Many patients, especially women, often experience chest pain after exertion or emotional excitement. The hospital emergency department, the electrocardiogram showed myocardial ischemia, but myocardial enzymes and troponin were normal, and coronary angiography was normal. The doctor said: There is no major problem. However, patients still experience chest pain repeatedly, which seriously affects the quality of life. At the same time, due to repeated visits to the hospital and repeated examinations, the economic burden and psychological pain are increased.
So what exactly is causing this situation? First we look at the pathogenesis of coronary heart disease:
1. Cardiac stenosis of the adventitia of the coronary artery (coronary angiography with at least 1 major vessel stenosis ≥50%). In this case, angina can be relieved by coronary stent implantation or coronary artery bypass graft.
2. Coronary artery focal or diffuse spasm contraction, due to the location of the spasm, the severity and the presence of collateral circulation and other clinical manifestations, such as asymptomatic myocardial ischemia, stable angina, instability Angina pectoris, myocardial infarction, and even the risk of sudden death.
3. Coronary artery microcirculation disorder. The coronary microcirculation network is the main resistance vascular bed of the coronary arteries and the site of myocardial metabolism, so coronary microcirculation disorders are also one of the mechanisms that cause myocardial ischemia. This is another very common angina pectoris-microvascular angina.
Microvascular angina pectoris is a special type of stable coronary heart disease, also known as “cardiac X syndrome”. Cardiac Syndrome in the broad sense refers to symptoms of significant angina and normal coronary angiography. The stricter definition of cardiac X syndrome should include the following indications: exercise-induced angina-like symptoms, but generally longer chest pain; ST segment depression during angina pectoris; normal coronary angiography; exclusion of coronary spasm; exclusion of other heart or Abnormalities of the cardiac microvasculature caused by systemic diseases, such as hypertrophic cardiomyopathy or diabetes.
Microvascular angina occurs in women, especially menopause and postmenopausal women. Cardiac X syndrome is generally considered to have a good prognosis, but recent studies have shown that the incidence of cardiovascular events in female patients with microvascular angina pectoris is significantly higher at 5 years, and it is more prone to punctate heart failure and heart failure.
So what to do with microvascular angina?
1. Improve your lifestyle. It is important to control blood pressure, blood sugar, and lipids, lose weight, quit smoking, and avoid stress and anxiety.
2. Drug treatment. Generally anti- coronary heart disease and angina pectoris drugs such as nitrates (nitroglycerin, sorbitol 5-mononitrate) are effective in half of the patients. If the symptoms persist, a long-acting calcium antagonist (diltiazem) or β Receptor blockers (betaloc, bisoprolol, etc.). Patients with dyslipidemia should use statin lipid-lowering drugs, and those with hypertension should add angiotensin-converting enzyme inhibitor drugs (benazepril, petropril, etc.). It should be mentioned that Nicorandil has a dual anti-angina pectoris mechanism, which can both dilate large coronary arteries and relax coronary microcirculation resistance vessels, increase coronary blood flow, and increase myocardial oxygen consumption while increasing Myocardial oxygen supply has a good effect on improving microvascular angina and can be used under the guidance of a doctor.
3. Psychotherapy. Many patients with microvascular angina pectoris have a mental illness. If conventional antianginal medications are ineffective and accompanied by insomnia, anxiety, and depression, be sure to assess the need for antianxiety and / or depression treatment in a regular psychiatric department.
4. Rehabilitation exercise. Cardiovascular rehabilitation exercise under the guidance of a rehabilitation practitioner.
5. External counterpulsation therapy. Place three pairs of inflatable airbags on the lower leg, thigh, and buttocks respectively. Under the trigger of the ECG R wave, the airbags are sequentially inflated from the lower leg, thigh, and buttocks from bottom to top, squeezing the arterial system of the lower body. Blood is driven back to the upper body of the human body to improve blood perfusion of important organs such as the heart and brain; at the same time, due to simultaneous compression of the venous system, the venous return of the right heart increases, increasing the stroke output of the heart; The sub-balloons are vented at the same time, reducing the resistance load of the heart ejection.