Mr. Zhao is not yet 40 years old and has been feeling unwell recently, suspecting that he has a heart attack and myocardial ischemia.
I asked someone to do an imaging examination. Because he smoked a lot for a long time, he was overweight, and had some uncomfortable symptoms, so an imaging examination was arranged.
A cardiac angiogram revealed that the patient had a severe stenosis of one blood vessel, almost 90% stenosis. Under normal circumstances, this stenosis is treated by blood pressure stents.
Mr. Zhao has severe stenosis
Let’s first look at the classification of cardiovascular stenosis:
Grade I: 25%-49% stenosis of cardiovascular plaque, sometimes this is not called stenosis, but is called plaque. No more than 50% can not even count coronary heart disease.
Grade II: Cardiovascular plaque that causes 50%-74% stenosis, which we call mild stenosis.
Grade III: Cardiovascular plaque, causing 75%-99% stenosis, we call it severe stenosis.
Class IV: Complete blockage of the cardiovascular system, 100% blockage.
Totally occluded cardiovascular
Mr. Zhao’s most severe stenosis in the heart vessel seems to be 90%, so it is a severe stenosis. Severe stenosis is usually treated with stents.
After the angiography, tell the patient that the stenosis is severe and that it is estimated that a stent is required. The patient also agreed to the stent because he also suspected that he had a heart disease and was willing to have the stent.
But we feel that his discomfort is not typical myocardial ischemia angina, and there is no obvious myocardial ischemia on the ECG, so we are not willing to give the patient a stent.
What is typical ischemic angina:
For example, if the exercise treadmill test is done, the patient has symptoms of angina, or the electrocardiogram shows (+).
For example, patients experience angina pectoris such as chest tightness and suffocation after activity, exercise, labor, and exertion, chest pain and pain in the precordial area, which last for a few minutes each time, and can be gradually relieved after rest.
For example, cardiac radionuclide imaging has been done, suggesting that the patient has myocardial ischemia.
However, Mr. Zhao’s symptoms were not typical, and the electrocardiogram did not suggest myocardial ischemia, nor did he have a cardiac nuclide. Therefore, it is a bit sloppy to directly judge severe stenosis through angiography, and then put a stent on the patient.
Is there a more accurate way to judge myocardial ischemia?
The patient was then scheduled for an intravascular ultrasound.
This kind of examination is simply a kind of micro-ultrasound, which can be put into the heart blood vessels of the patient through the peripheral blood vessels, that is, the way of angiography. See the heart blood vessels clearly to see if there is myocardial ischemia.
There is a metric called FFR.
The Chinese name is: coronary flow reserve fraction (FFR). This test can measure a data.
When FFR measured data
When FFR>0.80, it means that there is no myocardial ischemia, and healthy life + regular drug treatment can be used first.
When the FFR is between 0.75 and 0.80, it is a borderline lesion. At this time, a doctor’s comprehensive judgment is needed to give the final treatment plan.
Then did an intravascular ultrasound examination for Mr. Zhao, and found that the FFR was 0.81, >0.80. It was confirmed that the patient had no myocardial ischemia, so no stent was placed on him.
This case tells us that even if the angiography shows severe stenosis, if the patient has no evidence of typical myocardial ischemia, then a comprehensive evaluation should be performed, and the stent should not be placed in a hurry! If you can’t stand, then don’t stand, it’s a last resort.
Cardiovascular doctor is a comprehensive doctor, not an angiography doctor. When you can’t see it, you can only say one sentence: You can’t do an angiography. It makes people feel that a cardiologist only does angiography.
Cardiovascular doctors can’t see cardiovascular stenosis and put stents. They feel that cardiovascular doctors are stent doctors.
Seeing a doctor is looking at people. It must be comprehensively looked at, not just angiography. It is necessary to comprehensively look at the patient, check the examination, check the symptoms, etc., and finally give the final recommendation.
Our principle is: if the disease can be controlled by a healthy life, do not rush to take medicine; if the disease can be controlled by medicine, do not rush to surgery!