Source: Comprehensive finishing of top three faxes
This young man His wife has been living in the hospital corridor for seven days. Every time I pass this bench, I will have a few words with her, is it cold here, are you afraid? She said it was right at the door of the ward, and the nurses and security guards were there, so I wasn’t afraid. 
She doesn’t really care about fear. Opposite the bench where she sleeps is the CCU, which is the security door of the cardiac intensive care unit. It is less than 10 meters inside. Her husband is lying on the hospital bed, under 24-hour monitoring. He is only 35 years old. I asked her, why don’t you go to the guest house next door? She said that this place is close to the child’s father, and I can see him at any time and take care of him. 
I have seen too many patients with myocardial infarction and their families, and this couple is the one that makes me sad and sad. Because her husband, a 35-year-old young man and father of two children, has partial necrosis of the heart muscle and heart failure, and the extent to which he can recover in the future is unknown. And all this could have been avoided. Because if the two of them knew a little bit of common sense about myocardial infarction and angina pectoris, they would not have come to this point. The reason why I wrote this case is to remind everyone that they must recognize and recognize the angina pectoris before the myocardial infarction and the angina pectoris that is occurring during the myocardial infarction. Because time is the heart muscle, and the heart muscle is life. The sooner it is detected and treated, the better the recovery. This young patient started two weeks ago, June 24th. Xiao Sun, who was working in the suburbs of Beijing, suddenly felt a faint pain in the sternum, the bone down from the throat. He thought, got angry? Sore throat? Actually, this is the first sign of angina, pain behind the breastbone. The next day, Tuesday, June 25, the pain in the sternum worsened. On the way to work, after driving on the highway, his left arm suddenly started to have pain, accompanied by chest tightness, and he couldn’t hold the steering wheel. It worsens after exertion and relieves after rest. This is a very typical angina pectoris. And it has been strung to the left arm. At this time, his myocardial ischemia was very serious, and death had beckoned to him. However, Xiao Sun had no idea. After arriving at the unit, Xiao Sun still felt tired. He thought it was because the air conditioner was too cold, so he turned off the air conditioner and lay in the duty room for a day. When he got home that night, he started to feel suffocated, the pain in his chest worsened, he couldn’t even lie down, and he was sitting almost all night. The back of the breastbone is hot, like a sore throat that is seriously lit. At this time, he has an acute myocardial infarction, and his life is in danger at any time. His heart muscle continued to die massively. Xiao Sun still doesn’t know. On Friday, June 28, he took his father-in-law to Beijing Chest Hospital to see a lung disease, and then he got another orthopaedic number! Thanks to the experienced orthopaedic doctor, he immediately realized something was wrong based on his description and asked him to visit the heart center. Xiao Sun then clutched his chest and came to the center of his heart. At the heart center, according to Xiao Sun’s state, he was immediately asked to do an electrocardiogram and an ultrasound. As soon as the electrocardiogram came out, acute anterior myocardial infarction! 
This is his ultrasound, staged wall motion abnormalities, what does it mean? It is his heart muscle, not a whole piece is systolic and diastolic, there are so many positions, almost motionless! This means that part of the myocardium has been dormant or dead! Myocardial death, left ventricular systolic function will definitely be reduced! 
This is his myocardial marker. The first indicator is nearly 300 times the standard value! No, go to the cath lab immediately for rescue! 
Angiography shows that Xiaosun’s anterior descending artery, also known as the “widow maker”, has severe stenosis and is still in the proximal segment. , equivalent to the upper reaches of the Yangtze River, it is more harmful. This narrow position will lead to large myocardial ischemia!
a stent was opened during surgery, The heart failure is serious, and the IABP pump is placed in the auxiliary support. This pump helps his heart work. Every time the heart beats, the pump also works once. Dying myocardium has a rest.
