The heart is an important organ to maintain life, once the following circumstances can not relax their vigilance, should immediately go to the hospital to clarify the condition:
When the patient is suspected of myocardial ischemia by physical examination or electrocardiogram examination;
Symptoms of discomfort near the heart, such as chest pain;
In addition to the discomfort of the heart, such as accompanied by other systemic symptoms, systemic symptoms, especially breathing difficulties, consciousness disorders, it is likely to indicate a serious condition.
Department for treatment
Myocardial ischemia, regardless of the cause, is generally treated in the department of cardiology. If it is assessed that coronary artery bypass surgery is required, it can be transferred to cardiac surgery for treatment.
Diagnostic process
During the visit, the doctor may ask the following questions to get an initial understanding of the condition, and the patient can be prepared to answer questions in advance:
What is your discomfort? How do they change? How long does each time last? Is it self-relieving? How long does it last?
What diseases have you previously diagnosed?
Do you smoke? How much? Are you drinking alcohol? How about the quantity?
Is there any other chronic cardiovascular disease, such as hypertension, diabetes, hyperlipidemia?
What medicine do you usually take?
Do family members have heart disease?
The doctor will make a preliminary judgment of the condition through symptoms and physical examination, determine the degree and location of myocardial ischemia by electrocardiogram, treadmill exercise test, load nuclide myocardial scan, etc., and determine whether myocardial infarction exists and the possible time of infarction by myocardial enzymes. CCTA (coronary CT angiography) or coronary angiography were used to determine whether there was severe coronary artery stenosis, the location and nature of the lesion.
At this point, the existence of myocardial ischemia can generally be clear, and the cause of myocardial ischemia can also be identified.
Correlation check
Doctor's physical examination
The physical examination of myocardial ischemia mainly includes percussion and auscultation of the chest, especially the heart, and measurement of blood pressure and pulse.
Physical examination is only used to find heart enlargement, abnormal heart function and some arrhythmias, and can not judge myocardial ischemia by physical examination alone.
Laboratory examination
Blood routine examination
Mainly used to check for the presence of anemia.
Blood lipid and blood sugar
Hyperglycemia can damage blood vessels and then cause atherosclerosis, which is an important risk factor for coronary heart disease. Excessive blood lipids (LDL-C, VLDL-C, TC, TG, etc.) can be deposited on the injured blood vessel wall and participate in the formation of atherosclerosis. It is also an important risk factor for coronary heart disease.
Doctors can use these two indicators to assess the risk of coronary heart disease.
Myocardial enzymes and troponin
These components of the heart muscle cells can enter the blood when the heart muscle is damaged, making the test results abnormally high.
Doctors use these indicators to determine whether there is myocardial ischemia or myocardial infarction.
Commonly used markers with high specificity to myocardium include cTnI, cTnT, CK-MB, etc.
Thyroid function
Sometimes there may be patients with unexplained heart palpitations, chest tightness and other symptoms, as well as rapid heart rate and other conditions, need to check thyroid function, rule out cardiac abnormalities caused by hyperthyroidism.
Commonly used indicators include FT3, FT4, TT3, TT4, and TSH secreted by the pituitary gland to regulate thyroid function.
Imaging examination
ultrasonic
Doctors can observe the abnormal changes in the structure and function of the heart through color B-ultrasound examination of the heart, and can determine whether there is heart enlargement, myocardial hypertrophy, and valvular disease, and evaluate cardiac function by observing the blood flow of the heart to predict the prognosis of the disease.
In the case of myocardial infarction, cardiac color ultrasound may find abnormal cardiac segmental motion at the site of the infarction.
After the injection of contrast agent, the advanced multi-slice spiral CT scan of the coronary artery can find the stenosis of the coronary artery, but the limitation is that once calcification occurs, the accuracy of the judgment of the vascular disease will be seriously affected.
Therefore, the main significance of CT examination of coronary arteries is the observation of negative results, which can basically exclude coronary artery disease.
Coronary angiography
An invasive test. It is necessary to perform a peripheral vascular puncture (wrist or thigh root), extend a catheter through the puncture site to the entrance of the coronary artery, apply contrast agent, and then observe the presence of coronary artery stenosis by digital subtraction X-ray machine, which is the gold standard for the diagnosis of coronary artery disease.
In addition to assisting in diagnosis, the test can also provide direct treatment, such as the use of a balloon to open a narrowed coronary artery, the use of a thrombectomy catheter to extract clots during acute myocardial infarction, and, most commonly, the placement of a stent at the site of the stenosis, to improve blood flow to the heart.
However, coronary angiography is expensive and invasive, so its application is limited.
Special inspection
electrocardiogram
It can observe the changes of the electrical activity of the heart, and initially locate the abnormal electrical activity, and is non-invasive, simple operation, and good repeatability. It is particularly important for the preliminary diagnosis of myocardial ischemia and what other heart problems are complicated, especially as the observation of disease changes.
Electrocardiogram tests include regular 12-lead, 18-lead, and 24-hour holter:
A 12-lead electrocardiogram (ECG) is a well-known method of connecting the chest and limbs;
The 18 leads increased the observation of the side and back of the chest compared with the 12 leads, and the form was the same as that of the 12 leads.
Dynamic electrocardiogram is to let the patient carry a mobile device on the back, and paste a connection on the body, continuously record the changes in cardiac electrical activity for 24 hours, you can find accidental, not easy to be detected by ordinary electrocardiogram abnormal lesions, and can do statistics on a variety of abnormal electrical activity in a day.
