Mental disorders associated with cardiovascular disease

Introduction to mental disorders associated with cardiovascular disease A mental disorder associated with cardiovascular disease is a type of mental disorder associated with physical illness. Mental disorders associated with physical illness refer to diseases such as internal organs, endocrine, nutrition, metabolism, blood, connective tissue, etc. Various mental disorders that affect brain function. Mental disorders associated with cardiovascular disease can be caused by various heart diseases due to circulatory disorders, such as brain ischemia, hypoxia and edema, which cause brain dysfunction and various mental disorders. More common clinical manifestations include cardiogenic encephalopathy and coronary atherosclerotic heart disease (CHD) and arrhythmia associated with mental disorders. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: congestive heart failure aortic valve insufficiency

Causes of mental disorders associated with cardiovascular disease

Generally speaking, in the cause of mental disorders caused by physical diseases, physical diseases are not the only cause of mental disorders. The appearance of mental symptoms is not always proportional to the severity of physical diseases. Biopsychosocial factors also have an impact on the onset. Although physical illness is not the only cause of mental symptoms, it is an important factor that cannot be ignored. Psychiatric symptoms are caused by various causes of heart disease, in the presence of cardiac insufficiency, decreased cardiac output, decreased oxygen saturation, decreased brain blood supply, leading to cerebral ischemia, hypoxia and then brain dysfunction So far.

Coronary heart disease (25%):

(1) The related factors of coronary heart disease include: family genetic tendency, family history of hypertension, arteriosclerosis, etc.; diet, high fat, high cholesterol can promote vascular atherosclerosis; bad habits, such as smoking , alcoholism, physical activity is too small, etc.; in the stress source, the cold has a very bad effect on the disease, can cause coronary artery spasm, leading to myocardial ischemia, hypoxia, necrosis, etc.; psychosocial factors are also very important, interpersonal The relationship is tense, the dissatisfaction of marriage and so on; the personality of the patient plays an important role in the pathogenesis. The incidence of type A behavior patterns (impatient, victorious, lack of patience, time urgency, hostility, aggressiveness, etc.) is more than that of type B. It is twice as many as it is (should be calm, not strong, etc.).

(2) The mechanism of coronary heart disease leading to mental disorders has the following explanations:

1 Coronary arteriosclerosis: due to coronary artery stenosis caused by myocardial ischemia, hypoxia, resulting in brain tissue ischemia, hypoxia, which is the basis of coronary heart disease encephalopathy, mostly occurs in physical activity or mental stress, manifested as loss of , syncope, etc., chronic heart dysfunction can occur , confusion, hallucinations, delusions and so on.

2 cerebral arteriosclerosis said: patients with coronary arteriosclerosis often accompanied by cerebral arteriosclerosis, the latter can reduce cerebral blood flow, various brain symptoms or stroke.

3 changes in blood oxygen content: Chongzhong Zhongxiong et al (1958) have suggested that even if the cerebral blood flow is normal, and the blood oxygen content or oxygen saturation is reduced, it can cause brain ischemia or severe hypoxia, and there is a loss of absence or vertigo. .

4 cardiac embolism said: the heart wall thrombus shedding or emboli in the treatment of atrial fibrillation is the main cause of cerebral infarction, Fujii Jun and other believe that in addition to the cause of embolus, we must also pay attention to the onset of myocardial infarction, blood pressure drop and blood pressure coagulation Increased sex can also cause thrombosis.

5 Personality characteristics and psychological factors: Friedman et al. (1985) reported that there are struggles, excitement, hostility, excessively serious personality characteristics, such as coronary heart disease, and those who have this personality trait are called A-type behavior patterns. Characteristics play an important role in the occurrence of coronary heart disease and myocardial infarction. Zhao Gengyuan (1991) comprehensive domestic data found that 95% of myocardial infarction is induced by psychological factors, while anxiety, depression, fear and extreme nervousness in patients with coronary heart disease can be Increased sympathetic-adrenal system excitability, increased secretion of catecholamines leads to coronary artery spasm and promotes further myocardial ischemia. Emotional stress can also promote fat storage through the hypothalamus, increasing TC, thereby aggravating the formation of myocardial infarction. Some studies have found that Mental disorders associated with coronary heart disease are not directly related to ECG changes and blood lipid levels.

