What medicines do I take for myocardial ischemia?
Many people have such a question, is it to eat aspirin, or statin, or mononitrate, or nitroglycerin?
Today we will make this question clear:
First, it must be clear whether it is myocardial ischemia
What we usually call myocardial ischemia can be simply understood as coronary heart disease.
But from a medical point of view, myocardial ischemia is only a condition, or a state, or a degree of coronary heart disease. Not all coronary heart diseases will have myocardial ischemia.
Coronary heart disease, the full name of coronary atherosclerotic heart disease, simply put, is the heart's arteries (called coronary arteries), there are plaques, plaque caused by cardiovascular stenosis more than 50%, this situation is called coronary heart disease.
But generally we say myocardial ischemia, not that cardiovascular stenosis more than 50% will have coronary heart disease, in most cases, when the cardiovascular stenosis exceeds 70% or even more severe stenosis, there may be myocardial ischemia.
And myocardial ischemia generally does not occur continuously, myocardial ischemia is a state, for example, angina is our common myocardial ischemic attack. When the myocardial infarction indicates that the cardiovascular system is completely blocked, this time is an extreme myocardial ischemia, because this time is not ischemia, but no blood, so myocardial infarction is an extreme special myocardial ischemia.
Second, the ECG shows myocardial ischemia, which is not necessarily true myocardial ischemia
There are many people with myocardial ischemia, which is diagnosed by an electrocardiogram, which is not rigorous.
Because it is difficult to diagnose myocardial ischemia in coronary heart disease with a simple ECG. It cannot be said that the ECG shows low ST-segment pressure, or T-wave inversion, which diagnoses a person's myocardial ischemia.
For the diagnosis of myocardial ischemia, there are generally exercise tests or myocardial nuclear tests in terms of instruments, which are currently more accurate instruments for checking myocardial ischemia.
If the ECG is to be diagnosed with myocardial ischemia, it must be combined with the symptoms of angina, or the symptoms of myocardial ischemia, and the dynamic changes of the patient's ECG. That is, when the patient does not have angina, there is an electrocardiogram, and when the angina attacks, there is also an electrocardiogram, and the two electrocardiograms are not the same, at this time, the diagnosis of myocardial ischemia can be diagnosed.
3. How to choose drugs for confirmed myocardial ischemia?
Myocardial ischemia after diagnosis by a professional cardiovascular doctor can be treated according to myocardial ischemia.
Simply put, myocardial ischemia is a condition of coronary heart disease, so the treatment of myocardial ischemia is first of all the basic treatment of coronary heart disease.
(1) Basic drug selection for coronary heart disease:
1. Drugs that control three highs and heart rate
Hypertension, diabetes, and hyperlipidemia are common factors in coronary heart disease, so most people with coronary heart disease may have three highs at the same time. Therefore, people with coronary heart disease must first control blood pressure, blood sugar, and blood lipids, which is the most basic treatment. At the same time, too fast a heart rate will induce angina, and even increase the risk of myocardial infarction, so people with coronary heart disease need to reduce their heart rate to 60 times / min as much as possible, generally there is no contraindication, they will choose lore drugs.
2. Statin drugs
Statin drugs can not only reduce cholesterol, but also the main role is to stabilize plaques, prevent plaque aggravation, prevent plaque rupture, prevent thrombosis, prevent myocardial infarction, so hetin drugs are the cornerstone of coronary heart disease treatment.
3. Aspirin
The golden companion of statin drugs is aspirin, which is an antiplatelet aggregation drug that can prevent blood clots. So for any clearly diagnosed coronary heart disease, or coronary heart disease that has progressed to myocardial ischemia, then statins plus aspirin must be used (unless there are contraindications).
(2) Drugs in the event of an attack of angina (myocardial ischemia):
When angina attacks, nitroglycerin is preferred.
But nitroglycerin should not be used for people with low blood pressure, or nitroglycerin allergies, or glaucoma, or who cannot take nitroglycerin.
At this time, you can choose a heart-saving pill.
(3) Drugs for myocardial infarction:
When myocardial infarction is diagnosed, aspirin and ticagrelor or clopidogrel are given immediately, and blood vessels are opened immediately, or thrombolytic, or stents are given.
Follow-up treatment for vascular opening is still based on aspirin and statin.
People who are spared stents need to take ticagrelor or clopidogrel for 1-1.5 years.
People who have had myocardial infarction, if there are no contraindications, need to take pry/sartan drugs for a long time, as well as lore drugs. These two drugs are drugs that prevent enlargement of the heart, prevent arrhythmias, and prevent heart failure.
(4) Drugs to prevent angina /myocardial ischemia
The drugs we mentioned above, such as aspirin, clopidogrel, ticagrelor, statin, pry, and sartan, cannot prevent angina attacks.
Nitroglycerin is a drug used in first aid and cannot be used for a long time. So which drugs can be used for a long time to prevent angina pectoris and myocardial ischemia?
1. Lore drugs
Lohr drugs are not only antihypertensive drugs, but also drugs for the treatment of heart failure, but also drugs for the treatment of angina. Lore drugs can reduce the heart rate, thereby reducing myocardial oxygen consumption, and then achieve the purpose of controlling angina, so for patients with fast heart rate, use lore drugs, reduce heart rate, control angina.
2. Diltiazem
For patients with coronary heart disease with fast heart rate and high blood pressure, or for patients with coronary heart disease who have had cardiovascular spasms. Diltiazem is the first choice for the treatment of this angina.
3, trimetazidine
For cases where the heart rate is not fast and the blood pressure is not high, but there are still angina attacks, trimetazidine may be considered to control the angina attack.
4. Nicodil
If a person has repeated angina, but his blood pressure is too low and his heart rate is slow, the above drugs to control angina should not be used, and nicoldil can be considered, nicoldil can control angina, and at the same time, the blood pressure heart rate is almost unaffected.
5. Other drugs
For people with severe cardiovascular stenosis, blood vessel dilating drugs can be used, such as the familiar isosorbide nitrate tablets or mononitrate isosorbide tablets and other long-acting nitroglycerin drugs.
These are the drugs commonly used to control angina/myocardial ischemia.
If you are diagnosed with coronary heart disease myocardial ischemia, the first thing to determine is not true coronary heart disease, whether there is myocardial ischemia. Then, according to the specific situation, under the guidance of a professional doctor, regular drug treatment for coronary heart disease or myocardial ischemia is carried out.
Medication is important, don't use it wrong, don't use it too much!