Author: Ji Wenyang
Source: Heartway Stardust
In the middle of the night a few days ago, a domineering female president was flirting with me, 10 million in three years, I pretended to be reserved, hesitated for a few seconds and was about to agree......
Suddenly woken up by the ringtone of the mobile phone, it turned out to be a call from the doctor on duty, and a patient with acute myocardial infarction needed emergency interventional surgery.
You can imagine how desperate I was at that time, 10 million was about to arrive, and in a few seconds, I woke up 10 million and it was gone.
Heartpath Stardust:
I quickly got dressed and rushed to the hospital, "time is money" was vividly reflected in my dream, and the hesitation at that moment lost 10 million
But for patients with myocardial infarction, "time is life" is the iron law of reality.
↑ taken casually at 3 o'clock in the middle of the night
This is a 52-year-old man who had recurrent chest pain for 2 hours, and at that time he mistakenly thought it was a stomach problem, and he came to the hospital after taking stomach medicine that could not relieve it.
He was an out-of-town truck driver, and after his colleagues took him to the emergency room, the doctor quickly checked an electrocardiogram and found that it was an acute myocardial infarction.
The emergency doctor immediately opened the green channel of the "chest pain center", let the patient take "aspirin, ticagrelor, rosuvastatin" and other first-aid drugs, and activated the catheterization laboratory to prepare for emergency surgery.
However, the patient felt that he was young and in good health, and did not want surgery or thrombolysis.
Judging from the electrocardiogram, this is a large-scale myocardial infarction, and the location of the blockage is very dangerous, and death may occur at any time.
The cardiologist communicated and explained for a long time, and called his wife who was out of town, but fortunately, after his lover understood, he thought about it for a long time, and finally made up his mind to operate.
At this time, nearly an hour had passed since he went to the emergency room, and ECG monitoring could see multiple premature ventricular contractions and low blood pressure, which was a very dangerous signal.
If nothing else, the unexpected happens.
As soon as the patient was escorted to the catheterization lab, the heartbeat stopped, and ventricular fibrillation ...... A bunch of people hula hula, hurriedly cardiopulmonary resuscitation, 200J electrical defibrillation, and at the same time immediately radial artery puncture coronary angiography.
I took it casually in the middle of the night
Some people will ask: is it so dangerous or emergency surgery? Aren't you afraid? Can I do it again when my condition is stable? Yes, it is dangerous, and doctors are not willing to take risks, but if you do not rush to emergency surgery, the patient may die immediately, and there is no chance to wait until the condition is stable, and there is only a chance to survive after opening the blood vessels as soon as possible.
The imaging revealed occlusion of the left anterior descending artery, a blood vessel that supplies most of the blood flow to the left heart, and is extremely honorable.
Quickly manipulate the guidewire through the blocked site, open the blood vessel, and implant the stent, and then ask the patient how he feels.
Answer: It doesn't hurt.
After washing my hands and taking a breath, I took a sip of cold water, it was already one o'clock in the morning, and I was about to go home.
At this time, the nurse in the catheterization laboratory called me: "Director, the chest pain WeChat group is posting pictures again", and then the phone called, another 50-year-old acute myocardial infarction.
Again... Again...
It has been said "again" for two consecutive days, and yesterday was also 2 emergency PCI surgeries, in fact, yesterday it should have been 3 patients with myocardial infarction, but there was a 78-year-old man who had a heart failure for 3 days before he came, and he could only postpone the operation after exceeding the emergency surgery time window.
So the catheterization laboratory was busy again, and the second patient was a proximal right coronary artery blockage, and when he came, his heart rate was only more than 40 times, and his blood pressure dropped, and his heart rate and blood pressure returned to normal soon after the blood vessel was opened.
It was already past 2 o'clock in the morning when I went back, and there will be a full outpatient service tomorrow.
In recent years, due to the prevalence of unhealthy lifestyles, the incidence of cardiovascular diseases in mainland China has continued to rise, and it is estimated that there are currently 330 million patients with cardiovascular diseases, and 3.09 million deaths due to cardiovascular diseases in 2005 increased to 4.58 million in 2020.
