According to statistics, the number of people who die of myocardial infarction and its complications in my country has exceeded 1 million every year! Myocardial infarction refers to the occlusion of coronary arteries and interruption of blood flow, leading to partial necrosis of part of the myocardium due to persistent ischemia, which is a great threat to life and health. Myocardial infarction has the characteristics of sudden onset, so it should adhere to the concept of early detection and early treatment.
The treatment principle of myocardial infarction is to save the dying myocardium, reduce the infarct size, protect the heart function to the utmost extent, and deal with related complications in time. Specific treatment methods include the following:
The prognosis of myocardial infarction varies from person to person. The greater the degree of the disease, the more difficult the treatment; if the patient has other diseases, the treatment will be more difficult. For those patients who have no complications, general treatment and monitoring can be appropriate. The acute phase of the disease should be in bed for 1 to 3 days. During this process, oxygen should be maintained and continuous ECG monitoring should be performed. Some hypotension or shock Patients should also monitor venous pressure; in terms of diet, patients should be low-salt, low-fat, and reasonably arrange eating time. It is best to eat small and frequent meals to reduce the pressure on the digestive system and ensure smooth stool; after 3 days of monitoring , You can gradually carry out a small amount of indoor activities.
At present, the drugs used to treat myocardial infarction mainly include antiplatelet drugs, anticoagulant drugs, β-receptor blockers, angiotensin converting enzyme inhibitors, and blood lipid regulating drugs.
1. Antiplatelet drugs. The first choice is aspirin, which has a good platelet inhibitory effect, and the optimal dose range is 75-150 mg/day. Clinically, clopidogrel is the same widely used antiplatelet drug as aspirin, but the risk of bleeding gradually increases with the prolonged medication time.
2. Anticoagulant drugs. “Guidelines for the Rational Use of Drugs for Coronary Heart Disease (2nd Edition)” pointed out that patients with stable coronary heart disease and angina pectoris do not need anticoagulation; patients with stable coronary heart disease who choose percutaneous coronary intervention (PCI) require intraoperative heparin; For patients whose platelets need anticoagulation, warfarin or new oral anticoagulants can be used in combination.
3. Beta-blockers. At present, Betaloc is the most widely used. It has significant curative effect and can effectively improve the clinical symptoms of patients, reduce the recurrence rate and improve the quality of life of patients. It is currently advocated that β-blockers should be used as soon as possible in patients with myocardial infarction without contraindications.
4. Angiotensin converting enzyme inhibitor. Commonly used clinically are captopril, enalapril, benazepril, fosinopril, ramipril and so on. They can delay and reverse ventricular remodeling, prevent the further development of myocardial hypertrophy, improve vascular endothelial function and cardiac function, reduce the occurrence of arrhythmias, and can also increase survival rate and improve prognosis.
5. Blood lipid regulating drugs. A number of randomized double-blind primary or secondary prevention clinical trials have shown that statins can effectively reduce cholesterol and low-density lipoprotein levels, thereby reducing the risk of cardiovascular disease.
The surgical treatment of myocardial infarction mainly includes two kinds of heart bypass and stent implantation. If the myocardium has left main stem disease and severe stenosis of the three vessels, it is necessary to take a bypass method to remove part of the blood vessels of the lower limbs and connect them to both sides of the heart vessels, thereby replacing the diseased vessels to supply blood to the heart. The stenosis reaches more than 70%, and the treatment of moderate to severe stable angina or unstable angina pectoris is not ideal. Stent implantation is required, that is, the stent is delivered to the diseased part of the heart blood vessel through the radial artery, so as to achieve the expansion of the heart. purpose.
For patients with acute myocardial infarction, if they have successfully passed the acute phase, and the condition is relatively stable, without other complications, they can go home for rehabilitation.
First of all, according to the doctor’s instructions, take a variety of drugs on time, according to the amount, and standard to prevent the recurrence of myocardial infarction.
Secondly, use the exercise load test to evaluate the physical state, and then perform exercise rehabilitation according to the exercise prescription issued by the doctor. Exercise prescription should include aerobic exercise, resistance exercise, flexible exercise, etc.; exercise time should be in the afternoon, starting as short as 10 minutes, and then gradually increasing to 20-30 minutes, usually once every other day; high temperature and severe cold The amount of exercise should be appropriately reduced in season.