To say that coronary heart disease causes death does not mean that as soon as you get coronary heart disease, you will die immediately as soon as you diagnose coronary heart disease; nor is it that no matter what the situation, coronary heart disease will die, and coronary heart disease is not an incurable disease. But coronary heart disease is indeed a dangerous disease, and the heart is important!
Therefore, if you have coronary heart disease, you must standardize the treatment. Improve myocardial ischemia, avoid myocardial infarction, and protect good heart function. Because as far as coronary heart disease is concerned, there is no problem in living to an average life expectancy. Our patients have stents, bridges, and some of them have long-term medication and live to be in their 80s and 90s.
It should be said that the research on coronary heart disease in medicine is really developing very well, and it is progressing rapidly, and new drugs and new technologies continue to appear. Therefore, compared with some other diseases, it is fortunate to have coronary heart disease.
In all aspects of the prevention and treatment of coronary heart disease, here we only pick the main ones, briefly.
First of all, drug treatment is the foundation and must be carried through.
The drug treatment of coronary heart disease is the basic treatment, whether it is a stent or not, whether it is a bridge or not, it is necessary to treat with drugs.
Many patients are afraid when they say that they take medicine, and feel that the drug has side effects. But you got sick first! Compared with the damage of the disease, the side effects of the drug are very mild.
The lesser of two evils. With coronary heart disease, you have to take medicine (coronary heart disease, angina, what medicine is good?). ）！
★ The basic treatment in drug therapy is cholesterol-lowering and anti-atherosclerosis, antiplatelet inhibition of thrombosis.
Cholesterol-lowering drugs are preferred as "statins", and antiplatelets are aspirin or clopidogrel. There is also a target value for lowering cholesterol, and LDL cholesterol should be reduced to at least 1.8mmol/L or less, and treatment should be up to standard. This basic treatment should be maintained and adhered to all the time.
★ In addition to anti-atherosclerosis and antiplatelet therapy, there are also treatments to improve blood supply to the myocardium.
There are three classic drugs to improve the blood supply to the heart muscle, "lore" β receptor blockers, nitrates, and calcium antagonists (some of which are antihypertensive drugs). Among them, the "lore" β receptor blocker is the only drug that can improve the prognosis.
That is to say, "lore" β receptor blockers can not only relieve angina, but also reduce seizures, protect cardiac function, reduce acute events, reduce sudden death, and even reduce cardiovascular death. Patients without contraindications can be taken for a long time. What is particularly important here is that long-term medication should not be abruptly stopped, otherwise it will cause the disease to "jump back" and accidents.
There are also second-line drugs to improve myocardial blood supply, such as trimetazide, which improves myocardial metabolism, nicodil, which can improve microcirculation, and some proprietary Chinese medicines that have been studied to resist atherosclerosis, such as musk heart pills, macaroni, etc. (in addition to the three classics, what other drugs are anti-angina?). ）。
Open blood vessel treatment, some patients can choose.
For coronary heart disease with severe vascular stenosis, severe myocardial ischemia, angina with poor drug treatment effect, unstable angina with unstable disease, or "acute coronary syndrome" that has been acute myocardial infarction, it is necessary to open the treatment of blood vessels and rebuild the blood supply channel for ischemic necrosis myocardial reconstruction (experts do not recommend stenting for patients with stable coronary heart disease? Doctor: Treat it differently).
In emergency, the methods of opening blood vessels include drug thrombolysis and coronary intervention, that is, balloon dilation or stenting; in non-emergency, there are also coronary artery bypass options.
Opening blood vessels in emergency is to open the "criminal" blood vessels, that is, blood vessels related to acute myocardial ischemic infarction; when slowing down, consider opening other narrow blood vessels.
Prevent myocardial infarction, and pay attention to "anti-remodeling therapy" after myocardial infarction.
★ For patients with coronary heart disease, whether there is myocardial infarction is very critical and important, the treatment is not the same, the consequences are not the same. So, be sure to guard against it.
There is no myocardial infarction, cholesterol lowering, antiplatelet therapy, anti-angina drugs for angina, no angina, nitrates, calcium antagonists can not be used.
With myocardial infarction it's not the same. Myocardial necrosis is lost, the normal myocardium with the ability to contract is reduced, and the heart function is also lost; between the necrotic myocardium and the normal myocardium, the circuit of the ECG may not pass, and various arrhythmias will occur; the part of myocardial necrosis will not contract, it will expand and thin, and it will become a ventricular wall tumor; it can also be contrary to normal contraction, "reverse contraction", and the heart function is even worse; the ventricular wall tumor can grow thrombosis, and the thrombus can be embolized to other places. Therefore, after myocardial infarction, a series of problems can be brought about: cardiac dysfunction, heart failure, arrhythmias, blood clots and so on.
In this way, patients who have had myocardial infarction have significantly worse outcomes than those without myocardial infarction.
Therefore, it is important to treat coronary heart disease and avoid myocardial infarction. When the coronary heart disease is aggravated and unstable, and the drug treatment is not well controlled, we must strive to open the blood vessels as soon as possible.
★ There is a very important treatment after myocardial infarction, "anti-myocardial remodeling (plastic)" treatment (after myocardial infarction will be repaired "remodeling", but doctors say to anti-"myocardial reconstruction" treatment).
It is to try to control the "tofu slag project" when repairing the necrotic myocardial part. Inhibits the proliferation of tissue cells that are not functioning, prevents the heart from enlarging, reduces the load on the heart, and protects heart function. The drugs used are "lore" β blockers, and another large category is inhibitors of the angiotensin system, which are familiar with "puly" or "sartan" drugs.
Comprehensive management, control of various risk factors.
Risk factors can aggravate coronary atherosclerosis and induce acute onset of coronary heart disease, so it must be controlled. The problem of blood lipids has been said, as well as high blood pressure, diabetes, smoking, alcohol, obesity, inactivity, mental tension and anxiety, etc., must also be controlled.
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