Chest pain for 10 years, thinking it was angina pectoris, and after the coronary movie creation was found to be misdiagnosed ...

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Please collect the main points of diagnosis!

Patients with coronary heart disease in clinical work are mostly complaints with chest pain and chest tightness. In order to avoid delaying the timing of treatment, the coronary arterial filmmaking is clearly diagnosed as soon as possible. However, some patients did not find obvious vascular lesions when they were in acting. They were only manifested in the delay of the lingering agent and the blood flow was slow. In order to understand the disease, we will share the case with everyone. Let's take a look!

Abstract

Patients, 56 years old, mainly intermittent chest pain for 10 years and aggravated in March.

The previous history of type 2 diabetes is 10 years. At present, the two -meta dual -dual -dual -in -law combined with insulin therapy can be used for self -prosecution blood glucose control;

Ten years ago, patients had no obvious causes of chest pain, which relieved about 3-5 minutes of rest and did not pay attention. The symptoms were disconnected. In the past March, the above -mentioned symptoms have increased, the duration has been prolonged, and the duration has been prolonged. With shortness of Qi, no other accompanimental symptoms. Moderate narrow.

Examination: 92 times/minute heart rate, 18 times/minute breathing, blood pressure 126/73mmHg, no obvious positive signs of cardiopulmonary abdominal examination.

Immediately improved the relevant laboratory test in the emergency: Fast muscle calcium protein T <0.04ng/ml, D-di-germ negative.

ECG Ⅱ, Ⅲ, AVF, V4-V6 lead ST segment pressure and T wave inverted (Figure 1).

figure 1

The doctor considers the seizures of unstable angina pectoris, and an emergency consultation of coronary arteries. The result returns: LAD's recent diffuse diseases, the most heavier stenosis is about 40%. Level (Figure 2, 3).

figure 2

image 3

Related test results: 67%of the ejaculation scores of the heart ultrasound, and a small amount of valve in two or three valve.

Myocardial enzymes, sodium peptides (BNP), full biochemical, four items, blood routine, thoracic CT, lower limb veins and neck blood vessel ultrasound have not seen obvious abnormalities.

In summary, considering the possibility of coronary slow blood flow syndrome (CSFP). Immediately after admission, aspirin combined with anti -platelets, heparin anticoagulary, statistics of jatinoma, β -blocker slowing heart rate, nitric acid pear pear pear Essence crown, cyclopensions, orbetrazole stomach protection, etc. The symptoms have not occurred.

Regular telephone follow -up, patients regularly take medicine, symptoms have not occurred, and they have not appeared again.

discuss

Coronary arterial angiography is a gold standard for coronary heart disease. It is not obvious for coronary arteries and does not meet the diagnostic standards of coronary heart disease. There is a delay in the existence of contrast agents during the radiography, called CSFP.

With the popularity of coronary angiography in Cardiology, CSFP is recognized by many people. The incidence of adverse vascular events such as long -term myocardial ischemia, arrhythmia, and myocardial infarction has gradually attracted clinical attention.

■ Cause

More people think that the essence of CSFP is microvascular dysfunction. At present, the influencing factors of CSFP are still being further explored. It is more recognized that includes atherosclerosis, damage to vascular endothelial function, inflammatory response, and blood cell morphology. Under the above factors, vascular resistance increased and blood flow was slow.

■ Clinical manifestations

Because of its slow flow of coronary veins, clinical manifestations are similar to angina pectoris, often manifestations of myocardial ischemia, that is, chest pain, chest tightness, discomfort in the first zone of the heart, and even malignant arrhythmia and sudden death.

■ diagnosis

Coronary arterial angiography is the gold standard, and no obvious lesions are seen in the vascular.

■ Treatment

The treatment of CSFP is similar to the plan for the treatment of acute coronary syndrome. However, there are certain differences. CSFP is mainly microvascular dysfunction. Nitrate vascular dilated drugs are mainly effective for> 200 μm diameter coronary veins. Other treatments for the cause of the cause Including a stabilized plaques of his lipids, anti -platelet agglomeration, expanding microvascular drugs such as Nicotoire have certain benefits to improving the symptoms and prognosis of patients.

Based on this, drugs that improve myocardial metabolism and delay the reshape of the heart, such as inceamine, β -blocker, vascular tensional converting enzyme inhibitors (ACEI)/vascular tension Ⅱ receptor antagonist (ARB ) The aldehyde solid antagonist antagonist may delay its development ending. In recent years, the application of psychological and blood -promoting blood stasis Chinese medicine has also played a certain role in the treatment of CSFP, and it still needs to be further explored.

■ Promotion

The causes of CSFP patients have different causes, which leads to certain differences in their prognosis. Studies have shown that the overall prognosis of CSFP patients is not optimistic. Compared with the traditional acute coronary syndrome (AMI), the short -term prognosis is better, but the incidence of long -term cardiovascular adverse events is not weaker than AMI. After the diagnosis as soon as possible, related treatment can help reduce the occurrence of adverse events.

summary

The development of medical technology has increased the discovery rate of CSFP year by year. At the same time, research has confirmed that the incidence of long -term cardiovascular adverse events in CSFP is high. It is recommended to intervene in early intervention. For patients who complained with chest pain and chest tightness, they were treated immediately after early diagnosis to delay the degree of worsening of the disease.

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