Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease. Refers to a kind of heart disease, also known as ischemic heart disease, which is caused by severe atherosclerosis or spasm of the coronary artery supplying nutrients to the heart, so that the coronary artery is narrowed or blocked, and thrombosis causes lumen occlusion, leading to myocardial ischemia, hypoxia or infarction. Coronary heart disease is the most common organ disease caused by atherosclerosis, and it is also a common disease that harms the health of middle-aged and elderly people. The occurrence of this disease is closely related to the degree and quantity of coronary artery stenosis, but a few young patients with coronary atherosclerosis can get sick even if they are not serious. There are also some elderly people with severe coronary atherosclerotic stenosis, but not all of them have clinical manifestations of coronary heart disease such as chest pain and palpitation. Therefore, the pathogenesis of coronary heart disease is very complicated. Generally speaking, it is organic, and coronary artery spasm also occurs in atherosclerotic coronary arteries.

This disease mostly occurs after the age of 40, with more men than women, more mental workers than manual workers, and more cities than rural areas. The average prevalence rate is about 6.49%, and the prevalence rate increases with age. It is the most common cardiovascular disease in the elderly. With the improvement of people's living standards, the prevalence of coronary heart disease in China is increasing year by year, and the onset age tends to be younger. Therefore, China is facing the challenge of cardiovascular diseases in 2 1 century, and prevention is the key to curb the "first killer" that harms human health.

What are the inducing factors of coronary heart disease?

With the extensive and in-depth study of coronary heart disease by medical scientists, it shows that the disease is a multi-factor disease, which is caused by many factors acting on different links. These factors are risk factors, or risk factors, mainly including:

(1) Age: This disease is more common in middle-aged and elderly people over 40 years old, and it progresses rapidly after 49 years old. The incidence of myocardial infarction and sudden death in coronary heart disease is proportional to age. In recent years, the incidence of coronary heart disease tends to be younger.

(2) Gender: In the multi-ethnic United States, the mortality rate of male coronary heart disease is significantly higher than that of female. According to the statistical data of 1979, the mortality rate of coronary heart disease in white men aged 35-44 is 5.2 times that of women. In China, the ratio of male to female is about 2:1. However, after menopause, the incidence of coronary heart disease increased significantly due to the obvious decrease of estrogen level and the increase of low density lipoprotein. Some data show that the incidence of coronary heart disease in women after 60 years old is greater than that in men.

(3) Occupation: There are more mental workers than manual workers, and jobs with a sense of urgency are more likely to get sick.

(4) Diet: People who often eat a high-calorie diet and have more animal fat and cholesterol are prone to this disease. At the same time, eating too much is also easy to get this disease. Researchers in Germany, the world's first obese country, believe that "eating too much is because of eating too much". Therefore, to control the incidence of coronary heart disease, in addition to controlling the intake of high-fat diet, we must also pay attention to controlling the intake of food.

(5) Blood lipids: abnormal blood lipids caused by genetic factors, or excessive fat intake, or disorder of lipid metabolism. For example, total cholesterol, triglycerides, low-density lipoprotein, very low-density lipoprotein increase, and high-density lipoprotein decrease, so it is easy to suffer from this disease.

(6) Blood pressure: Elevated blood pressure is an independent risk factor for coronary heart disease. Coronary artery and cerebral artery are the most common hazards of atherosclerosis caused by hypertension. 60% ~ 70% patients with coronary atherosclerosis have high blood pressure, which is four times that of normal people.

(7) Smoking: Smoking is the main risk factor of coronary heart disease. Compared with non-smokers, the incidence and mortality of the disease increased by 2 ~ 6 times, and it was directly proportional to the number of smokers every day.

(8) Obesity: Overweight people (65,438+00% are mild, 20% are moderate and 30% are severely obese) are prone to this disease, especially those who gain weight quickly. However, at present, it is considered that we should pay attention to the research on the method of evaluation weight. Not only the body mass index, but also the thickness of subcutaneous fat. Previous prospective research data showed that the risk of centripetal obesity was high.

(9) Diabetes: It has been recognized that diabetes is easy to cause cardiovascular diseases. Some data show that the incidence of diabetes is twice that of non-diabetic people.

(10) Heredity: If there are people in the family who are prone to the disease when they are young, their close relatives are five times more likely to get sick than those in families without this condition.

Among the above ten factors, hypertension, overweight and high or low cholesterol are the most dangerous factors leading to coronary heart disease and stroke. This is the eighth five-year plan project jointly completed by Fuwai Cardiovascular Hospital of China Academy of Medical Sciences and other units 17, and it is also the result of the first large-scale follow-up survey. The study also shows that the increase of diastolic blood pressure and average body weight leads to the increase of stroke incidence, while the increase of average systolic blood pressure, average body weight and serum cholesterol leads to the increase of coronary heart disease incidence.

What is the definition and classification of coronary heart disease by the World Health Organization?

