Coronary Heart Disease: TCM and Western Medicine Diagnosis and Treatment

Author: Chief Editor: Cai Zhongsheng et al.
Publisher:
Publishing Date: 1998-08-01
Features: The book is a specialized work on modern practical integrated traditional Chinese and Western medicine in the treatment of coronary heart disease. It is divided into 4 parts, 43 chapters, and approximately 1 million words. It systematically discusses the basic theories of traditional Chinese and Western medicine in coronary heart disease; emphasizes the traditional Chinese and Western medicine treatment and progress of angina pectoris, myocardial infarction, arrhythmia, heart failure, and sudden death in coronary heart disease; provides detailed discussions on various clinical examinations that can be currently conducted, as well as modern treatment methods and progress in coronary heart disease, such as hemodynamic monitoring, ultrasound examination, X-ray examination, nuclear medicine examination, and invasive examinations of coronary heart disease; thrombolytic therapy for acute myocardial infarction; interventional treatment of coronary heart disease, intra-aortic balloon counterpulsation therapy, anticoagulant and blood-activating therapy for coronary heart disease, coronary artery bypass grafting, laser myocardial revascularization, and modern anesthesia; and provides a comprehensive discussion on other clinical diagnoses such as asymptomatic myocardial ischemia, ischemic cardiomyopathy, and X syndrome; and systematically discusses the clinical medication for coronary heart disease. This book is written collectively by over 30 cardiovascular specialists, referencing a large amount of domestic and international clinical data and combining their clinical practices. It reflects the current status of Western medicine in the diagnosis and treatment of coronary heart disease while also emphasizing the characteristics of traditional Chinese medicine, integrating both to strive to reflect the current state of the field of "coronary heart disease." The content is novel, comprehensive, highlights key points, and is highly practical. It is an important professional reference book for cardiologists, internal and surgical doctors, researchers, faculty and students of medical schools, and medical workers engaged in traditional Chinese medicine and integrated traditional Chinese and Western medicine.
Excerpt:
History: The typical history is the occurrence of severe and persistent chest pain. Sometimes, the history is atypical, with pain that can be mild or even absent, primarily manifesting as other symptoms.
Electrocardiogram: The definite changes in the electrocardiogram are the appearance of abnormal, persistent Q waves or QS waves, as well as progressive injury currents lasting more than 1 day. When these definite changes appear, a diagnosis can be made solely based on the electrocardiogram. In other cases, the electrocardiogram shows uncertain changes, including: ① static injury currents; ② symmetrical T-wave inversion; ③ a pathological Q wave in a single electrocardiogram recording; ④ conduction abnormalities.
Serum Enzymes: ① Definite changes include sequential changes in serum enzyme concentrations, or an initial rise followed by a subsequent decline. This change must be related to specific enzymes, symptom onset, and the time interval between blood sampling. The elevation of cardiac-specific isoenzymes is also considered a definite change. ② Uncertain changes include an initial rise in concentration without a subsequent decline, and the inability to obtain an enzyme activity curve.
(1) Definite Acute Myocardial Infarction: If definite electrocardiogram changes and/or definite enzyme changes occur, a definite diagnosis of acute myocardial infarction can be made, with a history that can be typical or atypical.
(2) Possible Acute Myocardial Infarction: When sequential and uncertain electrocardiogram changes persist for more than 24 hours, accompanied by or without uncertain enzyme changes, a diagnosis of possible acute myocardial infarction can be made, with a history that can be typical or atypical. During the recovery period of acute myocardial infarction, some patients may present with spontaneous chest pain, sometimes accompanied by electrocardiogram changes but without new enzyme changes. In some cases, these can be diagnosed as Dressler syndrome, while others are cases of spontaneous angina, and some may be recurrent acute myocardial infarction or potentially extending. Other diagnostic measures may help establish a definitive diagnosis.
2. Old Myocardial Infarction: Old myocardial infarction is often diagnosed based on definite electrocardiogram changes, without a history of acute myocardial infarction or enzyme changes. If no residual electrocardiogram changes are present, it can be diagnosed based on previous typical electrocardiogram changes or previous definite serum enzyme changes.
(4) Heart Failure in Ischemic Heart Disease: Ischemic heart disease can lead to heart failure due to various reasons, such as complications of acute myocardial infarction or previous myocardial infarction, or triggered by angina attacks or arrhythmias. In patients with heart failure without previous ischemic heart disease clinical or electrocardiogram evidence (excluding other causes), the diagnosis of ischemic heart disease is speculative.
