and coronary heart disease the same thing?

Ischemic heart disease refers to myocardial damage caused by the imbalance of coronary blood flow and myocardial demand caused by changes in the coronary circulation. The most common cause is sub-coronary occlusion and occlusion caused by coronary atherosclerosis. Therefore, ischemic heart disease is often used as a synonym for coronary atherosclerotic heart disease, that is, coronary heart disease.

In a broad sense, ischemic heart disease also includes coronary artery diseases other than coronary atherosclerosis, such as coronary artery dissecting aneurysm, calcinosis, intimal hyperplasia, lupus, rheumatic fever, syphilis, viral infections, etc., involving coronary artery openings , Coronary artery embolism caused by emboli formed by atheroma fragments, bacterial endocarditis vegetation shedding, etc.

No.6 Is myocardial ischemia equal to coronary heart disease?

The simple electrocardiogram indicates that "myocardial ischemia" does not mean "coronary heart disease". There are many reasons for myocardial ischemia. Coronary heart disease is the main cause of myocardial ischemia, not the only cause. Other diseases can also cause myocardial ischemia. In the outpatient clinic, the electrocardiogram is generally a preliminary method for diagnosing heart disease. Under normal circumstances, the T wave of the electrocardiogram is "upright", and the T wave of patients with chronic myocardial ischemia will show a "low flat" or "inverted" shape. However, the diagnosis of myocardial ischemia is not equivalent to coronary heart disease.

In middle-aged women, sympathetic nerve excitement caused by anxiety, hypertension, full meal, myocarditis, atrial fibrillation, fast heart rate, etc. can show T wave changes on the electrocardiogram. The high incidence of coronary heart disease in women is after menopause, and women with normal menstruation before menopause, if there is no family history of coronary heart disease or high cholesterol, due to the protective effect of estrogen on the coronary arteries, the chance of coronary heart disease is very small. Epidemiological surveys show that the incidence of coronary heart disease is gradually equal to that of men when women are 65 to 70 years old. Therefore, when the ECG indicates that there is a T wave change, you must not automatically match the number with coronary heart disease, and you should go to the cardiology department for further examination.