"Doctor, I have a heart failure, you give me a check-up, check it out?" There are often many patients who make such requests after hanging up in the outpatient clinic. However, there are many heart examinations, and it cannot be said that the heart is uncomfortable, so open a test. Cardiovascular doctors prescribe examinations to patients, usually through consultation and auscultation, initially have a direction, and then decide what test to give the patient. Choose only the right one, not the expensive one. So suspect that there is a problem with the heart, how to check it in the end?
Author: Zhang Ming Beijing Anzhen Hospital affiliated to Capital Medical University
This article is published with the permission of the author.
Although this problem should be left to a professional doctor to solve, as a patient to understand these basic knowledge and principles, it is conducive to communication between doctors and patients, and patients can take fewer detours. First of all, the patient's own symptoms are the first signal of the disease, as a patient to know the common symptoms of heart disease, Professor Zhang Xiaoqian of Peking Union Medical College Hospital once said: "About 50% of the cases can draw a preliminary diagnosis or diagnostic clues from the medical history." Therefore, patients provide doctors with accurate symptom descriptions and their characteristics to judge the direction of treatment. The details are as follows:
1. The main symptoms are episodic chest pain, chest tightness, dyspnea, and are closely related to exercise intensity. If the patient walks fast, an agitated or full meal or cold and other stimuli appear the above symptoms, such as before going upstairs can walk like flying, and now feel obvious endurance decline, unable to cope, the third floor needs to rest, this situation should consider whether there is coronary heart disease, whether there is blood vessel blockage. Similar symptoms can occur in associated heart failure caused by cardiomyopathy, with a focus on coronary CT and echocardiography, most of which cannot be detected by ECG.
2. The main symptoms are heart lies, palpitations, such as feeling that the heart beats very fast, jumps to the throat or jumps randomly, heart excitement, etc., this situation is mostly arrhythmia diseases, such as atrial fibrillation, supraventricular tachycardia or premature heartbeat and other diseases, check the ECG is the most direct, a cheap ECG can be diagnosed, rather than first check the echocardiogram or expensive coronary CT!
3. It is also very important to know the characteristics of age and common risk factors for cardiovascular disease, such as risk factors such as hypertension, diabetes, smoking, obesity, etc. The more risk factors are combined, the greater the possibility of atherosclerosis-related diseases. The younger the age, the less likely it is that the blood vessels will block. In particular, the probability of organic heart disease in children is extremely low. Outpatient clinics often encounter some parents with their children to come to see the doctor, telling the doctor that the child always has chest tightness, shortness of breath, panic, long breath and other symptoms, and has done various examinations and can not find the cause. In fact, most of this situation is related to mental and psychological factors, and it should be focused on communicating with psychological experts.
The heart is an important organ of the human body, equivalent to the engine, responsible for the blood supply and oxygen supply to various organs in the body, once the heart has a problem, the impact is systemic, early detection, early treatment is indeed very important. There are many kinds of cardiac tests. When going to the hospital to check the heart, doctors sometimes ask patients to do cardiac ultrasound, sometimes to do Holter electrocardiograms, or even coronary CT. So how exactly do you check your heart? Why does the heart feel uncomfortable, but the doctor's choice is very different? Why do electrocardiograms and echocardiography often fail to detect coronary heart disease and blood vessel blockage? Why can't the expensive coronary CT or coronary angiography find the cause of palpitations and panic, while the inexpensive ECG can tell what type of arrhythmia it is, whether it is premature beats or atrial fibrillation, or other types of arrhythmias, so as to give a precise treatment plan?
In fact, from a professional point of view, it is not difficult to find the answer. To take a popular analogy: the heart as the engine of the human body, also like a room, has a door (heart valves, see Figure 1), a water pipe (the blood vessel that supplies the blood supply to the heart, see Figure 2), and a wire (heart conduction system, see Figure 3). Arrhythmias are like a wire is wrong, and coronary heart disease is a problem with the pipeline, the blood vessels supplying the heart are blocked; valvular heart disease is a problem with the door, the door is broken, the door cannot be opened or closed tightly. Congenital heart disease atrial defects, ventricular septal defects are the wall between the atrium and the ventricles is broken, so each test has its own pertinence and limitations.
