Mr. Chen, aged 60. A few years ago, a general physical examination was found to have myocardial ischemia, and the medical examination hospital suggested that Mr. Chen have a detailed examination of cardiovascular disease, but Mr. Chen did not show any uncomfortable symptoms, so he did not care.
However, some time ago, he had frequent chest pain and chest tightness, which became more and more severe, resulting in a serious decline in the quality of sleep at night, and Mr. Chen also had difficulty breathing, and Mr. Chen was accompanied by his family to visit the emergency department of our hospital.
Mr. Chen, who reported that he was in good physical condition and had no history of underlying diseases such as hypertension and diabetes, performed auscultation of the chest cavity, and found that there was a significant feeling of pressure in the ventricular area and obvious murmurs.
We perform a body temperature check of 389. Heart rate 110 beats, blood pressure 140 90mmHg, no abnormal signs of lungs.We perform an ultrasound of the heart, which can show the contractile function of the myocardium, abnormal wall movement.The ECG showed a downward shift in the ST segment by 01 mV may indicate myocardial ischemia, and serum cardiac enzymes should be performed immediately with a CK-MB 40 L and CTNI 005ng/ml
Acute myocardial infarction is confirmed based on clinical findings, and the cause of myocardial infarction is long-term myocardial ischemia.
We have formulated a first-class plan, acute myocardial infarction is a relatively common acute and critical illness in clinical practice, and effective nursing measures must be taken immediately. Immediate intravenous infusion of nitroglycerin helps to dilate coronary arteries and increase myocardial perfusion, while intravenous infusion of dipyridamole can effectively inhibit platelet aggregation and reduce the size of myocardial infarction
Oral aspirin helps inhibit platelet aggregation, reduce thrombosis, give oxygen inhalation, maintain tissue oxygen supply, closely monitor ECG changes, and detect and treat arrhythmias in time.
Monitor your blood pressure closely to keep it within an acceptable range. During the process, it is necessary to maintain bed rest, eat lightly, avoid mental stimulation, and we closely monitor the changes in the patient's condition and adjust the ** plan in time.
After 3 consecutive days**, the patient's symptoms were significantly relieved, and the ECG showed that the ST segment had basically returned to normal.
The patient's cardiac enzyme test results gradually normalized, and oral medications** were continued after discharge, and cardiac function and ECG were regularly reviewed. The patient actively cooperates with the training in the first stage and is stable.
For patients with myocardial infarction due to myocardial ischemia, early diagnosis and early intervention are crucial. Taking effective measures in time can effectively reduce the area of myocardial infarction, reduce the pain of patients, and improve the rate. Let's take a closer look at myocardial ischemia
Myocardial ischemia refers to the lack of oxygen in the heart muscle due to insufficient blood**, which can cause dangerous conditions such as myocardial infarction. Myocardial ischemia is mainly caused by blocked or reduced blood flow to the coronary arteries.
1) Myocardial ischemia caused by atherosclerosis
It is a chronic and progressive disease that forms plaque in the inner walls of the arteries, causing the arteries to narrow, causing blood flow to slow down, which reduces blood flow**
When the heart needs more blood and oxygen, the narrowed arteries can't provide enough blood, resulting in myocardial ischemia. The main causes of atherosclerosis are unhealthy lifestyles and poor eating habits.
A diet high in fat, salt and sugar increases fat deposits in the arteries and aggravates vascular stenosis, thereby promoting the development of atherosclerosis and increasing the risk of myocardial ischemia.
2) Myocardial ischemia caused by thrombosis
When the artery stenosis is severe, the blood tends to clot into a thrombus at the narrowing, and when the blood is too viscous, or the blood flow slows down, it can also cause blood clotting, which can lead to thrombosis.
If a blood clot blocks a coronary artery, it can lead to myocardial ischemia. Thrombosis is usually caused by damage to arterial endothelial cells caused by atherosclerosis, and clotting factors in the plasma form blood clots on the inner walls of damaged blood vessels, and the formation of blood clots causes blockage of blood flow to the coronary arteries, resulting in myocardial ischemia.
3) Myocardial ischemia caused by coronary artery spasm
This is a pathological contraction that can lead to a lack of blood**, which can cause myocardial ischemia.
Coronary artery spasm is usually caused by impaired endothelial function, imbalance of vasoconstriction or dilation factors, or cardiovascular disease. When blood vessels spasm, coronary artery blood flow is blocked, resulting in myocardial ischemia and unstable angina, which in turn affects myocardial cells and causes myocardial ischemia. Spasms may be related to autonomic nervous system disorders, intracellular metabolic disorders caused by ischemia, and other factors.
4) Myocardial ischemia caused by insufficient myocardial blood supply
The human heart is a highly metabolic organ that requires cells to function constantly, and when the function of the cells declines, there may be insufficient blood supply, then the tissues will not be able to get enough oxygen and nutrients, resulting in myocardial ischemia.
Insufficient blood supply to the heart may be due to coronary artery stenosis, spasm, arteriosclerosis or thrombosis, and some other primary diseases can also cause this to occur, patients with congenital heart failure, the blood supply capacity of myocardial cells may be lower than that of ordinary people, and some diseases, such as anemia, hypotension or arrhythmia, can also lead to insufficient blood supply to the myocardium, which in turn leads to myocardial ischemia.
We should do myocardial ischemia as soon as possible** to prevent myocardial ischemia from causing some emergencies and avoid critical situations affecting our life and health.
1.Angina pectoris
It is mainly divided into exertional angina or stable angina, which usually occurs during physical activity or emotional agitation. This condition occurs because the heart muscle needs more oxygen and nutrients when it moves, but it can't provide enough blood** due to narrowing of the coronary arteries, resulting in myocardial ischemia
Angina pectoris usually presents with chest pain or pressure, sometimes radiating to the shoulders or back, accompanied by symptoms such as shortness of breath and sweating. The disease is very risky and can progress to myocardial infarction if it lasts longer or occurs more frequently.
