Differential diagnosis
Myocardial ischemia mainly needs to be distinguished from various diseases with chest pain as the main manifestation, and it is also necessary to identify the different causes of myocardial ischemia.
Distinguish from other diseases that cause chest pain
Aortic dissection
The pain is intense and persistent, often accompanied by a history of hypertension; Dissection involving the opening of the coronary artery can lead to acute occlusion of the coronary artery, and there are clinical manifestations of acute myocardial infarction, such as ST segment elevation in the ECG. Cardiac color ultrasound or aortic CTA can make a definitive diagnosis.
Intercostal neuralgia and costal chondritis
The nature of the pain is stinging or burning pain, and it is persistent. Coughing, breathing and other actions can aggravate the pain due to the tug on the lesion site, which makes it easy to distinguish from myocardial ischemia.
Cardiac neurosis
The nature of the pain is mostly brief sharp pain or persistent dull pain. The onset time of chest pain is mostly after fatigue, rather than when fatigue, and continue to physical activity, chest pain often will not worsen, and may even be reduced. Easily distinguishable from myocardial ischemia.
All kinds of atypical pain
Including reflux esophagitis, diaphragmatic hernia, peptic ulcer, intestinal disease, cervical spondylosis and so on. Whether it is the symptom or the further examination of the cause, it is quite different from myocardial ischemia, and it is easy to identify.
Identification of causes of myocardial ischemia
The manifestations of different degree of coronary artery disease were different from the results of myocardial enzyme examination. And myocardial ischemia caused by other non-coronary factors can be easily distinguished by history and imaging results.
prognosis
The prognosis of myocardial ischemia depends on the type and degree of the disease causing myocardial ischemia, and the survival time is difficult to estimate due to a large number of unknown factors.
If the myocardial ischemia is caused by simple tachycardia, it will not have significant effects on health.
If myocardial ischemia is caused by coronary heart disease, the situation is more complicated. If the coronary artery disease is mild, after standard treatment, can survive for a long time; If myocardial infarction has occurred before, or if ischemic cardiomyopathy occurs due to long-term myocardial ischemia, survival is significantly shortened, and the mortality rate of myocardial infarction itself is relatively high. If ischemic cardiomyopathy or myocardial infarction is severe and causes chronic cardiac insufficiency, the prognosis is poor.
If myocardial ischemia is caused by other non-coronary artery disease, the prognosis is generally good, but there is also a sudden aggravation and the risk of myocardial infarction.
rehabilitation
In the first 3 to 6 weeks after discharge from hospital after myocardial infarction treatment, physical activity should be gradually increased, and it is recommended that patients carry out moderate amounts of physical activity, such as walking, gymnastics, tai chi, etc. This is beneficial for reducing the risk of cardiovascular events and improving the health of patients.
If after the above reasonable rehabilitation exercise, there is still good heart function 6 weeks after myocardial infarction, it indicates that the patient's life can basically return to normal.
complication
Myocardial infarction
Severe myocardial ischemia, which lasts for a long time and leads to myocardial necrosis, can be either a severe type of coronary heart disease or caused by other coronary artery diseases.
Myocardial infarction has a high mortality rate and can cause a series of subsequent problems, such as heart failure and cardiogenic shock in those with large infarcts.
Deep infarction may lead to the thinning of the ventricular wall under the influence of blood pressure bulge, called ventricular aneurysm, or even heart rupture; Infarction leads to dysfunction or rupture of the papillary muscle, which can lead to mitral insufficiency. After infarction, it is also easy to have thromboembolism lung or other organs and tissues; After myocardial infarction, there may also be repeated episodes of pericarditis, pleurisy, and pneumonia, which are related to allergic reactions caused by the body to dead tissue.
Ischemic cardiomyopathy
A disease caused by the degeneration of the myocardium under chronic ischemia and hypoxia, characterized by the heart becoming stiff and enlarged, which may be complicated by various arrhythmias and heart failure. The 5-year fatality rate is 50%~84%.