(5) Arrhythmia: Arrhythmia can be the only symptom of ischemic heart disease. In such cases, unless coronary angiography confirms coronary artery obstruction, the diagnosis of ischemic heart disease is speculative. The terms "pre-infarction angina" and "intermediate coronary syndrome" are not included in this standard, as the former is a recall diagnosis confirmed in only a few cases according to WHO, and the latter can be classified into one of the ischemic heart disease categories described in this standard. The World Health Organization (WHO) naming, clinical classification, and diagnostic criteria basically summarize the status of "coronary heart disease." However, with further basic and clinical research, some scholars have drawn reliable conclusions, enriching its content and gradually being accepted by scholars worldwide. For example, in the late 1970s and early 1980s, the Fuwai Cardiovascular Hospital in Beijing found that exertional angina and spontaneous or variant angina could coexist. In 1985, Maseri proposed the term "mixed angina," believing that in patients with definite exertional thresholds for exertional angina, angina occurring at rest or under normal tolerance levels of exertion should be diagnosed as "mixed angina" as a supplementary type in angina classification. During his research on recumbent angina, Chen found that recumbent angina has a significant relationship with myocardial oxygen consumption and included it in the category of exertional angina, which is of great significance for guiding clinical treatment. WHO classification and diagnostic criteria are based on clinical observation, electrocardiogram, and enzyme changes and do not include some new clinical examination methods that have been developed or gradually matured in recent decades, such as coronary angiography (SCA), dynamic electrocardiogram (DCG), echocardiography (UCG), intravascular ultrasound, esophageal ultrasound, ultra-high-speed CT (UFCT), magnetic resonance imaging (MRI), nuclear medicine examination (ECT), electrophysiological examination, and hemodynamic monitoring, which are of great significance for clinical diagnosis and treatment. Some have gradually been incorporated into routine examinations, and clinical attention should be paid to their preferred application. Currently, clinical examinations for coronary heart disease include invasive and non-invasive examinations, which can also be divided into three types: non-invasive, minimally invasive, and invasive examinations. Clinical examinations should be conducted according to specific conditions. For details, see relevant chapters.
Seven. Prevention and Treatment of Coronary Heart Disease
1. Prevention of Coronary Heart Disease: Primary prevention refers to the intervention of risk factors for coronary heart disease. Actively controlling and eliminating risk factors for coronary heart disease is very important for preventing its occurrence and development. In 1981, the WHO Expert Committee drafted a report on the prevention of coronary heart disease, proposing that prevention strategies for coronary heart disease can adopt two approaches: targeting the general population and high-risk populations. The former involves changing the lifestyle habits, social structures, and economic factors of a certain population, region, or country related to coronary heart disease risk factors to reduce the average level of risk factors in the population; the latter targets individuals with one or more recognized (such as hypertension, hypercholesterolemia, smoking, and obesity) and clearly causal risk factors for coronary heart disease, controlling them to effectively reduce the incidence of coronary heart disease. China is a low-prevalence country for coronary heart disease, but it has been gradually increasing, especially in major northern cities, where the incidence of coronary heart disease has been rising year by year. This may be related to factors such as improved living standards, accelerated life rhythms, and environmental influences. In light of China's specific conditions, current prevention measures mainly target high-risk populations, actively controlling their risk factors, such as controlling blood pressure, reducing serum cholesterol, discouraging smoking, adjusting lifestyle and dietary structures, limiting calorie and salt intake, and increasing exercise to maintain a healthy weight. At the same time, regular surveys should be conducted in high-risk areas and populations to improve the early detection rate of coronary heart disease, strengthen treatment, control its development and recurrence, promote recovery, i.e., the secondary prevention of coronary heart disease.
2. Treatment of Coronary Heart Disease: Once coronary heart disease is diagnosed, active treatment should be strengthened to improve its quality of life and reduce mortality. Once the patient develops the disease, active self-rescue should be taken, such as remaining stationary and sublingually administering nitroglycerin, and efforts should be made to notify relevant personnel to send the patient to the nearest emergency station or center to shorten the time to admission. In recent years, due to the widespread establishment of coronary heart disease monitoring rooms (CCU), the mortality rate of coronary heart disease has decreased from about 30% in the 1950s and 1960s to 10%–15%. In specialized hospitals with conditions, the mortality rate is even lower, below 10%. Drug treatment mainly improves the imbalance between myocardial oxygen supply and demand. Commonly used drugs include nitrates, calcium antagonists, and β-blockers. The former two have vasodilatory effects, reducing cardiac preload and afterload while also lowering the tension of the coronary artery wall and relieving spasm. β-blockers mainly reduce the effects of sympathetic nerve excitement on the heart during exercise and emotional excitement by slowing heart rate and weakening myocardial contractility, thereby reducing myocardial oxygen consumption. For patients with unstable angina, antiplatelet and anticoagulant treatment should be given, such as oral aspirin, intravenous or subcutaneous heparin, which is important for preventing the occurrence of myocardial infarction, recurrent myocardial infarction, and sudden death from coronary heart disease. For acute myocardial infarction with thrombolytic indications, active thrombolytic treatment should be given to improve prognosis. When necessary, emergency percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) should be performed to restore blood flow and improve quality of life while reducing mortality. Selective coronary angiography should be performed for patients to understand the degree of coronary artery stenosis, which is instructive for treatment. It is generally believed that when the degree of coronary artery stenosis is <75%, drug treatment should be primarily adopted, and when the stenosis degree is >75%, PTCA or CABG treatment is more appropriate. The degree of coronary artery stenosis is positively correlated with prognosis. For patients with arrhythmia from coronary heart disease, when drug treatment is unsatisfactory, electrophysiological examination and radiofrequency ablation can be used. For patients with heart failure from coronary heart disease, positive inotropic drugs should be used in conjunction with drugs that reduce cardiac preload and afterload. Patients with mechanical complications after myocardial infarction should undergo surgical treatment as soon as possible. In units with conditions, for acute left heart failure, especially patients with cardiogenic shock, when drug treatment is ineffective, intra-aortic balloon counterpulsation (IABP) treatment can be given. For related diseases of coronary heart disease, such as hypertension, diabetes, and hyperlipidemia, corresponding treatment should be actively given to control the condition and prevent it from worsening. In summary, for coronary heart disease, corresponding measures should be actively taken to rescue and treat it according to its different types.