Unstable angina pectoris

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Unstable type angina pectoris , is between tiredness Stable angina pectoris And acute myocardial infarction And sudden death. Mainly including initial angina pectoris and worsening Exertional angina , Resting angina pectoris with electrocardiogram Ischemic changes and early angina after myocardial infarction. It is characterized by progressive increase of angina pectoris symptoms and prolonged duration of new onset rest or nocturnal angina pectoris or angina pectoris. Because of its unique pathology physiological mechanism And clinical prognosis If proper and timely treatment is not available, the patient may develop into acute myocardial infarction.

Unstable angina pectoris is secondary to acute exacerbation of coronary artery occlusion, which is caused by Fibrous plaques Cracking, resulting in platelet Caused by adhesion. Compared with stable angina pectoris, unstable angina pectoris is more painful, lasts longer, can be induced with lower activity, and can also occur spontaneously at rest（ Decubitus position Angina pectoris), which is progressive (worsening) in nature, and these changes can be combined arbitrarily. About 30% of patients with unstable angina pectoris may have myocardial infarction within 3 months after the attack. Sudden death is rare, Chest pain The obvious change of ECG is an important sign of myocardial infarction and sudden death.

TCM disease name: Unstable angina pectoris
Foreign name: unstable angina
Alias: Unstable angina pectoris
Visiting department: Internal Medicine-Cardiovascular Department

Common location: heart
Common causes: Often induced by light labor or emotional excitement
common symptom: Chest pain and discomfort
infectivity: nothing

catalog

seven prognosis

pathogeny

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one atherosclerosis Disease progression

Most patients with unstable angina have severe obstructive disease ischemic heart disease , the development of coronary atherosclerosis may cause progressive Coronary stenosis 。

two platelet aggregation

coronary artery Stenosis and intimal injury, platelet aggregation vasoconstriction material Thromboxane A2 , while normal endothelial cells Anti aggregation substances produced, such as prostacyclin, tissue Plasminogen activator And endothelium derived relaxation factor, causing coronary artery contraction, lumen stenosis aggravation and even occlusion Power Coronary artery resistance increased.

three Thrombosis

Platelet aggregation, fibrin Main component D of collagen and fibrin fragments- Dimer It increases and forms thrombus in coronary artery lumen, leading to progressive coronary artery stenosis.

four Coronary spasm

Clinical Coronary angiography Both autopsy studies and autopsy studies have confirmed that coronary artery spasm is an important mechanism that causes unstable angina pectoris.

clinical manifestation

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1. Clinical symptoms

The nature of chest pain or chest discomfort is similar to that of typical stable angina pectoris, but the pain is more severe, often lasting for 30 minutes, and occasionally occurs in sleep. Bed rest and Including clothing Nitrates The drug only appears temporarily or not Completeness Chest pain relieved.

2. Clinical signs

Apex of heart Partially audible Transitory Third heart sound and Fourth heart sound , cardiac apex lifting pulsation can be seen in left heart failure, ischemia Audible at onset or immediately after ischemic attack Systole Mitral regurgitation Sexual murmur.

inspect

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one ECG examination

(1) Routine ECG ST segment is depressed or elevated and/or T-wave inversion , often transient, completely or partially disappeared with the relief of angina pectoris. If ST-T changes last for more than 6 hours, it indicates non Q wave myocardial infarction. ST-T can also remain unchanged.

（2） Dynamic ECG continuity 24 hours Most patients have ECG monitoring above Asymptomatic myocardial ischemia 85%~95% of dynamic electrocardiogram changes were not accompanied with angina pectoris and other symptoms. For unstable angina pectoris prognosis The dynamic electrocardiogram is more sensitive than the conventional electrocardiogram. Dynamic electrocardiogram is not only helpful to detect Myocardial ischemia It can also be used as a reference index for the evaluation of routine anti angina drug treatment and the decision of whether coronary angiography and vascular reconstruction are needed for patients with unstable angina pectoris.

(3) Exercise electrocardiogram It is applicable to patients whose symptoms have stabilized or disappeared, and is often used to judge the prognosis of unstable angina pectoris. Normal resting electrocardiogram and negative exercise test, 5 years Survival rate >95%； Normal resting ECG, negative exercise test, but with Chest pain Fatal myocardial ischemia event incidence rate Relatively low; The occurrence rate of fatal myocardial ischemia attack and death is high in those with ischemic ST-T change, reduced heart rate blood pressure product and chest pain symptoms during exercise test.

two Echocardiography inspect

It shows transient abnormal wall motion. Persistent abnormal ventricular wall motion, indicating Poor prognosis 。 radioactivity nuclide Myocardial imaging Examination can determine the location of myocardial ischemia. TI myocardial imaging shows sparse or missing radioactivity in myocardial ischemic area at rest, indicating that the myocardium is in blood flow Hypoperfusion Status.

three Cardiac catheterization

Coronary angiography showed that most patients had two or more coronary artery lesions, of which about half had three coronary artery lesions, but recent angina pectoris and no myocardial infarction or chronic stable angina The patients with a history of disease are mostly those with single coronary artery disease. Severe coronary artery disease, plaque rupture and/or partial Thrombolysis , mostly eccentric stenosis. coronary artery Endoscopy Most of the obstructive lesions were complex plaques and (or) thrombosis.

4. Laboratory Enzymological examination

Available Blood cholesterol Increased, myocardial enzymology CKMB troponin There is no abnormal change after inspection.

diagnosis

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1. Original stable type angina pectoris Change in nature, that is, frequent attacks, severe degree and prolonged duration of angina pectoris.

2. Angina attacks at rest.

3. Recently occurred and slight in the last month physical activity It can also induce angina pectoris. One or more of the three items, accompanied by electrocardiogram The diagnosis can be established if ST-T changes. If you have stable angina in the past miocardial infarction , abnormal coronary angiography and exercise test Positive and other medical history, even if there is no ST-T change in ECG, but there are typical symptoms of unstable angina pectoris, the diagnosis can also be established. Angina pectoris occurs in the heart muscle infarct Those within the last two weeks are called post infarction unstable angina pectoris.

differential diagnosis

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The differential diagnosis is the same as that of stable angina pectoris. What needs to be distinguished from it is acute myocardial infarction The latter has more severe pain, and the ECG has infarct patterns and specific changes in myocardial enzymes for differentiation.

treatment

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1. General treatment: stay in bed for 1-3 days, and stay at the bedside for 24 hours ECG monitoring 。 yes dyspnea . Cyanosis should be given oxygen, irritability, severe pain can be given morphine , if necessary Duplicate detection Myocardial necrosis Marker 。

2. Pain relief: available glyceryl trinitrate Oral or Intravenous drip 。 Variant angina pectoris with Calcium channel blocker The curative effect is the best.

3. Anticoagulation: aspirin and heparin It is important for unstable angina pectoris Treatment measures Its purpose is to prevent thrombosis and prevent the disease from developing towards myocardial infarction.

4. Hospitals with conditions should Emergency coronary angiography interventional therapy Or choose a date Coronary angiography Interventional treatment.

Remission period Further examination, long-term treatment plan and stable type Exertional angina Same.

prognosis

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Elderly people with persistent angina pectoris and coronary artery thrombosis, Left heart failure The patients with coronary artery disease and multi branch coronary artery disease have poor prognosis. Angina pectoris or ischemic type during exercise test ST segment Significant depression, or Heart rate blood pressure product The incidence of myocardial infarction, recurrent unstable angina pectoris and mortality Both are high.

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