Hu Dayi: Do the right bracket and ignore heart failure

I saw a 76-year-old male patient who had smoked for many years, had high blood pressure and normal blood sugar. Insist on exercising all year round and have an ideal weight.

Half a month ago, before going to bed, I suddenly felt chest tightness, chest pain, back pain, sweating, and realized that there was a heart problem. Ask your family to quickly call the 120 emergency number and go to a local tertiary hospital for emergency treatment. Entering the catheterization chamber at 2 a.m., coronary angiography and stenting were done, and the ECG showed extensive anterior myocardial infarction.

During the operation, the patient listens to the doctor on the stage and says", and the patient thinks that it may be the part where the stent should be supported. Soon, the patient soon feels a relief of pain in the chest and back. Then he stayed in the intensive care unit for eight days and went home through the discharge procedures.

Three days after arriving home, I could not lie flat at night and had difficulty breathing. Immediately call 120 to go to another hospital, diagnosed left heart failure, pleural effusion. After 3 days of treatment, the symptoms were significantly reduced. After returning home, the daughter bought oxygen inhalation equipment and continued to use the medicines from the second hospital, and her condition gradually stabilized. The patient's family said that they did not know whether the medicine prescribed by the second hospital had worked or the effect of oxygen inhalation.

Now let me tell you how to evaluate the diagnosis and treatment of the first hospital?

The patient suffered from acute myocardial infarction and decided to go to the hospital decisively and decided correctly. The hospital made a stent as early as possible, and the patient's symptoms disappeared quickly, and the treatment was timely and appropriate, and the effect was immediate.

But why did left heart failure occur shortly after discharge? Patients suffer from extensive anterior wall myocardial infarction, which has a large impact on cardiac function, and echocardiography before discharge has clearly shown a significant decrease in left ventricular systolic function and a left ventricular ejection fraction of 40% (normal 50% to 55%). There is a ventricular wall tumor at the tip of the heart. At the time of discharge, the ST segment of the CEB chest lead of the ECG was still elevated and did not return to the isosterimetric line. Discharge with drugs: 1, aspirin; 2, clopidogrel (to prevent thrombosis in stents); 3, rosuvastatin 10mg (lowering cholesterol); 4, rabeprazole (with two antiplatelet anti-thrombotic drugs, worried about gastrointestinal bleeding in elderly patients).

Unfortunately, this hospital neglected to have a widespread anterior wall myocardial infarction, patients who have a significant decrease in left ventricular systolic function, and patients with ventricular wall tumors, discharged with drugs that protect left heart function to prevent heart failure.

Why do my symptoms get better so quickly after being hospitalized at my second hospital? The second hospital used the diuretics furosemide and spironolactone, along with a new drug for heart failure, sakubatrex/valsartan (noxinto). Rapid relief of symptoms is mainly due to diuretics, which reduce the burden on the heart. Oxygen at home is not necessary.

However, the second hospital did not explain to the patient and his family how to continue treatment after discharge when the patient was discharged. For example, furosemide can not always be used, when to stop the drug. Three important drugs for the protection of left heart function, the treatment of heart failure and the improvement of heart function, spironolactone, sacobatriptan / valsartan and sustained-release metoprolol (or bisoprolol), no third drug, no sacobatrex / valsartan require individualized dose adjustment.

After the patient is discharged from the hospital, the family still has palpitations about the disease, how to treat it? Why use these medicines? How to use these medicines well? What problems should I pay attention to during medication? What are the main side effects of these drugs? Confused.

Sit in the hall and practice medicine, wait for people to get sick, wait for those who are not sick to get sick, and wait for the recurrence of those who get sick. Only the emergency was treated, follow-up follow-up, and rehabilitation was completely missing, which is a drawback of the medical system, and it is difficult to return!