When you are young, you always think that wantonness is the tone of life, and you can't quit smoking, and you can always find a reason for yourself.
When you enjoy life with great pleasure, you don't know that the hidden dangers of your body are slowly forming.
Late at night, if suddenly you feel:
Intense heartache, probably behind the sternum [1], occasionally in the neck, teeth, throat, and shoulders.
This feeling recurs, which may be a distress signal from the heart, and it is shouting: "Help!" ”。
There is a phenomenon called coronary artery spasm, which causes vasospastic angina.
Today, Dian Ge takes everyone into the "heart engine" to understand how this disease occurs.
The human body is like a precision factory, and the heart is like the engine of the factory, through which it beats, pumping nutrient-rich blood to all parts of the body to ensure the normal operation of other organs.
If the heart is constantly overloaded, it may malfunction, and even" when sitting in a daze, it will also have unbearable pain in the chest."
The high risk factors for this condition are [2-4]:
1. Smoking. Long-term smoking is like the humid air of the rainy season, causing the heart engine to rust and malfunction.
2. Drug abuse, such as cocaine, marijuana, alcohol, sumatriptan for the treatment of migraines, etc. Drug abuse is like a big earthquake caused by a human factory, where various systems will be hit, and the heart engine will naturally be doomed. If you suffer a few more times, the factory may collapse.
3. Allergic vasospasmodic angina, low incidence. This is caused by angina caused by the stimulation of blood vessels by allergic substances in the body, resulting in angina, and some people may even get sick because they eat tuna or kiwifruit. It was as if there was a problem with the internal mechanical structure of the engine itself, which led to the consequences of a major power outage.
First, let's take a look at the "coronary vein" that is relatively unfamiliar to everyone:
The coronary arteries are the energy-supplying vessels of the heart's engine that keep the heart running.
It has three layers from the inside out: the inner membrane, the middle membrane (mainly smooth muscle), and the outer membrane[5], and the function of these three layers of structures is disturbed, and coronary spasm occurs [6-8].
1. Vascular smooth muscle is highly reactive.
It is the muscles that control our bodies, and the smooth muscles that control the blood vessels.
The high reactivity of the vascular smooth muscle is like the failure of the engine's power furnace, which makes the engine's operation out of order, resulting in the entire machine strike.
2. Autonomic nervous system disorders.
The autonomic nerve can be understood as a nervous system that is not governed by our will, that is, the superior control unit that controls the engine has a problem, and from time to time it outputs a large amount of energy to the engine, so that the engine is overloaded, and the engine is likely to strike when it is overloaded.
3. Endothelial dysfunction – this is an adjunctive cause of coronary spasm.
The endothelium is part of the endometrium of blood vessels, and endothelial dysfunction is like the oil and carbon deposits deposited in the machine itself, making the strike come faster and easier.
Although each heartache attack may only take a few minutes, this does not mean that you can endure until you recover, so if you feel discomfort in your chest, seek medical treatment as soon as possible.
During the acute phase of the onset of "heartache" symptoms, it should be [13]:
1. Immediately rest, calm the mood, stop smoking or drinking and other behaviors;
2. Conditional can take nitroglycerin under the tongue.
Long-term life should:
1. Strictly quit smoking, limit drinking, change bad habits, and actively exercise appropriately [14];
2. Take the drug according to the advice of a professional doctor.
Coronary spasm not treated in time may:
1. Almost 100% of patients will experience chest pain;
2. Approximately 25% of untreated people develop myocardial infarction or fatal arrhythmias [9].
Coronary spasm-related myocardial infarction fatality rates are 4.7 percent [10], and if other obstructive coronary diseases (e.g., coronary heart disease) are associated, the five-year survival rate is as low as 77 percent [11].
That is, in every 10 such patients, there may be 2.3 people who will die within five years.
However, if treated promptly, the five-year survival rate can increase to 94 percent [12].
Today's popular science is over, and DianGe knows that there will be fans who say:
Smoking, drinking life is forced, life is already very difficult, smoking, drinking is not free.
But if the freedom of the present will plant a landmine for future lives, then how should we choose the present?
When people reach middle age, they can truly feel that peace and health are blessed, but when they look back, they are full of regret.
There is no regret medicine in life, but there are preventive injections, may our lives have fewer regrets.
bibliography
Ge Junbo,Xu Yongjian. Internal Medicine[M]. 9th ed. Beijing: People's Medical Publishing House, 2018.
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[3] Stern S, Bayes de Luna A. Coronary artery spasm: a 2009 update. Circulation. 2009 May 12;119(18):2531-4.
[4] Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract. 1991 Summer;45(2):121-8.
Ding Wenlong,Wang Haijie. Systematic Anatomy. 3rd ed. Beijing: People's Medical Publishing House, 2015.
[6] Ong P, Athanasiadis A, Hill S, et al. Coronary artery spasm as a frequent cause of acute coronary syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. J Am Coll Cardiol. 2008 Aug 12;52(7):523-7..
[7] Sakagami T, Tsuji T. Rare case of coronary spastic angina during treatment of invasive group A streptococcal sepsis. BMJ Case Rep. 2021 Aug 23;14(8):e244693.
[8] Vancheri F, Longo G, Vancheri S, et al. Coronary Microvascular Dysfunction. J Clin Med. 2020 Sep 6;9(9):2880.
[9] Uptodate: Vasospastic angina. Duane SP, John FB, Filippo Crea, Literature review current through: Nov 2021. This topic last updated: Jun 12, 2019.
[10] Pasupathy S, Air T, Dreyer RP, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015 Mar 10;131(10):861-70.
[11] Kim HL, Jo SH. Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina. J Clin Med. 2021 Sep 21;10(18):4270.
[12] Chow E, Diep B, Getman T, et al. Clinical presentation and management of myocardial infarction with nonobstructive coronary arteries (MINOCA): A literature review. Heliyon. 2021 Nov 11;7(11):e08362.
[13] Yasue H, Nakagawa H, Itoh T, et al. Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment. J Cardiol. 2008 Feb;51(1):2-17.
[14] Saeidifard F, Wang Y, Medina-Inojosa JR, et al. Multicomponent Cardiac Rehabilitation and Cardiovascular Outcomes in Patients With Stable Angina: A Systematic Review and Meta-analysis. Mayo Clin Proc Innov Qual Outcomes. 2021 Jul 24;5(4):727-741.
Editors: Guo Qian, Wu Wei, Zhang Liang
Illustrator: Kishi Chi | Author: Liao Yuhan
Proofreading: Wu Yihe | Typesetting: Li Yongmin
Operation: Han Ningning | Coordinator: Wu Wei