An elderly friend told Hua Zi that his heart is not very good and he has a problem of myocardial ischemia. As long as he gets angry or does more activity, he will experience chest tightness and shortness of breath. symptoms, what should I do, and is there any way to treat it?
Hua Zi said that myocardial ischemia refers to the stenosis of the coronary arteries that supply blood to the heart, resulting in insufficient blood supply to the heart, hypoxia and ischemia of myocardial cells, and chest tightness, chest pain, Symptoms such as difficulty breathing. However, a common cause of similar symptoms is cardiac neurosis, which needs to be identified.
I. How to judge whether there is myocardial ischemia
The main cause of myocardial ischemia is atherosclerosis in the coronary arteries, and the sclerotic plaques can narrow the arterial lumen. However, when the stenosis does not exceed 50%, there are generally no symptoms, and when the coronary artery stenosis exceeds 50%, it is the diagnostic criteria for coronary heart disease.
Cardiac neurosis, caused by autonomic disorders, can also cause angina-like symptoms. The difference from myocardial ischemia is that cardiac neurosis usually occurs at rest and before bedtime, while myocardial ischemia caused by coronary heart disease usually occurs during activity and exertion.
The “gold standard” for diagnosing myocardial ischemia in the hospital is coronary CT or coronary angiography. The electrocardiogram is easily disturbed and may be missed.
Second, 5 commonly used drugs to improve myocardial ischemia
1. Nitrate drugs: commonly used drugs such as nitroglycerin, isosorbide dinitrate and isosorbide mononitrate can release nitric oxide (NO ), promote vasodilation, reduce cardiac load, reduce cardiac tension, reduce cardiac oxygen consumption and relieve angina symptoms.
However,nitrates will produce rapid resistance and become ineffective when used continuously, of which nitroglycerin is only suitable for sublingual administration of acute angina pectoris to relieve symptoms , not for routine prophylaxis. Other nitrates need to use the “eccentric dosing method” and set a drug-free interval.
2. Nicorandil: Nicorandil is also a nitrate compound, but its mechanism of action is different from that of nitrate drugs. The permeability of calcium and potassium ions play the role of dilating coronary blood vessels, and the effect lasts for a long time without drug resistance.
3. Calcium channel blockers: including dipine drugs (such as nifedipine, amlodipine, felodipine, benidipine, etc.) and Nondipine drugs (such as diltiazem, verapamil, etc.) can dilate blood vessels and lower blood pressure and have a good therapeutic effect on variant angina pectoris. Among them, non-dipine drugs can also slow down the heart rate and are used for the treatment of arrhythmia.
4. Beta-blockers: commonly used are metoprolol, bisoprolol, carvedilol, etc. Slow heart rate, lower blood pressure, reduce myocardial oxygen consumption. May improve long-term prognosis of coronary heart disease.
5. Trimetazidine: Not as a symptomatic treatment for angina pectoris, but when other anti-angina pectoris drugs are ineffective, trimetazidine can be used in combination . Trimetazidine can promote the energy metabolism of cardiomyocytes under hypoxia and ischemia, maintain the stability of the intracellular environment, protect cardiomyocytes, and increase the effect of other drugs.
Three, the prevention of myocardial ischemia should be emphasized
The factors that cause myocardial ischemia cannot be changed except age and genes. Other factors such as smoking, blood pressure, blood lipids, blood sugar, etc. can be changed. Abstaining from tobacco and alcohol, weight control, exercise, regular work and rest, and control of the “three highs” can effectively delay the progression of atherosclerosis and prevent the occurrence of myocardial ischemia.
At ordinary times, you should also be careful not to eat too much. You should add or remove clothes according to the changes in the ambient temperature. The bath water should not be too cold or overheated. Exercise should be done according to your ability, not too tired, and keep your mood. Stable and not violent, to avoid inducing symptoms of myocardial ischemia.
To sum up, if you experience symptoms of chest tightness and shortness of breath during exertion or activity, you should go to the hospital for examination in time to confirm whether it is myocardial ischemia caused by coronary stenosis. The use of drugs under the guidance of a doctor can improve the symptoms of angina pectoris during myocardial ischemia. We must develop healthy living habits, “disease prevention” is more important than “disease cure”. If you have any doubts about the medication, please consult your doctor or pharmacist. I am Huazi, a pharmacist. Welcome to follow me and share more health knowledge.