2.Myocardial infarction
This is one of the more serious cases of heart disease, we have myocardial ischemia, which may lead to myocardial cell necrosis, decreased cell function, and insufficient oxygen delivery of myocardial cells, which will lead to tissue damage or necrosis in the myocardial area, affecting the normal function of the heart.
Myocardial infarction is clinically manifested as severe chest pain, dyspnea, cold sweat and other symptoms, and even fainting, cardiac arrest and other serious conditions. After a myocardial infarction, the patient's heart function may be impaired and there is a risk of another myocardial infarction. For acute myocardial infarction, the patient requires immediate emergency management.
3.Ischemic cardiomyopathy
The disease is a disease in which chronic damage and dysfunction of the heart muscle occurs due to prolonged ischemia of the heart muscle
Long-term myocardial ischemia can lead to degeneration, necrosis, and eventually fibrotic scar tissue formation, which affects the systolic and diastolic function of the heart.
The early symptoms of ischemic cardiomyopathy may be less obvious, including chest pain, shortness of breath, fatigue, etc., but as the disease progresses, patients may experience serious conditions such as arrhythmias, heart failure, and enlargement of the heart muscle. The key to ischemic cardiomyopathy is timely relief of myocardial ischemia, improving blood flow to the heart and reducing myocardial damage.
4.Sudden death
It is a sudden, unexpected cardiac arrest in which the patient loses consciousness and breathing for a short period of time, often resulting in death. Myocardial ischemia is one of the common causes of sudden death, particularly due to coronary artery spasm or acute myocardial infarction.
This occurs usually in association with arrhythmias, which may be due to abnormal myocardial cell excitation and conduction disturbances caused by myocardial ischemia. Prevention of sudden death is very important, including regular medical check-ups, maintaining a healthy lifestyle and timely cardiovascular disease.
Myocardial ischemia can lead to the occurrence of dangerous diseases such as angina, myocardial infarction, ischemic cardiomyopathy and sudden death. Therefore, for people with high-risk factors for cardiovascular disease, relevant examinations and ** should be carried out in time to maintain a healthy lifestyle and prevent serious consequences caused by myocardial ischemia.
If symptoms such as angina pectoris, myocardial infarction appear, you should seek medical attention in time and receive professional ** to avoid worsening of the condition and life-threatening. Let's take a look at how to **myocardial ischemia.
Myocardial ischemia is a cardiovascular disease caused by insufficient blood supply to the coronary arteries, which can lead to myocardial infarction in severe cases. For myocardial ischemia, we use antiplatelet drugs, receptor blockers, calcium ion antagonists and other drugs. These drugs work on different mechanisms to alleviate myocardial ischemia.
First: antiplatelet drugs
The drug improves blood flow in the coronary arteries by inhibiting platelet aggregation and aggregation and preventing thrombosis**. These drugs reduce the aggregation and agglutination of platelets by inhibiting thromboxane A2 synthesis of platelets and the activation of platelet aggregators, thereby reducing the risk of thrombosis and improving the symptoms of myocardial ischemia. Commonly used antiplatelet drugs include aspirin, clopidogrel, etc.
The second: receptor blockers
The drug mainly improves the symptoms of myocardial ischemia by blocking the activation of receptors, reducing the stimulation of the sympathetic nervous system to the heart, reducing the load and oxygen consumption of the heart
In addition, these drugs improve the symptoms of myocardial ischemia by slowing the heart rate, reducing the contractility and diastolic force of the heart, reducing myocardial oxygen consumption, and commonly used receptor blockers include metoprolol.
The third: calcium ion antagonists
The drug mainly reduces the influx of calcium ions by blocking the calcium ion channels on the myocardial cell membrane, thereby reducing the contractility of myocardial cells and myocardial oxygen consumption, and improving the symptoms of myocardial ischemia
By dilating the coronary arteries, the blood flow to the coronary arteries is increased, and the blood supply to the heart muscle is improved, thereby relieving the symptoms of myocardial ischemia. Commonly used calcium antagonists include nifedipine and amlodipine.
In addition to the above 3 drugs can improve myocardial ischemia, statins are also one of the important drugs for myocardial ischemia. Statins mainly reduce the level of cholesterol in the blood by inhibiting cholesterol synthase, thereby reducing the formation of atherosclerotic plaques, improving the patency of coronary arteries, and increasing the blood supply to the heart muscle
These drugs work through different mechanisms to improve the symptoms of myocardial ischemia and improve the blood supply to the myocardium. However, the specific situation of each patient is different, and the selection and use of drugs should be carried out according to the doctor's recommendation to ensure the safety and effectiveness of **.
Myocardial ischemia should be received as soon as possible to avoid emergencies, and myocardial ischemia can be treated with antiplatelet drugs, receptor blockers, and calcium ion antagonists, which can effectively reduce myocardial ischemia.
Mr. Chen, mentioned above, was diagnosed with myocardial ischemia a few years ago, but he did not show obvious symptoms, so he did not care about it, and a few years later due to long-term myocardial ischemia caused myocardial infarction, so we found that myocardial ischemia should be timely**.
1.Tianyu Zhang, Lu Wang, Xiaohua Zhang. A review of the mechanism of myocardial ischemia leading to the occurrence of acute illness[J].Medical Review, 2018, 24(22): 4395-43992.Lu Xiaoming, Zhang Yujie, Wu Xiaoyu. Advances in early diagnosis and treatment of myocardial ischemia and acute myocardial infarction[J].Journal of Clinical Cardiology, 2017, 33(11): 727-730