The drug of choice for stable angina

To treat a common heart disease like angina pectoris, you need to take the medicine correctly. You need to take the medicine according to the doctor's instructions and pay attention to the symptoms of angina pectoris, so that you can relieve the symptoms of angina pectoris. If patients want to stabilize the symptoms of angina pectoris, it is best to use nitrates or nitroglycerin for continuous treatment to prevent patients from experiencing breathing difficulties.

Treatment has two main purposes: one is to prevent myocardial infarction and sudden death and improve prognosis; the other is to alleviate symptoms and ischemic attacks and improve the quality of life.

1. Generally, patients should rest immediately when an attack occurs. Generally, the symptoms will disappear after the patient stops the activity. In normal times, you should try to avoid various known triggering factors, such as excessive physical activity, emotional excitement, and overeating, and keep warm in winter. Adjust your diet, especially do not eat too much at one time, avoid greasy food, and abstain from smoking and drinking. Adjust daily life and workload; reduce mental burden; maintain appropriate physical activity to avoid pain symptoms; treat related diseases such as hypertension, diabetes, anemia, hyperthyroidism, etc.

2. Drug treatment The first consideration of drug treatment is to prevent myocardial infarction and death, followed by relieving symptoms, reducing ischemia and improving quality of life.

(1) Anti-angina and anti-ischemic treatment

1) Nitrates

①Nitroglycerin .

②Isosorbide dinitrate.

③ 5-Isosorbide mononitrate.

2) β-adrenergic receptor blockers This drug is often used in combination with nitrate preparations, and its effect is better than using it alone. But be careful:

① This drug has a synergistic effect with nitrate preparations, so the dosage should be small, and the initial dose should be especially reduced to avoid causing side effects such as orthostatic hypotension;

②When discontinuing the drug, the dosage should be gradually reduced. If it is discontinued suddenly, it may induce myocardial infarction;

③ It is not recommended for patients with bronchial asthma, bradycardia, or high-degree atrioventricular block;

④Most patients in China are sensitive to this drug and may not be able to tolerate large doses.

3) Calcium ion antagonists: This class of drugs inhibits the entry of calcium ions into the myocardium and also inhibits the role of calcium ions in the excitation-contraction coupling of myocardial cells. It inhibits myocardial contraction and reduces myocardial oxygen consumption; dilates coronary arteries, relieves coronary artery spasm, and improves blood supply to the subendocardial myocardium; dilates peripheral blood vessels, lowers arterial pressure, and reduces cardiac load; it also lowers blood viscosity, resists platelet aggregation, and improves myocardial microcirculation. Commonly used preparations include:

①Dihydropyridines .

②Verapamil .

③Diltiazem .

(2) Drug therapy to prevent myocardial infarction and death

1) Antiplatelet therapy

①Aspirin .

②Adenosine diphosphate (ADP) receptor antagonist.

③ Other antiplatelet agents.

2) Lipid-lowering drugs

3) Angiotensin-converting enzyme inhibitors (ACEI)

3. Percutaneous coronary intervention Percutaneous coronary intervention (PCI) refers to a group of percutaneous interventional techniques, including percutaneous balloon coronary angioplasty (PTCA), coronary artery stent implantation and atherosclerotic plaque ablation technology.

4. Coronary artery bypass surgery Coronary artery bypass surgery (CABG) uses the patient's own great saphenous vein, free internal mammary artery or radial artery as bypass graft material, one end of which is anastomosed to the aorta and the other end to the distal end of the diseased coronary artery segment; blood flow from the aorta is diverted to improve the blood supply to the myocardium supplied by the coronary artery. Selective coronary angiography is performed before surgery to understand the extent and range of coronary artery lesions for reference in formulating surgical plans (including determining the number of blood vessels to be transplanted). This operation has become the most common elective cardiac surgery in countries with a high incidence of coronary heart disease, and is very effective in relieving angina pectoris. Recent minimally invasive coronary artery bypass surgery, performed while the heart is beating, has fewer complications and faster patient recovery. Indications for surgery:

① Multivessel coronary artery disease, especially in patients with diabetes;

②Left main coronary artery disease;

③ Patients who are not suitable for interventional treatment;

④ Patients with ventricular aneurysm after myocardial infarction who need ventricular aneurysm resection;

⑤ The lumen of the distal segment of the occluded segment is unobstructed and there is viable myocardium in the vascular supply area.

5. Exercise therapy: Carefully arrange the progress of appropriate exercise to help promote the development of collateral circulation, increase the tolerance of physical activity and improve symptoms.