Xiao Sun was admitted to CCU intensive care after operation”
This is the comparison between Xiao Sun’s electrocardiogram the day before yesterday and the day of emergency rescue. However, the ECG remained QS, a sign of myocardial necrosis. His ejection fraction was also only 43%. According to Xiaosun’s body size, it should be at least 60%. All the evidence points to one, Xiao Sun’s myocardium has a lot of necrosis! 
This is Xiaosun’s neck. These deep lines reveal Xiaosun’s weight. He told me that the pain was gone for the past few days, but he was sweating after eating and turning over. This is clearly a symptom of heart failure. Xiaosun suffered a fracture three years ago and was lying still for half a year, and her weight soared by 40 pounds. But he never thought that the heart attack had anything to do with him. He told me that if he had a little common sense, he would definitely go to the emergency room as soon as possible, and it would not be delayed to the extent that he is now. 
Xiao Sun’s blood pressure is already normal, and the injured myocardium may recover, but it will take half a year to find out. In the best case, there is compensation, and there is no heart failure. In the most pessimistic case, heart failure worsens. At that time, it depends on the ejection fraction. Above 35, the risk of sudden death is smaller, and below 35, it is very dangerous. Xiao Sun’s experience is a typical tragedy, and such a tragedy is staged in the hospital almost every day. When I think of his young wife and two children who are guarding the corridor day and night, my heart is not happy either. Common sense, common sense, common sense! If they knew a little common sense about myocardial infarction and angina pectoris, this tragedy could be completely avoided! So how to identify chest pain, how to know all kinds of discomfort, it may be angina pectoris, may be a precursor to myocardial infarction? Remember 16 words: Exercise induced, relieved by rest, relieved by medication, above 2 points. Below I will explain one by one. Exercise-induced: Generally, in the case of exertion, such as walking, brisk walking, going up the overpass, going upstairs, having a full meal, etc., its pain will be induced, or aggravated. Relief with rest:Rest immediately after the onset of pain, and the pain will ease after a while. 2 points or more: The pain should last for more than two minutes. If it’s lightning pain, it’s definitely not. Medication for relief:Here mainly refers to nitroglycerin and Suxiaojiuxin pills. How to choose these two kinds of drugs, and who is the real life-saving drug, the three top three will explain in detail:Both of these two drugs are used for “angina pectoris”! These two medicines are used for the same disease, which is angina pectoris. Angina pectoris is a typical symptom of coronary heart disease. Simply put, blood lipids are too high and plaques form, which narrows the heart blood vessels. 
So when the patient is tired or excited, the heart muscle will be ischemia due to the narrowed blood vessels and insufficient blood supply, so angina pectoris will occur. 
The effect of these two drugs is to make the blood vessels dilate, temporarily unblock the blocked blood vessels and relieve the symptoms of chest pain. Then the question is, when coronary heart patients suffer from angina pectoris, should they take nitroglycerin first? Or quick-acting pills? Nitroglycerin is the first aid drug! 1. Who should keep nitroglycerin? Patients with confirmed coronary heart disease need standing nitroglycerin as the first-choice emergency medicine. 
2. When to use nitroglycerin? When patients with coronary heart disease have an acute attack of angina pectoris (chest pain or chest tightness after exertion), nitroglycerin can be taken under the tongue. Important Note: Patients with frequent hypotension, glaucoma, cerebral hemorrhage, and high intracranial pressure should be used with great caution, and must consult a doctor or pharmacist in advance. 3. How to use nitroglycerin correctly? First of all, be sure to put the tablet under the tongue, do not swallow it, but chew it slightly. It takes 2 to 3 minutes to take effect, and the effect lasts for 20 to 30 minutes. 