Figure 1: The individual valves of the heart correspond to the gates of the heart and are associated with heart valve disease
Figure 2: The blood vessels that supply the heart are equivalent to the heart's piping system and are associated with coronary heart disease
Figure 3: The cardiac conduction system acts as a circuit wire of the heart and is associated with arrhythmias
The ECG is mainly aimed at judging arrhythmia-related diseases and a small number of patients with coronary heart disease, especially those with acute myocardial infarction, but many times it is impossible to judge whether there is myocardial ischemia and whether there is coronary heart disease according to the ST-T waveform of the ECG. In clinical practice, st-T abnormalities abound in patients rather than coronary heart disease. This is also why the annual physical examination not only can not avoid the tragedy of sudden death, but also some physical examination reports often lead to patient anxiety, the most common is the electrocardiogram ST-T change released by the physical examination center, giving patients a hat of myocardial ischemia, causing patient anxiety, and then a series of excessive examinations, such as coronary CT, and even coronary angiography. The physical examination program lacks specificity, much like a large screening, and does not include the most critical tests that can identify coronary heart disease, such as coronary CT. Specifically:
1. Check whether there is coronary heart disease and myocardial ischemia, which is equivalent to checking whether the pipeline supplying the heart is blocked, that is, the water pipe is not blocked, and can be checked by coronary CT or coronary angiography. Coronary CT and coronary angiography can intuitively understand whether there are lesions and stenosis in coronary arteries, but coronary CT is not effective in examining calcified lesions and vascular tortoises, and it is easy to miss diagnosis or false positives. Coronary angiography is the gold standard for diagnosing coronary heart disease, and can be treated directly after contrast if the patient has severe narrowing of coronary arteries. Symptoms are atypical or resistant to coronary CT, can also be judged by exercise tablet ECG, non-invasive tests are cheap, eight or nine accurate.
2. Check whether there is heart failure and congenital heart disease: the simplest and most convenient is the heart color ultrasound, which can detect the size, structure, and thickness of the heart muscle whether it is normal and estimate the ejection function of the heart, and can diagnose whether the patient has heart hypertrophy, heart failure, congenital heart disease, etc. Severe myocardial lesions use MYOmagnetism and myocardial nuclide scans to help make the diagnosis more accurate.
3. Check whether it is arrhythmia, in fact, it is equivalent to checking the heart conduction circuit system, the simplest and most direct method is the electrocardiogram, which can check the rhythm and frequency of the patient's heart beating, but because the ECG records the heart electrical activity time is relatively short, sometimes it may miss the heart electrical activity at the time of the onset, so many times the doctor will give the patient a holterogram examination to monitor the patient's 24-hour heart electrical activity, to see if there is a rapid arrhythmia, premature beats, etc.
Warm reminder, want to know whether you have heart disease, for some heart examination items to understand clearly, especially high-risk groups in the symptoms can choose according to their own needs to get the most accurate results. If the patient friend has to tell me a more reliable answer, ecglycogram + echocardiography + coronary CT is basically satisfied, but to analyze the specific situation, after all, the price of coronary CT is more expensive, there is a certain radiation damage to the human body, not as a routine recommended physical examination item.
Expert Profiles
Professor Zhang Ming
• Chief Physician of the Department of Cardiovascular Medicine, Beijing Anzhen Hospital affiliated to Capital Medical University, Professor (promoted out of the ordinary), Doctoral Supervisor, Postdoctoral Research Fellow of Mayo Medical Center, Beijing Science and Technology Rising Star, Backbone of cardiovascular Internal Medicine, High-level Talent of Beijing Health System, National Natural Science Foundation Review Expert, Published more than 20 SCI papers in professional journals such as European Journal of Cardiology (EHJ) as the first author or corresponding author.
• Editor-in-chief of "Cardiovascular Physician Growth Manual", "Cardiovascular Physician Diary and Comments", "Discussion of Difficult Cases in Internal Medicine - Circulatory Fascicle", accumulated rich clinical practical experience in the diagnosis and treatment of cardiovascular difficult and acute critical diseases, and was good at interventional treatment of complex coronary heart disease, assisting more than 30 hospitals across the country to carry out interventional surgical treatment and academic guidance for coronary heart disease, ranking among the best in the reputation and reputation of patients, and was selected into the list of good doctors in China for 4 consecutive years. It attracted more than 8,000 patients from all over the country to see and receive surgical treatment.