35-year-old grandson, father of two children, has partial myocardial necrosis and heart failure.
He had been lying in the Cardiac Intensive Care Unit (CCU) for a week and had improved since resuscitation.
Doctors say that although the heart muscle has recovered, it is still unknown to what extent. In the best case, there is compensation, and there is no heart failure. In the most pessimistic case, heart failure is aggravated, then look at the ejection fraction, above 35%, the risk of sudden death is smaller, and below 35%, it is very dangerous. Cardiac arrest can occur at any time, with death within minutes [4].
If Xiao Sun had known some common sense of heart disease and went to the emergency department as soon as possible, it would not have developed to this point.
▍Life and death hang by a thread, I thought it was "on fire"! [1,4-5] The story begins with one day two weeks ago.
Xiao Sun works in a suburb of Beijing and goes to work on Monday, when he suddenly feels a dull pain in the bones under his throat. He thought it was caused by a sore throat.
Actually, this is the first symptom of angina, retrosternal pain.
The next day, the sternum hurt even more. When I was driving to work and driving on the highway, my left arm suddenly began to hurt, and my chest was tight, and I couldn't even hold the steering wheel. Hurry up to the auxiliary road and rest for 40 minutes to get better.
The pain worsens after exertion and is relieved with rest, which is typical of angina symptoms, and the pain has spread to the left arm. The myocardial ischemia was so severe that death beckoned him.
But Xiao Sun didn't know.
Finally drove to the unit, Xiao Sun still felt tired, thought that the air conditioner was too cold, turned off the air conditioner, and lay in the duty room for a day.
When he got home in the evening, he began to feel breathless, his chest hurt even more, he couldn't even lie down, and he sat almost all night. The back of the sternum was hot, like a sore throat that was badly on fire.
Why can't you lie flat?
It is because when lying down, more blood flows back to the heart, which will increase the burden on the heart, resulting in chest tightness or chest pain, and sitting can be better. If you feel uncomfortable lying down, it means that the coronary heart problems (such as angina or heart failure) are already serious.
These are all symptoms of acute myocardial infarction, and the myocardium continues to die on a large scale, threatening to live at any time.
But Xiao Sun still didn't know.
On Friday, he took his father-in-law to the chest hospital to see a lung disease, and he hung up his orthopedic number.
Fortunately, the orthopedic surgeon was experienced and immediately asked him to go to the heart center.
The doctor asked Xiao Sun to have an electrocardiogram and ultrasound. The electrocardiogram showed that acute anterior myocardial infarction, the first indicator of myocardial markers, exceeded the standard value by nearly 300 times!
Cardiography showed that the anterior descending artery (the famous "widow maker") had severe stenosis and was proximal blood vessels, meaning that the "water source" was stuck upstream, causing a large area of myocardial ischemia.
After resuscitation, the ST segment of the electrocardiogram raised by Xiao Sun fell back, but the myocardium was still heavily necrotic. Moreover, I was sweating when I ate and turned over, which was obviously heart failure.
ECG shows ST-segment elevation
The most common cause is ST-elevation myocardial infarction, but other diseases that can be described include left bundle branch block, left ventricular hypertrophy, pericarditis, myocarditis, pulmonary embolism, variant angina, hyperkalemia, etc.
From this example, it can be seen that many people will ignore the warning symptoms because they do not know about angina, myocardial infarction, etc., and one day, tragedy may occur.
▍How to identify angina before a myocardial infarction? [1，3]
For us, identifying angina before a myocardial infarction, and angina when a myocardial infarction is occurring, is a PK with death. Time is the heart muscle, and the heart muscle is life. The sooner it is detected and treated, the better the recovery.
If you have coronary heart disease, you may notice more angina (chest pain) before you have a heart attack (also known as an acute heart attack), and a small amount of activity can trigger angina, even at rest or at night. This indicates that the coronary plaque is unstable and requires immediate access to the hospital. If left untreated, plaques can rupture, forming blood clots, leading to a heart attack.
In addition, people who have never had coronary heart disease should pay special attention to angina pectoris for the first time. Most people experience chest pain or chest tightness after activity before a heart attack, but some elderly people suddenly become reluctant to move and have poor spirits one day, which may also be an important sign of a heart attack. Check for myocardial ischemia, myocardial infarction, or heart failure.
▍Angina doesn't have to hurt! 4 Misconceptions Cleared Up [4-5]
Angina pectoris is one of the types of coronary heart disease, but many people think that angina is pain near the heart, but in fact, this is the most common misunderstanding, resulting in many people not being able to seek medical attention in time.