Arrhythmia (20%):

Arrhythmia is a group of syndromes. There are many causes of arrhythmia. Almost all heart diseases can occur. Some of them are functional diseases caused by psychological and emotional factors (such as anxiety). For sinus tachycardia, paroxysmal atrial tachycardia, atrial and ventricular premature contractions, and even various ventricular arrhythmias, but the heart itself has no substantial damage, due to arrhythmia, causing transient brain deficiency Blood, cerebral hypoxia, cerebral edema and loss of consciousness, patients often accompanied by convulsions, clinically known as cerebral hypoxia syndrome, or Adams-Stokes syndrome, the mental disorder of this syndrome is more common in seizures In the early stage, during the intermittent period, some patients may also experience confusion, mental decline and other clinical manifestations of carbon monoxide poisoning after awake period of 2 to 4 weeks. Mental disorder and cerebral blood circulation disorder after the onset of A-S syndrome Caused by brain dysfunction.

Other factors (10%):

Biopsychosocial factors also have an impact on the onset.

Pathogenesis

The mental disorder associated with all physical diseases does not depend on the type of primary physical disease, but is related to two factors: first, physical and mental disorders, psychological reactions to physical illness, such as suffering from certain physical illnesses. After anxiety, depression, irritability, suspiciousness, loneliness, etc.; second, biological factors directly caused by physical diseases, such as insufficient energy supply (insufficient blood supply to the brain, hypoxia, etc.), toxins, water, electrolyte imbalance , stress response, neurotransmitter changes, etc., leading to mental symptoms, however, the clinical occurrence of mental disorders is often the result of the combination of the two.

Almost all heart diseases can cause mental disorders in patients with cardiac insufficiency. Although the causes of heart disease are different, the resulting mental disorders are not specific, and the pathogenesis is similar. Both are reduced cardiac output and oxygen saturation. Lowering, the blood supply to the brain is reduced, causing cerebral ischemia, hypoxia and then brain dysfunction, leading to the appearance of mental symptoms, but the mental disorders associated with different diseases are different, and some diseases are easily attached. Symptoms, such as rheumatic heart disease can be caused by heart valve stenosis and insufficiency caused by brain ischemia; rheumatic cerebrovascular changes are also prone to cerebral thrombosis or cerebral embolism and different types of disturbance of consciousness (fainting, lethargy, lethargy, or confusion or even coma) or seizures; endocarditis is associated with infection, fever, toxemia and other factors appear more sputum; in congenital heart disease, due to the promotion of current cardiac surgery, Improvement of cardiac function can be solved in a timely manner, so cerebral ischemia, cerebral hypoxia cause cerebral circulation disorder caused by mental symptoms than before , But because the disease cardiac function does not affect brain development plenary session, patients can cause personality changes and mental retardation and so on.

Prevention of mental disorders associated with cardiovascular disease

Cardiovascular disease prevention - 5 lines of defense:

1. Prevention of disease: First-level prevention, prevent problems before they occur; the most basic measure of primary prevention is to change the unhealthy lifestyle. There are three main points of primary prevention: intervention of blood sugar, intervention of blood pressure, and intervention of blood lipids.

Because few people have only one risk factor, they often have multiple risk factors such as smoking, high blood pressure, dyslipidemia, diabetes, obesity, resting lifestyle, etc. Therefore, primary prevention also requires heart, diabetes, nerve, endocrine and old age. Diseases and other disciplines are united to jointly control and control multiple risk factors, and establish scientific research hospital treatment in-hospital first aid pre-hospital first aid social, community, multi-medical functions, special emphasis on hospital specialists and community-wide The doctor's joint defense, only the specialists and the community general practitioners understand the same in cardiovascular disease prevention and action, in order to ensure the continuity of cardiovascular disease prevention and treatment practices, such as high-risk hypertension patients (20%), relying only on Diet, exercise can not control blood pressure, must use drug intervention, and should pay special emphasis on moderate and moderate exercise; middle-risk hypertensive patients (10%), lifestyle changes such as reasonable diet and aerobic exercise exercise; 5% low Dangerous, very mild hypertensive patients, can be adjusted by exercise, control risk factors, etc. for 6 months, to see the aftereffect, sugar Patients with hyperlipidemia and two risk factors must take medicine and effectively change the bad lifestyle. For patients with mild hypertension without diabetes, you can change your lifestyle and limit your salt for 6 months. Whether to take medicine, here is a special reminder, in the intervention of dyslipidemia, the risk of diabetes and coronary heart disease myocardial infarction is equivalent to the same risk, can not be ignored.

