Recently, the Department of Cardiology of Sunshine Harmony Hospital successfully completed the intervention of 1 patient with silent myocardial infarction.
The patient, Mr. Tian, 63 years old, was admitted to the hospital with "edema of both lower limbs for 3 days and could not lie flat for 1 day". Previous history of "hypertension, type 2 diabetes, persistent atrial fibrillation". The cardiology team diagnosed acute non-ST-elevation myocardial infarction based on the patient's medical history, electrocardiogram changes and myocardial marker test results. **The core problem is to restore coronary blood as soon as possible**, but the patient cannot lie flat and it is difficult to intervene**. After a night of aggressive medication**, the symptoms of heart failure were reduced, and coronary angiography was performed the next morning, which showed multiple lesions in the anterior descending artery, circumflex artery, and right coronary artery, with a stenosis of 99%. With as little contrast agent as possible, the operation is as simple as possible, and after balloon dilation, a stent is implanted in the anterior descending and circumflex branches that have a great impact on cardiac function (elective retreatment of the right coronary artery). After the operation, the patient's heart failure symptoms disappeared, the BNP index decreased significantly, and the patient recovered well and was discharged from the hospital.
Shao Jingbo, director of the first department of cardiology of Sunshine Harmony Hospital, introduced that silent myocardial infarction, that is, asymptomatic myocardial infarction, refers to acute myocardial infarction that lacks characteristic chest pain symptoms, and its concealment is easy to be ignored. In the past, clinicians did not know enough about this, and the diagnosis was often retrospective, that is, some patients without a history of chest pain were presumed to have had a ** myocardial infarction after an abnormal Q wave was accidentally detected on the ECG. Some diagnoses even mistake patients with ** myocardial infarction for the absence of typical chest pain because the lesion is mild. Diabetic patients are prone to nerve damage, dysesthesia, atypical symptoms, and are more likely to delay the onset of the disease.
However, missing a silent myocardial infarction often leads to serious consequences. Analysis of studies has shown that silent myocardial infarction is common and is associated with an increased risk of long-term mortality. Another study has shown that if silent myocardial infarction is missed, nearly half of patients will not benefit from **, and the risk of dying from cardiovascular disease is 2 times higher than that of ordinary patients.
The typical symptoms of myocardial infarction are crushing, bulging, or asphyxiating pain that occurs suddenly after the upper or middle sternal body, affecting most of the precordial area, radiating to the left shoulder, anteromedial aspect of the left upper extremity, and may be accompanied by shortness of breath, nausea, sweating, and a sense of impending death, which is not relieved by rest or sublingual nitroglycerin and other drugs. However, the symptoms of silent myocardial infarction are vague or even asymptomatic. So, what are the current markers that can identify silent myocardial infarction?
In general, silent myocardial infarction can be broadly divided into two categories, one of which is that people do not have any symptoms. True silent myocardial infarction may be detected on ECG changes and laboratory troponin and cardiac enzyme profiles, or at presentation of the patient for heart failure due to myocardial infarction. Myocardial infarction can also be detected during an echocardiogram** or other examination. This is followed by symptomatic silent myocardial infarction, but symptoms are not detected in time. This is common in women with myocardial infarction and has different symptoms than in male patients. Many women do not seek medical attention as soon as they have atypical chest pain symptoms and may only experience palpitations, fatigue, malaise, or shortness of breath. However, this condition can sometimes be a myocardial infarction because a woman's heart attack may not be as typical as a man's. Therefore, this situation requires increased vigilance.
Sunshine Harmony Hospital is a large-scale comprehensive medical institution integrating medical treatment, teaching, scientific research, prevention, health care, translational medicine and industrial development jointly established by Sunshine Insurance Group and Weifang City under the new situation of national medical reform, approved by the China Insurance Regulatory Commission. It is one of the few large-scale non-public general hospitals in the country that has obtained international JCI accreditation (seventh edition), HIMSS7 rating and domestic top three evaluation, and three highly influential and representative international and domestic authoritative certifications, and served as a provincial centralized treatment center for new crown pneumonia during the new crown epidemic. The hospital has been identified as a designated hospital for medical examination of model workers in the national financial system, a national civilized unit, the best volunteer service project in the country, a national management innovation hospital, a May Day Labor Award in the national financial system, a national humanistic management innovation hospital, an advanced health unit in Shandong Province, a demonstration hospital for improving medical services in Weifang City, a medical institution trusted by Weifang citizens, a national medical insurance, a medical insurance designated medical institution in Shandong Province, a designated medical institution for medical insurance in Weifang City, and a regional medical center in Weifang City.