Coronary insufficiency

Introduction Coronary artery insufficiency: There is no episode of angina at all, but the electrocardiogram at rest or during exercise has a manifestation of insufficient coronary blood supply, ie, a decrease in ST segment and a change in T wave, called coronary insufficiency. Clinically divided into two types, one without angina pectoris, but with cardiac insufficiency and arrhythmia, called symptomatic coronary insufficiency; if only the waveform of the electrocardiogram is abnormal, and there is no symptom, called asymptomatic Insufficient blood supply to the coronary arteries, also known as recessive coronary heart disease.

Cause

Coronary artery insufficiency: There is no episode of angina at all, but the electrocardiogram at rest or during exercise has a manifestation of insufficient coronary blood supply, ie, a decrease in ST segment and a change in T wave, called coronary insufficiency. Coronary artery insufficiency is mainly caused by coronary atherosclerosis, but because of the mild degree, it has not caused symptoms, so it is easy to cause the cause of arteriosclerosis, such as hypertension, hyperlipidemia, diabetes and smoking. Direct relationship.

an examination

Related inspection

Cardiovascular MRI, resting imaging, dynamic electrocardiogram (Holter monitoring), wall motion, movie display

Because the patient has no symptoms such as angina pectoris, it is often performed before surgery or during physical examination, and most of them are found by electrocardiogram. Most of the patients are middle-aged and above, with more males.

In the case of symptomatic coronary artery insufficiency, there may be swelling of the lower extremities and difficulty in breathing. Symptoms such as shortness of breath and palpitations may occur in the upper step. In addition, I often feel guilty about arrhythmia. The onset is slow and easy to be misdiagnosed.

Differential diagnosis

Cardiac neurosis

The patient often complained of pain in the precordial area, located in the apex of the apex or under the nipple, and the position was limited. It was acupuncture-like, lasting only a few seconds, with nitroglycerin ineffective or immediate "effective", or more than 10 minutes "effective"; patients There are often sighs of breathing, palms and underarms sweating, palpitations, insomnia, inattention and so on.

2. Myocardial infarction

The pain characteristics of acute myocardial infarction are very similar to angina pectoris, but the following differences: 1 acute myocardial infarction pain is more serious, longer duration, nitroglycerin can not relieve it; 2 chest pain usually has nothing to do with labor; 3 patients uneasily In the case of typical angina pectoris, most patients are forced to stop activities; 4 acute myocardial infarction is often accompanied by varying degrees of left ventricular dysfunction, hypotension or even shock, arrhythmia and so on.

3. Aortic valve disease

More obvious aortic stenosis or regurgitation can cause angina pectoris, which is not difficult to identify according to the physical examination. If the age is over 40 years old, aortic valve disease is mild but angina pectoris should be considered with coronary heart disease. Coronary angiography should be routinely performed in patients with aortic valve surgery. It should be pointed out that such patients may induce syncope or severe arrhythmia during exercise stress test, so it should be strictly prohibited.

4. Mitral valve prolapse

The disease may have symptoms of chest pain, but often lacks the characteristics of typical angina. One-third of patients with conventional lead electrocardiogram show myocardial ischemic ST-T changes, 25% of patients have positive treadmill test; coronary angiography Except for a small number of patients with coronary artery spasm and no stenosis, echocardiography is of great value in the diagnosis of this disease.

5. Hypertrophic cardiomyopathy

An increase in oxygen demand due to cardiac hypertrophy can induce angina in an event of a shortage of supply. Echocardiography can make a definitive diagnosis of the disease.

6. Pulmonary thromboembolism

The pathological and clinical state of pulmonary vascular obstruction caused by thromboembolism. Trauma, long-term bed rest, venous intubation caused by deep venous thrombosis of the lower extremities, various types of heart disease combined with atrial fibrillation, subacute bacterial endocarditis is a common cause. Patients may have post-sternal pain, similar to myocardial infarction, clinical dyspnea and hemoptysis, nitroglycerin is not effective. X-ray and pulmonary angiography can help confirm the diagnosis.

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