Biliary syndrome

Introduction Biliary heart syndrome: It is a biliary system disease (cholecystitis, gallstones), etc., and causes coronary artery contraction through nerve reflexes, resulting in insufficient blood supply to the coronary arteries (oxygen-aerobic imbalance), causing angina, irregular heart rate, and even Clinical syndrome of symptoms such as myocardial infarction. Clinical symptoms: 1. First, there are biliary diseases and then secondary heart symptoms. 2. There are different degrees of dullness or cramping in the precordial area. Each episode has a long time, and some can last for several hours. There are often palpitations, irregular heartbeats and myocardial ischemia changes in the electrocardiogram. 3. Heart symptoms are mostly caused by eating greasy food or emotional excitement. It is not easy to use nitroglycerin or Jiuxin Pill, but it can be relieved with atropine and dulidine.

Cause

The mechanism:

1. The heart is innervated by T2-8 spinal nerves, while the gallbladder and common bile duct are innervated by T4-9 spinal nerves, and there are crosses at the T4-5 spinal nerves. Therefore, when the biliary tract has inflammation and the pressure in the bile duct increases, the coronary artery contraction is caused by T45 nerve reflex, the blood flow is reduced, and the heart activity disorder is induced.

2. Both bilirubin and bile acid are vagus nerve excitatory substances. When the concentration of both is increased in the blood, it is easy to cause vagus reflex. It can also directly inhibit the energy metabolism of cardiomyocytes and reduce the function of cardiac activity.

an examination

Related inspection

Electrocardiogram cardiac vascular ultrasound

Auxiliary inspection

(1) B-mode ultrasound: biliary diseases such as cholecystitis and gallstones can be found.

(2) Electrocardiogram: 1 rhythm change: including tachycardia or tachycardia, atrial or ventricular premature beats, atrial fibrosis, etc., more common in clinical. 2 myocardial ischemia: manifested as T wave drop flattened, T wave inversion and ST segment decline, etc., are also more common. 3 conduction block: there may be different degrees of left or right bundle branch block.

Differential diagnosis

Differential diagnosis of biliary syndrome:

1, biliary cirrhosis: cirrhosis caused by biliary obstruction, cholestasis, less common, can be divided into secondary and primary. Primary people are even rarer. Diagnosis basis: 1 middle-aged women, the skin is obviously itchy, hepatomegaly, xanthoma; 2 serum total cholesterol is significantly increased, serum bilirubin is mild, moderately elevated, alkaline phosphatase is increased, bile acid concentration is increased; 3IgM liter High, anti-mitochondrial antibody positive and high titer. If you can get a piece of histological evidence, it will help to confirm the diagnosis.

2, cardiogenic respiratory distress: refers to cardiotoxic dyspnea caused by factors such as increased hydrostatic pressure, common in left cardiac dysfunction caused by cardiogenic pulmonary edema, and thus caused by respiratory failure. Cardiac dyspnea is mainly caused by left heart and/or right heart failure. The mechanism of the two is different. The dyspnea caused by left heart failure is more serious.

3, pulmonary heart disease: referred to as pulmonary heart disease, is due to a variety of chest and bronchial lesions secondary to pulmonary hypertension, and finally lead to heart disease characterized by right ventricular hypertrophy. Most of the pulmonary heart disease develops from bronchitis and obstructive emphysema, and a small part is related to bronchial asthma, tuberculosis, and bronchiectasis. Pulmonary heart disease exists all year round, more than respiratory and tract infections in winter and spring, leading to respiratory failure and heart failure, and the mortality rate is higher. The disease belongs to the category of "hepatitis syndrome", "sputum syndrome", "edema" and "drink syndrome" in Chinese medicine.

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