In a communiqué issued by the World Heart Day on September 26, WHO encouraged children and young people to live a lifestyle because more and more adolescent obesity, unreasonable diet, smoking and drinking And unhealthy phenomena such as sports are the main causes of heart disease and other cardiovascular diseases. Encourage the public to increase physical activity and promote aerobic metabolism. Walking, running, skipping, cycling, rollerblading, balls, etc. Promote healthy eating and smoking cessation, especially recommended for skipping rope as a simple way of aerobic exercise. Globally, for blood glucose intervention, endocrinologists call for early identification and diagnosis of metabolic syndrome in non-diabetic patients. These patients should accept Strong behavioral interventions, lifestyle changes, and intensification of antihypertensive and lipid-lowering treatments.

For blood pressure intervention, the blood pressure of hypertensive patients should be controlled below 140/90mmHg. In June 1998, in Amsterdam and Hong Kong, the Netherlands announced the results of an international Hypertension Ideal Treatment HOT experiment. An average of 3.8 years of follow-up in 18,790 hypertensive patients in the country showed that: 1 the optimal blood pressure for acute myocardial infarction, stroke and other cardiovascular deaths in patients with hypertension is 139/83 mmHg, if Lowering blood pressure to this level can prevent four deaths from the above reasons in every 1000 patients. 2 If blood pressure continues to drop, below 139/83mmHg, there is no increased risk, 3 significant blood pressure reduction for diabetes and ischemia Secondary prevention of sexual heart disease will bring significant benefits. 4 Aspirin can significantly reduce cardiovascular and cerebrovascular events in patients with high blood pressure, especially in high-risk groups, and it is safe and does not cause serious complications such as cerebral hemorrhage.

Intervention of dyslipidemia is the top priority of primary prevention, and it is also the main line running through five lines of defense. Cardiologists are verifying a hypothesis of understanding heart protection. This is likely to have no uniform target cholesterol level, but should be considered comprehensively. The patient has a dangerous level, and the intervention is a dangerous level, rather than a single blood lipid level. Some scholars have suggested that statin is a new aspirin, which should be widely used in patients with coronary heart disease or high-risk groups. Currently, dyslipidemia is present. The rate of intervention for intervention is very low. The statin-based drug is mainly too late, too little, too small, too short, 50% of patients discontinue after 1 year, 90% of patients after 5 years With regard to withdrawal, less than a quarter of those who received interventional therapy in the past had reasonable use of statins.

2. Anti-incident: to maintain the stability of atherosclerotic plaque, prevent thrombosis, prevent acute coronary syndrome ACS and stroke may be disabling and causing serious events.

The occurrence of myocardial infarction and severe stroke is based on "unstable plaque" and the different degrees of thrombosis caused by rupture. As mentioned above, more than half of the incidents have no aura and sudden onset. There is no predictive means. The event for stable plaque patients, seen in stable angina, is to ensure that their plaques continue to be stable and not to develop in an unstable direction; for unstable plaques, in unstable angina or acute myocardial infarction, it is to stabilize Transformation, to prevent the occurrence of myocardial infarction and stroke, the first thing to prevent the event is to build a lipid-lowering-statin defense line. In addition to lipid-lowering effects, statins may have the function of stabilizing plaque, that is, by improving vascular endothelial function. The role of anti-inflammatory and anti-thrombosis to promote plaque stability, the second is anti-thrombotic, the cheapest, most effective century-old medicine aspirin, prevention dose 75 ~ 80mg, 1 / d, at night before going to bed, but not When stabilizing angina or acute myocardial infarction, the first dose of aspirin should not be less than 150 mg. The tablets should be chewed and served in order to function as soon as possible. The ideal treatment "experimental results show that while taking control of blood pressure, taking 75 mg of aspirin every day can reduce the risk of myocardial infarction by about 30% without increasing the risk of cerebral hemorrhage, but may cause bleeding outside the brain, such as Gastrointestinal hemorrhage increased by 2 times. In general, adequate treatment of hypertension, combined with low-dose aspirin is beneficial for the prevention of myocardial infarction, but should pay attention to two points: 1 should be combined with aspirin based on the control of blood pressure, 2 Reduce bleeding complications, patients with a history of ulcers, especially elderly patients should be more careful, the current anti-thrombotic treatment has a new idea, for unstable plaque (clinical manifestations of unstable angina) alone with aspirin alone, for These high-risk patients should also use clopidogrel in combination. The side effects of clopidogrel are small, the gastric stimuli are small, and the threat of reducing white blood cells is small. Now it has become the routine medication before and after coronary intervention (PTCA, balloon dilatation stent). In summary, for the clinical manifestations of plaque instability in acute coronary syndrome, emphasis on strengthening antithrombotic, Adopt a multi-pronged strategy.