Myth 1: Angina pectoris is always painful
Qiao Yan, deputy chief physician of the cardiology department of Beijing Anzhen Hospital, said that one of his patients had chest tightness after walking more than 200 meters or climbing a floor, like a stone pressed on his chest, and he could rest for two or three minutes. He had typical angina. He was puzzled: "I don't have pain, how can it be angina?" In fact, many patients do not feel pain when they are myocardial ischemia, but feel "a burning sensation in the chest, a bandage on the chest, and a stone on the chest".
Myth 2: It must be uncomfortable near the heart
The pain of angina pectoris can be "radiating pain": it travels to other parts of the body through the splanchnic nerves and usually does not spread to the lower limbs. The symptoms of angina can be misdiagnosed for other conditions, such as:
- The pain spreads to the shoulders and arms, and it is easy to be misdiagnosed as frozen shoulder or cervical spondylosis.
- Spread to the back, it may be misdiagnosed as back muscle disease.
- It spreads to the neck, throat, jaw, cheeks, and teeth, and can be mistaken for pharyngitis, neuralgia, dental disease, or mandibular joint disease.
- Transmission to the upper abdomen may be mistaken for gastric or hepatobiliary disease.
A common feature of angina pectoris is that it "likes to be quiet but not moving", and the pain or discomfort occurs during activity and is relieved by rest. Myth 3: Nitroglycerin must be angina pectoris.
For real angina, the pain will generally be relieved within 1~5 minutes after containing nitroglycerin. It takes more than 10 minutes to resolve, either unstable angina or myocardial infarction, or not myocardial ischemia. For example, esophageal spasm can also cause chest pain, which can be relieved by nitroglycerin. It is necessary to see a cardiologist to confirm the diagnosis before treatment.
Myth 4: If the electrocardiogram is normal on physical examination, it means that there is no angina.
More than half of patients with angina have a normal ECG when they do not have the disease. Some people with coronary heart disease have a normal ECG when they have an attack of angina. Therefore, if the ECG is normal but there are symptoms of angina, coronary angiography should be done to confirm the diagnosis so as not to delay treatment.
▍Are angina pectoris and myocardial infarction coronary heart disease? [1，4，7]
Types and definitions of coronary heart disease (click to enlarge it)
Coronary heart disease is a general term for myocardial ischemia, angina pectoris is an important symptom of aggravation of coronary heart disease, and myocardial infarction is the most serious consequence of coronary heart disease. Angina pectoris and myocardial infarction are collectively referred to as coronary heart disease, which are manifestations of different stages of the development of coronary heart disease.
angina
The pathological basis is generally coronary artery stenosis, but not complete occlusion. Patients do not have myocardial necrosis, but have symptoms of myocardial ischemia, such as chest tenderness and fullness, which may radiate to the shoulders and back, and usually improve with rest or nitroglycerin for a few minutes.
myocardial infarction
Patients often feel chest discomfort due to angina, and nitroglycerin or fast-acting pills are not relieved after 15-20 minutes of sublingual administration, which means that a heart attack may have occurred.
Myocardial infarction is an emergency caused by complete blockage or near-complete blockage of the coronary arteries, resulting in interruption of the blood supply to the myocardium and death of myocardial cells after ischemia. Once the myocardium is necrosis, the damage is irreversible, if the infarct area is large, even if it is rescued, there is a risk of heart failure in the later stage, so if a myocardial infarction occurs, it must be sent to the hospital immediately. ▲
Reference 1.Guidelines for the management of chronic coronary heart disease in the elderly, 2023
2. Geriatrics Branch of Chinese Medical Association, Chinese Expert Consensus Writing Group on the Diagnosis and Treatment of Coronary Heart Disease in the Elderly. Chinese Journal of Geriatrics,2016,35(7):683-691.
DOI:10.3760/cma.j.issn.0254-9026.2016.07.001
3. Wang Fang: Do you really know about heart attack? Expert: Everything you want to know is here, Xinhuanet, November 26, 2019
4. Only 5 days from "fire" to myocardial death This case is a wake-up call for everyone! Fixed Focus Expert
Angina pectoris does not necessarily hurt to ignore the 5 major misunderstandings, beware of missing opportunities, People's Daily Online, August 06, 2015
5. How much do you know about coronary heart disease, Beijing Anzhen Hospital2020-10-23
6. Cardiac ejection fraction less than 35% Measures must be taken to prevent sudden death from heart failure, Beijing Evening News, August 14, 2009
7. What is the relationship between coronary heart disease, angina pectoris, and myocardial infarction? Xue Chao, Attending Physician, Department of Cardiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, People's Daily, 2021-10-09
Tips: Popular science articles do not provide professional diagnosis and treatment opinions, please carry out specific diagnosis and treatment under the guidance of professional doctors, the picture comes from Visual China
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