1979, the world health organization defined coronary heart disease as myocardial damage caused by the imbalance between coronary blood flow and myocardial demand caused by functional changes or organic lesions of coronary arteries, including acute temporary and chronic conditions.

The classification of ischemic heart disease is as follows:

(1) Primary cardiac arrest: Primary cardiac arrest is an emergency, presumably caused by ECG instability; Other diagnoses have no basis. If resuscitation is not performed or fails, primary cardiac arrest can be attributed to sudden death. In the past, evidence of ischemic heart disease was dispensable. If no one sees it at the time of death, diagnosis is speculation.

(2) angina pectoris:

① Fatigue angina pectoris: Fatigue angina pectoris is manifested as a short-term chest pain attack induced by exercise or other conditions that increase myocardial oxygen demand. After rest or sublingual administration of nitroglycerin, the pain often disappears quickly. Fatigue angina pectoris can be divided into three categories: a initial fatigue angina pectoris: the course of fatigue angina pectoris is less than one month. B stable angina pectoris: the course of angina pectoris is stable 1 month or more. C worsening angina pectoris: the frequency, severity and duration of chest pain induced by the same degree of fatigue gradually increased.

② Spontaneous angina pectoris: The characteristic of spontaneous angina pectoris is that chest pain attack has no obvious relationship with the increase of myocardial oxygen consumption. Compared with fatigue angina pectoris, this kind of pain generally lasts for a long time and is severe, and it is not easy to be relieved by nitroglycerin. No change of enzyme was observed. Some temporary ST segment depression or T wave changes often appear on ECG. Spontaneous angina can occur alone or in combination with fatigue angina.

The frequency, duration and degree of pain in patients with spontaneous angina pectoris may have different clinical manifestations. Sometimes, patients may have chest pain attacks lasting for a long time, similar to myocardial infarction, but ECG and enzymes have no characteristic changes.

Some patients with spontaneous angina pectoris have temporary ST segment elevation during the attack, which is often called variant angina pectoris. However, this name cannot be used when recording this ECG pattern in the early stage of myocardial infarction.

(3) myocardial infarction:

① Acute myocardial infarction: The clinical diagnosis of acute myocardial infarction is often based on the changes of medical history, electrocardiogram and serum enzymes.

Medical history: The typical medical history is severe and persistent chest pain. Sometimes, the medical history is atypical, and the pain can be mild or even absent, or it can be mainly other symptoms.

Electrocardiogram: The positive changes of electrocardiogram are abnormal and persistent Q wave or QS wave and progressive damage current lasting for more than one day. When these positive changes appear in ECG, diagnosis can only be made through ECG. In other cases, the ECG shows uncertain changes, including: static damage current; Symmetry inversion of b-T wave; C. pathological q wave exists in a single ECG record; Conduction disorder.

Serum enzyme: Positive changes include the sequence changes of serum enzyme concentration, or increase first and then decrease. This change must be related to specific enzymes and the time interval between the onset of symptoms and blood collection. The increase of cardiac specific isoenzymes also has positive changes. B does not necessarily change to the initial concentration increase, but it is not accompanied by the subsequent decrease, so the curve of enzyme activity cannot be obtained.

Judgment: A-positive acute myocardial infarction: If ECG changes and/or enzymology changes are positive, it can be diagnosed as definite acute myocardial infarction. The medical history can be typical or atypical. B possible acute myocardial infarction: when the sequential and uncertain ECG changes last for more than 24 hours, with or without enzyme uncertainty changes, it can be diagnosed as possible acute myocardial infarction. The medical history can be typical or atypical.

In the recovery period of acute myocardial infarction, some patients may have spontaneous chest pain, sometimes accompanied by ECG changes, but no new enzyme changes. Some cases can be diagnosed as dressler's post-infarction syndrome, some patients have spontaneous angina pectoris, and some may be the recurrence and expansion of acute myocardial infarction. Other diagnostic measures may help to establish an accurate diagnosis.

② Old myocardial infarction: Old myocardial infarction is often diagnosed according to the positive changes of ECG, and there is no history of acute myocardial infarction and enzyme changes. If there is no left ECG change, the diagnosis can be made according to previous typical ECG changes or previous serum enzyme positive changes.

(4) Heart failure of ischemic heart disease:

Ischemic heart disease can lead to heart failure for many reasons. It can be a complication of acute myocardial infarction or early myocardial infarction, or it can be induced by angina pectoris or arrhythmia. The diagnosis of ischemic heart disease is still speculative for patients with heart failure who have no clinical or ECG evidence of ischemic heart disease before (excluding other reasons).

(5) Arrhythmia:

Arrhythmia may be the only symptom of ischemic heart disease. In this case, the diagnosis of ischemic heart disease is still speculative, unless coronary angiography proves coronary artery occlusion.

The names "angina pectoris before infarction" and "intermediate coronary syndrome" are not included in this report. Because according to our opinion, the former diagnosis is a retrospective diagnosis, which is only confirmed in a few cases. All cases diagnosed by the latter can belong to one of the classification of ischemic heart disease described in this report.