For thromboembolism with severe venous thromboembolism and atrial fibrillation, aspirin is less effective than warfarin, but when warfarin is used, the anticoagulation intensity after administration must be monitored regularly. The index used is the international standardized ratio. (INR), INR is too high (>3.0), easy to bleed; too low (<2.0), often poor efficacy, INR control is appropriate in 2.0 to 3.0, warfarin is effective, but the clinical effect is affected by diet and other conditions Interference, need to monitor INR, bring a lot of inconvenience to patients, is currently studying a new direct oral thrombin inhibitor, quickly converted into an effective metabolite after oral administration, no need to monitor, more safe and effective, around the clinical clinical The study started from four aspects:

1 prevention of venous thromboembolism after major orthopedic surgery;

2 treatment and secondary prevention of venous thromboembolism;

3 stroke prevention of non-valvular atrial fibrillation;

4 After acute coronary syndrome, prevent death, myocardial infarction and recurrent cerebral ischemia.

3. Anti-results: After serious events such as ACS, early identification, early intervention, saving myocardium, saving lives; here to send you a warning: "There is chest pain in the hospital", the most common manifestation of coronary heart disease is chest pain, acute myocardial More than half of the infarcts have no aura, but sudden chest tightness, chest pain as a manifestation, from thrombosis to vascular supply of myocardial tissue necrosis, zoology experiments are 1h, in humans at the latest 6 ~ 12h, so our cardiologists most The important idea is "lifeline 1h", which is the "time window" that is often said in medicine - that is, the golden time of rescue, the time window is not grasped, the patient will pay the disability, the price of death, the thrombolytic requirement is reached Within half an hour after the hospital, PTCA requires 60 to 90 minutes after arriving at the hospital. If revascularization can be performed within 1 hour of onset, there is almost no necrosis in the myocardium.

4. Anti-recurrence: secondary prevention, rehabilitated, it is not too late; for the rescued myocardial infarction, the survivor of stroke, the most important is secondary prevention - anti-recurrence, which is the recurrence of serious cardiovascular events In high-risk groups, primary prevention is no disease to prevent disease, then secondary prevention is to prevent the second recurrence after the onset of disease. There is sufficient clinical experimental evidence that the five lines of defense for secondary prevention are of great significance.

(1) Aspirin (aspirin); ACE inhibitor (angiotensin converting enzyme inhibitor).

(2) -Blocker (-blocker); Blood pressure control.

(3) Cholesterol lowing (Cholesterol lowering); Cigarette quitting (quit smoking).

(4) Diabetes control; Diet (reasonable diet).

(5) Exercise (Education).

This life-critical secondary prevention of five aspects, each item has two contents, are very important, each patient must be strictly and item by item, and persevere, this secondary prevention advocates "double effective", that is Effective drugs, effective doses, a large proportion of patients now take the right variety of drugs, but the dose is too small or the time is not right; and a considerable number of people have been treated after the first onset, no problem, not to see a doctor, also If you don't take medicine, it is very dangerous; there are some troubles in using medicine, eating and stopping, stopping to eat, not only bad effect, but also dangerous. If the family needs secondary prevention, supervise them to take the medicine effectively and on time. Effective exercise, effective control of risk factors, patients requiring secondary prevention should follow these 5, self-management of their own condition, course of disease, may wish to do a health file, daily health diary, explore the law of self-health, has Patients with coronary heart disease, stroke or PTCA or bypass should go to the hospital or community for regular follow-up, and there are reports of illness, no report of peace, and access to disease prevention. .

5. Prevention and treatment of heart failure: Due to the success of early intervention, more and more patients with myocardial infarction and stroke survived. Generally, chronic heart failure is a common destination from 10 to 15 years after myocardial infarction because of chronic heart failure. Poor prognosis, cost, has become the world's heaviest medical burden, there are many new treatments for chronic heart failure, drugs are relatively cheap, but hospitalization costs are high, because the chronic heart disease has a relatively long course of disease, press Therefore, large hospitals are unwilling to accept, patients are unwilling to live, chronic heart failure medication needs to gradually adjust the dose, and a relatively fixed doctor is responsible for the individualized systemic treatment process. The model we envisage is to establish a heart failure clinic in a large hospital for each A patient builds a case file, forms a network with the community's electronic medical records, sets a family medical record, monitors each patient's condition, and has a treatment fee and hospitalization fee that can be controlled at the lowest level of consumption. This family ward model is done in many developed countries. Very good, such as a lot of early hospitals in Denmark, and later the nursing homes have increased, and then there are fewer hospitals and nursing homes, especially patients with some chronic Patients return to society, return to the family, this is a systematic project, we integrate the overall capital of cardiovascular prevention plan can save a lot of money, with a minimum cost, highest quality to save more lives.

