视频加载中...

各位朋友：

大家好，现在是“每天健康三分钟”时间，我是道简-心血管康复医生集团的李佳念，今天我们来共同学习下关于冠心病的一些小知识。

日常生活中，人们常常会问：“我血管堵了，是不是就是冠心病？”这是一个典型误区，其实，要诊断冠心病，并不完全看心脏上的血管堵塞了多少，而是看是否造成了心肌缺血或者心肌坏死。

心脏上的动脉血管叫冠状动脉。研究发现，有些人虽然有冠状动脉堵塞，但是一点症状也没有，心电图也没有心肌缺血的表现，诊断冠心病的检查（比如运动试验）也是正常的，这种情况即使血管有堵塞，我们也不诊断冠心病，而叫冠状动脉粥样硬化症。

冠心病的全称叫“冠状动脉粥样硬化性心脏病”。从冠状动脉粥样硬化，到冠心病，中间的区别就是这种堵塞是否导致了心脏病。有心肌缺血或者心肌坏死了，就叫有了冠心病。

为什么这么讲？因为动脉粥样硬化是一种老年病，如果从大街上随便抽样50个80岁的老人，给他们做造影，会发现50%的人有冠状动脉的堵塞，这些人都需要做支架吗？没有必要。

那么。如何确定有心肌缺血？这个需要看症状，如果是典型的心绞痛症状，或者明确的缺血证据，包括有心电图、运动试验或者心肌核素等检查可以确定。现在做造影时用一些高级的检查，也可知道有无问题。

如何确定有心肌坏死？这个也可以根据症状，通过心电图、心脏超声、抽血化验检查心肌坏死的迹象等来判断。不过冠脉造影或者冠脉ＣＴ发现的血管堵塞只是影像学检查，不能判断堵塞造成的影响。有些冠心病，血管根本没堵塞，是血管痉挛造成的，或者小血管病变，冠脉造影就看不出来，也是冠心病，因人而异，所以说，并不是血管堵了就是冠心病，要区分清楚。

最后祝大家生活愉快，身体健康！想了解更多冠心病科普小知识，请关注我们，咱们下期见。

【英文版】

Criteria of coronary artery occlusion for diagnosis of coronary heart disease

Dear friends, nice to meet you!Now it is time for “Health talk for three minutes every day”,My name is Li Jianian, I’m from Daojian Doctor Group of Cardiovascular Rehabilitation and Henan Zhonghui Cardiovascular Hospital.Today we'll learn some knowledge about coronary heart disease.

In daily life, people often ask: "my heart blood vessel is blocked, is it coronary heart disease?" This is a typical misunderstanding.In fact, to diagnose coronary heart disease,it is not entirely to see how much blood vessels on the heart are blocked, but whether it causes myocardial ischemia or myocardial necrosis.

The heart has an artery called the coronary artery.Studies have found that although some people have coronary artery occlusion, but no symptoms, ECG has no myocardial ischemia performance,the diagnosis of coronary heart disease (such as exercise test) is normal, in this case, even if the blood vessel is blocked,we do not diagnose it as coronary heart disease, but as coronary atherosclerosis. The full name of coronary heart disease is "coronary atherosclerotic heart disease".The difference between coronary atherosclerosis and coronary heart disease lies in whether this vascular blockage leads to myocardial ischemia or myocardial necrosis.If so, it is called coronary heart disease.

The reason for the above is that atherosclerosis is a kind of senile disease. If you randomly select 50 people aged 80 from the street and give them angiography, 50% of them will find that their coronary arteries are blocked. Do these people need stents? The answer is no need. So how to determine if there is myocardial ischemia? This depends on the symptoms. If the patient has typical angina symptoms or clear evidence of ischemia, including ECG, exercise test or myocardial radionuclide, it can be determined that the patient has coronary heart disease.Now there are also advanced examinations, such as angiography, to know whether the patient has cardiovascular problems.

How to determine the presence of myocardial necrosis? This can be judged by symptoms, as well as ECG, cardiac ultrasound, blood sampling and other tests. However, the occlusion found by coronary angiography or coronary CT is only imaging examination, which can not judge the influence caused by the blockage. There is an alternative, the coronary heart disease is caused by vasospasm or small vascular lesions rather than vascular blockage,so coronary angiography shows no abnormality. Therefore, the diagnosis of coronary heart disease varies from person to person, the vascular blockage is different from coronary heart disease, thus it is necessary to distinguish between them.

Finally, I wish you all a happy life and good health!To learn more about coronary heart disease, please pay attention to us. See you next time.