Keywords: diagnosis of coronary artery disease
With the rapid development of modern science and technology and medical researchers of coronary heart disease in-depth study and exploration, the diagnosis of coronary heart disease is improving. The earliest major is based on the typical clinical presentation (signs and symptoms), serum creatine kinase examination and ECG characteristics to diagnose myocardial infarction, coronary heart disease and coronary insufficiency. In recent years, the development of many new inspection methods and techniques, such as radionuclide examination, echocardiography Figure coronary angiography, blood pool imaging used in the diagnosis of coronary heart disease.
(1) Clinical manifestations: The main symptoms and signs. The main clinical symptoms of angina is coronary heart disease, angina attack site, nature, incentives, duration, characteristics and associated mitigation methods can identify symptoms and signs of angina and myocardial infarction, we can say, the typical signs and symptoms of crown heart disease angina and myocardial infarction diagnosis is crucial.
(2) ECG: ECG is the oldest, the most commonly used and the most basic diagnostic method in the diagnosis of coronary heart disease. Compared with other diagnostic methods, ECG is easy to use, easy to spread, when the patient’s condition changes can promptly capture changes, and capable of continuous dynamic observation and for a variety of load test, in order to improve the diagnostic sensitivity. Either angina or myocardial infarction, has its typical ECG changes the arrhythmia diagnosis more clinical value, of course, there are some limitations.
(3) ECG stress test: the exercise stress test and drug test (such as dipyridamole, isoprenaline test, etc.). ECG is a simple method for clinical observation of myocardial ischemia most commonly used. When angina attack, the ECG can be recorded ECG abnormalities of myocardial ischemia. However, many patients with coronary heart disease, coronary artery reserve capacity has declined, usually resting state to maintain a normal coronary blood flow and the performance of the patients without myocardial ischemia ECG can be completely normal. Discloses reducing or fixed relative to the blood flow, through the movement or other methods, to the heart load, induced myocardial ischemia, and thus confirm the presence of angina. Exercise test is essential for cardiac function after ischemic arrhythmias and myocardial infarction.
(4) dynamic electrocardiogram: a long time continuous recording and compilation of ECG changes in the method of analysis of cardiac activity and quiet state. This technology is applied in the first instance in 1947 by Holter monitoring electrical activity, so called Holter monitoring. Resting ECG can only record short-term only dozens of cardiac cycle waveform, dynamic electrocardiogram within 24 hours can be recorded continuously up to about 100,000 ECG can improve on the non-persistent ectopic rhythm, especially had arrhythmias and transient myocardial ischemic attack detection rate, expanded the scope of ECG clinical use, and the time with the patient’s activities and corresponding symptoms.
(5) myocardial perfusion imaging: According to history, EKG angina to do this check can not be ruled out. Myocardial perfusion imaging can display the ischemic area, the size of the location and extent of ischemic clear. Exercise test re-imaging, you can improve the detection rate.
(6) coronary angiography: is currently the “gold standard" diagnostic coronary heart disease. Clearly coronary whether narrow, narrow location, extent, scope, and can thus guide further treatment measures to be taken. At the same time, left ventricular angiography, cardiac function evaluation. The main indications for coronary angiography: ① medical treatment under angina is still heavier, clear arterial lesions to consider bypass graft surgery; ② The chest pain similar to angina can not be diagnosed.
(7) ultrasound and intravascular ultrasound: echocardiographic cardiac morphology, wall motion and left ventricular function checks, one of the most commonly used means of checking. Aneurysm, intracardiac thrombosis, cardiac rupture, papillary muscle function have important diagnostic value. Intravascular ultrasound can clear the coronary wall morphology and degree of stenosis, is a promising new technology.
(8) serum creatine kinase checks: It is one of the important means of diagnosis and differential diagnosis of acute myocardial infarction. The clinical sequence variation and specificity of serum enzyme concentration isozymes elevated enzyme changes affirmative can confirm the diagnosis of acute myocardial infarction.
(9) blood pool imaging: dynamic images that can be used for observation ventricular wall contraction and relaxation of important reference value for the determination of wall motion and cardiac function.