Complications of mental disorders associated with cardiovascular disease Complications, congestive heart failure, aortic valve insufficiency

There may be serious complications such as congestive heart failure, aortic insufficiency, and aortic aneurysm rupture.

Symptoms of mental disorders associated with cardiovascular disease Common symptoms Angina palpitations, fatigue, shortness of breath, shortness of anxiety, irritability, blood hypoxia, obsessive-compulsive disorder

Clinical manifestations of several common cardiovascular disorders caused by mental disorders:

1. Coronary atherosclerotic heart disease with mental disorders: refers to mental disorders and neurological symptoms caused by chronic hypoxia in the brain during coronary heart disease.

(1) Anxiety and depression: The most common anxiety is the patient's irritability, nervousness, fear, etc., often accompanied by depression, mostly in patients with long course of illness and pessimistic personality.

(2) Illusion delusion state: When the blood circulation disorder is serious, auditory hallucinations may occur, often argumentative and imperative, and delusions are mostly victimized.

(3) disturbance of consciousness: there is disappointment, syncope episodes, and symptoms of mild pain in the anterior region before the symptoms appear, after the weakness, nausea, followed by black Mongolian, transient loss of consciousness, common in angina, arrhythmia and myocardial infarction.

(4) A small number of dementia states.

(5) neurological symptoms: epileptic seizures, moderate strokes (mostly cerebral embolism or cerebral thrombosis).

(6) When combined with heart failure, especially in the case of angina pectoris or myocardial infarction, there may be obvious death horror, severe anxiety, depressive symptoms, and some patients may have loss of consciousness, syncope, dizziness, etc., in severe cardiac function compensation. Disorders of consciousness, such as paralysis and insanity, can occur when incomplete.

2. Arrhythmia with mental disorders: Cardiac cerebral hypoxia syndrome or Adams-Stokes syndrome due to arrhythmia, manifested as reduced interest, memory loss, association difficulties and other symptoms, frequent attacks Patients are often in a state of weakness, and some have abnormalities such as depression, increased excitement, fear of death, lethargy, no desire or dreamlike state.

(1) Brain weakness syndrome.

(2) Depression status.

(3) Excited state, the patient danced and danced, hitting the wall with his head.

(4) Disorder of consciousness, often manifested as confusion. At this time, the patient is irritated and self-talking, and there may be auditory hallucinations, visual hallucinations, murderous delusions, etc., but most of them cannot be recalled afterwards, in addition to absence of seizures and lethargy.

3. Mental disorders caused by rheumatic heart disease: refers to mental disorders and neurological symptoms caused by brain ischemia and hypoxia mainly due to heart valve stenosis and insufficiency.

(1) Cerebral weakness syndrome: more often appear within 1 year after the illness, showing burnout, irritability, shortness of breath, palpitations, irritability, emotional instability, insomnia, forgetfulness, multiple dreams, difficulty in concentration, depression, etc. Patients may have obsessive-compulsive symptoms and snoring-like episodes, often sputum-like convulsions, emotional instability, and so on.

(2) disturbance of consciousness: With the appearance and aggravation of heart failure, when the brain hypoxia is obvious, there may be conscious disturbances of varying degrees, such as cerebral ischemic attack or syncope, lethargy, paralysis and the like.

(3) Illusion and delusion state, manic or depressed state, stupor state.

(4) autonomic dysfunction: dizziness, loss of vision, syncope and sweating may occur.

(5) neurological symptoms may have cerebral infarction, epileptic seizures or cerebral infarction with epilepsy, cerebellar chorea and subarachnoid hemorrhage.

(6) Symptom staging: The first phase is neurasthenic syndrome, followed by cerebral ischemic attack, snoring-like symptoms or chorea, etc., stage 2 syncope or hallucinations, delusions, stupor, epileptic seizures, brain Infarction, etc., stage 3 is lethargic, paralyzed or confused and even coma.

