The etiology and treatment of angina pectoris

Angina is a temporarily from myocardial ischemia, caused by hypoxia, onset of chest pain or chest discomfort as the main performance of the clinical syndrome. 1, cause: for the main coronary atherosclerotic stenosis and coronary thrombosis in this and / or coronary artery spasm, X syndrome, myocardial bridge, then found aortic valve disease, hypertrophic cardiomyopathy, syphilitic aortic inflammation, such as mitral valve prolapse syndrome. 2, symptoms and signs (1) onset of the sternum after crushing pain, back to the left shoulder, left arm or jaw and neck radiation ulnaris, accompanied by fast or slow down the heart rate, blood pressure fluctuations, anxiety and looking pale or cold sweat. (2) by regular physical activity or emotional excitement, cold, eat three square meals induced. (3) attack patients often do not consciously stop their activities, rest after 3 to 5 minutes mitigation, it seldom more than 15 minutes, with clothes nitroglycerin remission after five minutes with. 3, clinical classification (1) labor-type: As physical activity, agitation or other increased myocardial oxygen consumption induced by the situation angina. ① early-onset: the early angina less than a month, or had angina past few months has no pain, the recurrence time is less than a month; ② stable: patients in 1 to 3 months angina attack incentives, frequency, the degree of pain duration and pain to alleviate the situation of the same type ③ deterioration: in the original stable angina based on the number of frequent attacks, the extent of increase, the duration of the extension, inducing factors increasingly not obvious, even when the rest can attack. (2) spontaneous type: when in the rest or sleep onset, pain heavier and longer time, it is not easy for nitroglycerin is easing. ① supine type: often in the middle of the night when sleep or rest Attack; ② variant: a tendency to regularly attack, pain for quite a long time attack related to lead electrocardiogram showed ST-segment elevation; ③ after infarction angina: acute myocardial infarction within 1 month after the angina, suggesting that more prone infarction . (3) mixed: Patients with angina can occur in any of the above circumstances. The early onset and worsening of spontaneous angina and all collectively referred to as unstable angina. 4, resting electrocardiogram: angina attack that ST-segment depression or elevation, flat or inverted T wave. 5, Holter: myocardial ischemia observed laws of the day, but 70 to 90 percent of ischemic ST-T changes without angina attack, known as painless myocardial ischemia. 6, exercise test: treadmill or exercise bicycle test in the secondary or at the time of exercise, there ischemic electrocardiographic changes, a small number of patients can be induced angina. 7, radionuclide examination: 201 Tl myocardial imaging photography show ischemic areas as sparse or defect. 90 technetium ventricular angiography showed abnormal wall local activities. 8, two-dimensional echocardiography: Visibility branch of the left coronary artery lumen and narrow, irregular wall thickening and Echo enhanced, regional myocardial ischemic campaign to reduce the rate or no movement. 9, coronary angiography: coronary artery stenosis can be found in the location of the lesion and to estimate the degree of stenosis. Treatment 1, the termination Attack (1) an immediate cessation of activities. (2) nitroglycerin 0.3 ~ 0.6 mg sublingual. (3) isosorbide dinitrate 5 ~ 10 mg sublingual. (4) Suxiao Jiuxin pill or Shexiangbaoxin pill 2 ~ 5-of. (5) nitroglycerin aerosol spray in the chest or arm skin, or through oral inhalation. 2, preventive attack (1) nitrate formulations: ① isosorbide dinitrate 5 to 10 mg three times a day; ② nitroglycerin patches daily 5 to 10 mg, affixed to the upper arm or chest medial skin; ③ benefits Lok scheduled 20 mg daily 2. (2) B-receptor blocker: ① US Metoprolol 50 ~ 10 mg three times a day; ② Atenolol 12.5 ~ 50 mg daily 2. (3) enteric-coated aspirin 100 mg daily 1st. (4) calcium antagonists: If there can be selected into the coronary artery spasm: ① nifedipine 10 mg three times per day oral; ② diltiazem Zhuo-30 ~ 60 mg three times per day. 3, cardiac catheterization and surgical intervention (1) percutaneous transluminal coronary angioplasty: Lack of a wider application of the current non-surgical treatment of coronary heart disease by attacking the expanding balloon lumen stenosis increase its success rate of 75 ~ 90%. (2) Control of coronary heart disease risk factors, such as workers quit, and actively treating hyperlipidemia, diabetes, hypertension. Obesity should reduce weight. (3) active treatment induce or aggravate angina attack factors, such as high blood pressure, anemia and hyperthyroidism, and so on. 5, unstable angina treatment (1) hospital bed rest and, if necessary, oxygen inhalation, to monitor ECG and cardiac enzymes except myocardial infarction. (2) long-acting nitrates merger B-blockers or calcium antagonists. (3) serious given nitroglycerin 5 ~ 10 mg in 5% glucose solution of 500 ml of intravenous injection Yang began to 10 ug / min, after increasing. (4) Heparin 1 to 2 mg / kg in 5% glucose 250 ~ 500 ml of intravenous drip, or 600 to 800 U / h continuous infusion, for PTT to maintain control of 2 times until angina ease later renamed the enteric-coated aspirin and / or oral dipyridamole.