Secondly, seated oral administration is recommended. This medicine will lower blood pressure. Taking it while standing may cause insufficient blood supply to the brain, and taking it while lying down may increase the burden on the heart. Important Note: When taking one tablet of nitroglycerin does not relieve after 5 minutes, you can take another tablet. If 3 tablets are not relieved within 15 minutes, you must suspect that it is not “angina pectoris” but “Myocardial infarction”, do not continue to use nitroglycerin at this time, you should immediately call the emergency number for medical treatment. 4. How to store nitroglycerin? Pills are best placed in a brown glass bottle, stored at room temperature away from light (not exceeding 30°C), and should not be placed in a close-fitting pocket when going out, so as to avoid exposure to body temperature and make it overheated. Nitroglycerin typically has a shelf life of one year. So even if it is not used up, it is best to replace it regularly. Important Note: If the tablet has “spots, discoloration” or you don’t feel the “spicy burning sensation” when you take it under the tongue, it may indicate that the tablet has expired. Suxiao Jiuxin Pill is an “emergency” medicine! Suxiao Jiuxin Pills are Chinese patent medicines, which can activate qi, activate blood, and dilate blood vessels, but they are not as fast as nitroglycerin. 
So when there are two drugs at the same time, nitroglycerin is still the first choice for first aid. 1. Who should always have quick-acting heart-relief pills? High-risk groups of coronary heart disease, such as the elderly, patients with “three highs” for many years, old smokers for many years, obese people, etc. Especially for those who have had symptoms similar to “angina pectoris” but have not been diagnosed with coronary heart disease, they can always prepare Suxiao Jiuxin Pills for emergency. 2. When should I use Suxiao Jiuxin Pill? When high-risk groups have some aura symptoms of angina pectoris, such as chest tightness, discomfort in the precordial area (left anterior chest), and the left shoulder feels sore and heavy, Suxiao Jiuxin Pills can be taken. 
Important note: Different people have different aura symptoms before the onset of angina, and patients need to experience and pay attention to these auras. For patients with confirmed coronary heart disease, when angina pectoris occurs, Suxiao Jiuxin Pills can also be used as an emergency in the following situations:(1) No nitroglycerin; < span>(2) The patient has contraindications to taking nitroglycerin;(3) The patient cannot tolerate nitroglycerin (such as dizziness after use). 3. How to use Suxiao Jiuxin Pill correctly? In acute attack of angina pectoris, take 10-15 Suxiao Jiuxin Pills under the tongue at one time. If it is invalid after 10 minutes, you can take it again. If there is no relief after more than 15 minutes, you should call 120 in time. Although the effect of Suxiao Jiuxin Pills in lowering blood pressure is not as strong as that of nitroglycerin, it is still recommended to take it while sitting. Important Note: Suxiao Jiuxin Pills can also be used as daily medication for coronary heart disease patients with “Qi stagnation and blood stasis type”, 4-6 capsules each time, 3 times a day. It can play a certain role in preventing seizures, but whether it should be eaten every day needs to be evaluated and judged by a doctor. 4. How to store Suxiao Jiuxin Pills? The storage method of Suxiao Jiuxin Pills is not as harsh as that of nitroglycerin. The general warranty period is 3 years. In the event of myocardial infarction, these two drugs are useless! Myocardial infarction and angina are very different. Angina pectoris is a narrowing of the blood vessel due to a long “plaque” in the wall of the blood vessel. Myocardial infarction refers to the rupture or detachment of plaque, forming a “thrombus” that completely blocks the blood vessel, which is more serious and can be fatal. 
Once the symptoms of angina pectoris in patients with coronary heart disease are not relieved for more than 15 minutes, it is necessary to suspect myocardial infarction. At this time, neither nitroglycerin nor Suxiao Jiuxin pills are of much use for myocardial infarction. The medicine that needs to be prepared at this time is:
The aspirin enteric-coated tablet 300mg (one 100mg tablet) is chewed and swallowed. May relieve myocardial infarction to some extent. Important reminder: If coronary heart disease patients suspect that they have a myocardial infarction, they should not take the medicine without authorization, but they should keep it aside, or call the emergency call first and ask the emergency personnel if they need to eat. In short, whether it’s nitroglycerin or quick action Pills are all drugs for temporary relief of symptoms of patients with coronary heart disease, not routine treatment drugs.
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