4. Mental disorders associated with congenital heart disease: refers to mental disorders and neurological symptoms caused by congenital heart structural defects, such as brain ischemia, hypoxia, etc., about 90% of clinical patients are associated with different Degree of mental disorder.

(1) neurasthenia syndrome: manifested as fatigue, irritability, depression, emotional instability, apathy, no desire, lack of concentration, slow movements, etc.

(2) Personality change: manifested as timidity, self-willedness, crying, shyness, and lack of confidence.

(3) Mental retardation: poor storage of concepts and knowledge, and poor computing power.

(4) Language barriers: poor pronunciation and poorer expression skills.

(5) Loss of consciousness, dizziness, syncope, and standing up.

(6) neurological symptoms: epileptic seizures, such as the occurrence of localized epileptic seizures should consider whether there is brain abscess or brain sclerosis.

5. Endocarditis associated with mental disorders: endocarditis associated with mental disorders refers to due to endocardial inflammation, embolism and other causes of mental disorders and neurological symptoms caused by ischemia and hypoxia.

(1) Illusion delusion state.

(2) Schizophrenia-like mental illness.

(3) Loss of consciousness, if there is fever, it often appears paralyzed.

(4) The nervous system may have cerebral embolism, cerebral hemorrhage, brain abscess and the like.

Examination of mental disorders associated with cardiovascular disease

Laboratory tests that meet the primary cardiovascular disease.

Auxiliary examination results consistent with primary cardiovascular disease (including complications: cerebral embolism, cerebral thrombosis, etc.).

Diagnosis and diagnosis of mental disorders associated with cardiovascular disease

Diagnostic criteria

1. General principles for the diagnosis of mental disorders associated with physical illness: those with clinical manifestations of disturbance of consciousness, mental retardation or amnesia syndrome should take into account the possibility of organic mental disorders, but mental disorders alone cannot be used as an instrument. For the qualitative or local diagnosis of sexual psychosis, the etiology must be made, the diagnosis of taxonomy must be established, and the diagnosis must be established with the following points:

(1) The basis for physical illness.

(2) There is a temporal connection between the appearance of mental symptoms and the progress of physical illness. Generally, physical illness is first, and mental symptoms occur later, but some early physical illnesses are difficult to find, more concealed or fail to attract attention, resulting in The illusion that mental symptoms appear first.

(3) Psychiatric symptoms often improve with or worsen with the relief of underlying diseases.

(4) Mental symptoms cannot be attributed to other mental illnesses.

(5) Severity reached: 1 The actual test ability is reduced; 2 The social function is reduced.

2. Classification of various types of heart disease with mental disorders:

(1) Coronary heart disease: First, we must determine the diagnosis of coronary heart disease; mental disorders are mainly disturbance of consciousness, loss of consciousness, syncope and vertigo, such as symptoms of functional psychosis (anxiety, depression, hallucinations, delusions, etc.) should pay attention to the original and subsequent Identification of hair; if combined with stroke, should consider more brain-like mental disorders.

1 On the basis of the diagnosis of coronary heart disease, if there is absence of ecstasy or dizziness, coma episodes should be considered with associated mental disorders.

2 There is a seizure, stroke or hallucinatory state of delusion.

3 Exclude other diseases that cause mental disorders.

4 combined with ECG, blood lipids, and changes in blood rheology.

(2) Cardiogenic encephalopathy: On the basis of the diagnosis of heart disease, if symptoms such as brain weakness syndrome, cerebral ischemic attack, hallucinations, delusions, and stupor are found, the spirit of heart disease should be considered. Obstacles, in the event of lethargy, convulsions, paralysis and other disturbances of consciousness, should be considered as the existence of cardiogenic encephalopathy; to exclude other possible factors, such as infection, drug poisoning and other factors.

(3) Rheumatic heart disease: On the basis of diagnosis of rheumatic heart disease, it is found that there are neurasthenia syndrome, cerebral ischemic attack, hallucinations, delusions, stupor, etc. should be considered as associated mental disorders, once there is drowsiness, brain Infarction, epileptic seizures, spasticity, etc. should be considered as the possibility of rheumatic encephalopathy, and other factors that cause mental disorders should be excluded.

Differential diagnosis

It is necessary to first determine the nature, type and extent of the primary cardiovascular disease, and then determine the relationship with the heart disease according to the nature, characteristics and developmental changes of the mental symptoms before the diagnosis can be established, and other physical diseases should be excluded. Mental disorder.

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