Commonly known as coronary heart disease, it is a heart condition caused by the narrowing of the coronary artery lumen due to the formation of atherosclerotic plaques on the vessel walls that supply the heart itself. Depending on the number and severity of narrowed coronary arteries, the clinical symptoms may vary.

bubble_chart Diagnosis

1. Medical History and Symptoms:

The typical symptom is exertional colicky pain, which manifests as compressive pain in the precordial region during physical activity or emotional agitation. In some patients, the pain may radiate to the left shoulder and/or left upper arm, generally lasting 5–10 minutes, and can be relieved by rest or sublingual nitroglycerin. Some patients may experience chest tightness as the primary or accompanying symptom. In severe cases, the pain is more intense, lasts longer, and may even occur during rest or sleep. When taking the medical history, attention should be paid to the triggers, location and duration of the pain, presence of radiation, accompanying symptoms, and methods of relief.

2. Physical Examination Findings:

Generally, there are no clear positive signs in the early stages. In more severe cases, the cardiac border may expand to the left and downward, with a weakened first heart sound. Arrhythmias such as premature beats or atrial fibrillation may be audible. In cases complicated by heart failure, moist rales may be heard in the lower lungs, and a gallop rhythm may be present at the cardiac apex.

3. Auxiliary Examinations:

The electrocardiogram may show flattened or inverted T waves and ST-segment depression, particularly horizontal or downsloping depression, which is more significant. Ultrasound may reveal segmental left ventricular wall motion abnormalities. Treadmill exercise tests are often positive. Myocardial ischemia may be detected via radionuclide myocardial perfusion imaging (ECT). Ischemic changes during exercise can be monitored via 24-hour Holter ECG. Coronary angiography is the gold standard for diagnosing coronary artery disease. Lipid profiles and blood glucose levels may also be checked if necessary.

4. Differential Diagnosis:

It should be differentiated from chest pain caused by myocarditis, hypertrophic obstructive cardiomyopathy, pericarditis, pleuritis, and other conditions.

Calcium channel blockers, nitrate esters, and ACE inhibitors can be selected for treatment. For patients with a faster heart rate, beta-blockers may be chosen, preferably in sustained-release formulations. Enteric-coated aspirin (100–325 mg once daily) can be added. Attention should be paid to treating risk factors for coronary heart disease, such as antihypertensive therapy, lipid-lowering therapy, diabetes management, smoking cessation, and alcohol abstinence. Polarizing solution and nitrate esters may also be administered intravenously. In cases complicated by {|###|}heart failure{|###|} and arrhythmias, additional treatments to correct {|###|}heart failure{|###|} and antiarrhythmic therapy should be included (see the sections on {|###|}heart failure{|###|} and arrhythmias for details). If necessary, interventional therapy for coronary heart disease (PTCA + stenting) may be performed, and severe cases may consider coronary artery bypass surgery.

Among middle-aged or elderly individuals over 60, coronary heart disease is not uncommon. Some people may have no symptoms, and their electrocardiogram may appear normal—this is classified as silent coronary heart disease. It only draws attention when intermittent symptoms of heart disease occur. Patients already diagnosed with coronary heart disease should learn to correctly use several medications, such as nitroglycerin, {|###|}heart pain{|###|} relief drugs, diazepam, and Chinese medicinals like Baoxin Pills. During a coronary heart disease episode, patients often experience warning symptoms, such as {|###|}stuffy pain{|###|} in the precordial area, a sense of tightness, or fear. Based on past experience, they can self-administer medication, rest on the spot, and, if possible, inhale oxygen for effective relief without waiting for a doctor, thereby preventing severe episodes. It is crucial to avoid forcing oneself to continue any activities—danger often arises from "pushing through"! When traveling or engaging in official activities, carry medications at all times. Special emphasis should be placed on quitting smoking, and smoking is strictly prohibited during frequent episodes of {|###|}colicky pain{|###|} in the heart.