It is no wonder that there are more and more patients with myocardial infarction, and they are getting younger and younger, and the number of patients with myocardial infarction in their 20s and 30s is increasing every year.
Both patients have 5 habits tonight: high blood pressure has not taken medicine for many years, smokes for a long time, does not like to eat vegetables, eats salty and greasy, and often stays up late to drive or socialize.
According to statistics, in 2022, there will be 1.034 million hospitalized patients with myocardial infarction in mainland China, of which 2.3% will be combined with cardiac arrest, and the in-hospital mortality rate will be 4.3%.
This is only for hospitalized patients, and this also means that a significant number of patients with heart attacks die suddenly before they have time to reach the hospital.
So is there a way to prevent it? Of course, as long as the following 6 points are usually achieved, the probability of cardiovascular accidents will be greatly reduced.
1. Pay attention to heat and cold prevention
High temperature will lead to an increase in cardiovascular mortality of 12.95%, although autumn, but the weather in the south is still relatively hot, the temperature of the air conditioner should not be too low, regularly open the window for ventilation, to properly replenish water, if there is no heart failure, about 1500 ml or more per day, to avoid excessive blood viscosity.
The northern region may already be relatively cold, or the temperature difference is very large, and the cold will also lead to a great increase in the probability of cardiovascular and cerebrovascular accidents. 2. Exercise appropriately and do what you can
It is recommended to exercise more than 5 times a week, about 30 minutes of aerobic exercise each time, brisk walking, jogging, and swimming are all good choices.
3. Maintain good living habits
To achieve a balanced diet, low-salt and low-fat diet, eat more foods rich in dietary fiber and vitamins, such as vegetables, fruits, coarse grains, etc., and also appropriately supplement poultry, eggs, and milk.
4. Quit smoking, limit alcohol, and stay away from secondhand smoke
Smoking will lead to damage to the endothelium of blood vessels, prone to plaque, and narrowing of blood vessels.
5. Maintain a good mindset and sleep
Nowadays, everyone has a lot of pressure in work and life, which is also a reason for the high incidence of cardiovascular disease, when you are emotionally stressed, you can stand naturally, close your eyes, and take deep breaths to help relax and relax.
6. Take medication regularly on time to control blood pressure, blood sugar, blood lipids, etc
Coronary heart disease is closely related to these high-risk factors, and many patients we meet with myocardial infarction usually do not have regular treatment, resulting in myocardial infarction, so we must take medication regularly under the guidance of a doctor.
In the event of a heart attack, how should I receive first aid?
1. Don't panic, rest on the spot, maintain a comfortable position, sit and lie down, don't believe in the so-called "coughing hard to save yourself", "slapping and jumping hard to flush the blood clot away", which will increase myocardial oxygen consumption and accelerate death.
2. Immediately call the 120 emergency number, grasp the golden 120 minutes, choose the nearest chest pain center for treatment, and don't be reluctant to seek far. Clinically, many patients with myocardial infarction have collapsed on inappropriate transport routes.
3. If you consider angina pectoris and your blood pressure is normal, you can try to take nitroglycerin and so on under the guidance of a doctor.
As for whether to take aspirin after chest pain, etc., it is necessary to have the professional judgment and guidance of a doctor.
4. If the patient has cardiac arrest, cardiopulmonary resuscitation should be carried out immediately, if you don't understand, you can call 120 for help, and actively rescue under the guidance of the doctor.
5. After arriving at the hospital, please do not hesitate if you have the opportunity to perform emergency PCI surgery or thrombolysis. At present, both domestic and foreign guidelines strongly recommend emergency stent surgery as the first choice.
It is precisely because of the current vascular recanalization techniques such as stents and thrombolysis that the in-hospital mortality rate of myocardial infarction has dropped to about 4% as mentioned above, compared with more than 30% in the past.
As cardiologists, we don't want to get up in the middle of the night to rescue us, after all, who doesn't want to get a good night's sleep? Moreover, staying up late is easy to get old, and it will also increase the risk of sudden death.
What's even more annoying is that I lost 10 million in a single phone call, alas, what a sin.
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