2016年 · 第44卷第07期

Everyone knows that smoking is harmful to health. In recent years, the incidence of myocardial infarction is getting younger and younger, and the primary risk factor is smoking. As a cardiovascular doctor, the reason why I have been actively involved in tobacco control in recent years is that I deeply feel that preventing diseases is fundamental and more important.

Cardiologists often encounter patients with so-called "atypical chest pain" in their work. How to more accurately judge the nature of patients' chest pain and reduce unnecessary diagnosis and treatment processes and expenses is of great significance in improving doctors' diagnosis and treatment level, improving patient satisfaction and reducing medical contradictions. According to statistics, among the patients who see a doctor for chest pain, the proportion of patients with angina pectoris caused by myocardial ischemia only accounts for about 20%. When judging whether the discomfort or pain in the chest area is coronary heart disease, as a cardiologist, you should broaden your thinking and pay attention to chest pain caused by other diseases. Especially when there is no obvious stenosis on coronary angiography admitted to the hospital with chest pain, how to analyze the cause of chest pain is a problem before cardiologists.

A 46-year-old male was admitted to hospital for more than 1 year due to repeated exertion chest tightness and discomfort, which was aggravated for 1 month. Twenty years ago, I had repeated skin petechiae and ecchymosis after collision, which lasted for more than 10 days each time to recover, and was diagnosed as "hemophilia A" after examination. No history of hypertension, diabetes, and long-term smoking history. Physical health at ordinary times. In the past 1 year or so, I have chest tightness and asthma during activities, which improve after a few minutes of rest every time, and there is no obvious chest pain. In the past month, the above symptoms have aggravated. CT angiography of coronary arteries in other hospitals showed severe lesions in the proximal circumflex artery. Considering that he had hemophilia and high risk of bleeding, he was not treated with nitrates, beta blockers and statins. However, the above symptoms still recurred and progressively aggravated. He visited our hospital on February 19, 2014, and was admitted to "coronary heart disease, acute coronary syndrome (ACS) and hemophilia A". Physical examination after admission: blood pressure: 122/67 mmHg (1 mmHg =0.133 kPa), heart rate 70 beats/min, normal cardiopulmonary auscultation, no petechia and ecchymosis on skin and mucosa. Sinus rhythm on resting electrocardiogram. Cardiac ultrasound showed the upper limit of left ventricular wall thickness, reduced left ventricular diastolic function and left ventricular ejection fraction of 70%. High sensitivity troponin I 0.042 μ g/L (normal value<0.03 μ g/L), creatine kinase isoenzyme (CK-MB) was normal. Blood routine, blood lipids, blood sugar, liver and kidney function and other indexes were normal. The measured factor VIII inhibitor was 0 U and the factor VIII activity was 5.0%.

A 48-year-old male was admitted to the hospital on 10 November 2014 due to "chest pain after activity for 3 months". The patient developed post-activity chest pain 3 months ago, lasting approximately 4 min each time, which was relieved after rest without radiating pain. He was diagnosed with coronary heart disease in a local hospital, but his condition did not improve after symptomatic treatment. Physical examination: blood pressure 120/80 mmHg (1 mmHg =0.133 kPa); The breathing sounds of both lungs were clear, and there were no dry and wet rales; The heart boundary was not enlarged, the heart rate was 80 beats/min, the rhythm was uniform, and no murmur was heard in the auscultation area of each valve; Soft abdomen, no tenderness, no palpation under the right rib of liver and spleen; There was no edema in both lower limbs. Laboratory tests: Blood routine, electrolytes, troponin I and liver and kidney function were normal. Echocardiography showed normal atrioventricular diameters and left ventricular ejection fraction of 58%. Admission diagnosis: chest pain to be examined, coronary heart disease?

A 34-year-old male was admitted to the hospital on 19 February 2015 due to "intermittent chest pain for 2 years and recurrence with fatigue for 4 months". The patient had a sudden retrosternal crushing pain at night in January 2013, radiating to the left upper limb, accompanied by sweating and palpitations, and the symptoms lasted for 4 hours without relief. He went to the emergency department of our hospital and was diagnosed as "acute ST segment elevation inferior wall, posterior wall and right ventricular myocardial infarction", and performed direct percutaneous coronary intervention. Intraoperative angiography revealed thrombotic occlusion of the middle right coronary artery. After thrombus aspiration, two 4.0 mm ×38 mm Promus-Element-Plus stents (Boston Scientific, USA) were placed in the right coronary artery. After surgery, he took aspirin (100 mg once a night), clopidogrel (75 mg once a day), rosuvastatin calcium (10 mg once a night) and perindopril (2 mg once a day) for 1 year, and then stopped taking all drugs on his own. Four months ago, the patient repeatedly experienced precordial pain during heavy physical work, without radiation pain, which resolved spontaneously after about 5 min of rest, and had asymptomatic attacks at rest or at night. Previous history of duodenal bulb ulcer. Has undergone surgery for left lower limb trauma. Smoked cigarettes for 10 years, averaging 20 cigarettes per day.

Acute myocardial infarction (AMI) has a high mortality and complication rate, which is a major public health problem worldwide. Persistent coronary artery occlusion for more than 40 min can cause irreversible myocardial damage. Although timely reperfusion therapy is beneficial to salvage ischemic myocardium, revascularization may lead to microvascular damage and further myocardial necrosis by triggering ischemia-reperfusion injury of the myocardium^[1]。 Microvascular injury mainly includes microvascular obstruction, and microvascular obstruction combined with myocardial hemorrhage. Myocardial hemorrhage is currently considered to be a more serious manifestation of microvascular obstruction. Myocardial hemorrhage is mostly accompanied by microvascular obstruction.

percutaneous pulmonary valve implantation (PPVI) is the earliest percutaneous valve replacement technique used in clinic. It is mainly used to treat patients with pulmonary regurgitation (PR) after surgical correction of tetralogy of Fallot (TOF)^[1]。 However, in China, PPVI was developed late^[2]Only a few hospitals can carry out this technology. Moreover, there is still a lack of relevant guidelines or consensus on PPVI indications and operation timing in China. This paper discusses the indication and operation opportunity of PPVI based on the latest progress in PPVI research.

aortic dissection (AD) refers to the tear of the intima of the aortic wall caused by various reasons. Circulating blood enters the middle layer of the aortic wall through the intima rupture, resulting in extensive tearing and dissection of the middle layer. AD is a cardiovascular emergency commonly characterized by severe pain, shock, and compression. Without proper and timely treatment, the possibility of AD rupture is high and the mortality rate is very high. The pathogenesis of AD is not fully understood at present. This article summarizes the latest research on its pathogenesis in order to improve the understanding of this disease.