The goal of treating ischemic heart disease is to relieve symptoms, improve cardiac function, and reduce the risk of future cardiac events. Treatment strategies typically combine medication, surgical interventions, and lifestyle modifications to achieve long-term disease control. Physicians tailor personalized treatment plans based on the patient's age, severity of the disease course, and comorbidities.
The treatment process emphasizes dual objectives of "preventing recurrence" and "delaying disease progression." For example, medication can provide immediate relief from angina, while interventional procedures can directly open obstructed coronary arteries. Additionally, active patient participation in lifestyle changes, such as smoking cessation and regular exercise, can significantly enhance treatment effectiveness. Most patients require long-term follow-up, including regular electrocardiograms or blood tests to assess treatment response.
Modern medicine offers multi-faceted treatment strategies, mainly divided into three parts: pharmacological control, surgical intervention, and lifestyle adjustments. Medications are categorized into acute symptom relief and chronic disease progression delay. Surgical treatments include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), aimed at restoring myocardial blood flow. Lifestyle modifications form the foundation of treatment and should be implemented alongside medical measures.
Acute phase treatment focuses on dilating coronary arteries and dissolving thrombi. For example, nitroglycerin is used for immediate relief of angina, while antiplatelet drugs like aspirin inhibit thrombus formation during acute myocardial infarction. Chronic treatment emphasizes long-term risk factor control, such as lipid-lowering drugs to slow atherosclerosis progression.
Nitrates (such as nitroglycerin) dilate arteries and reduce myocardial oxygen demand, making them the first-line drugs for acute angina. Beta-blockers (such as metoprolol) lower heart rate and blood pressure, decreasing myocardial oxygen consumption, and also possess anti-arrhythmic properties. Calcium channel blockers (such as amiodarone) are used in specific patients to control vasoconstriction but should be used cautiously in patients with severe heart failure.
Statins (such as atorvastatin, rosuvastatin) are core treatments. Studies show long-term use can reduce low-density lipoprotein cholesterol (LDL-C) by 30-50%, with additional anti-inflammatory and plaque-stabilizing effects. Antiplatelet agents (such as aspirin, clopidogrel) inhibit platelet aggregation, reducing thrombotic risk.
Emerging drugs like PCSK9 inhibitors target patients with refractory hyperlipidemia, capable of lowering LDL-C by over 60%. Diuretics and ACE inhibitors are used in patients with concomitant heart failure to improve cardiac afterload and reduce hospitalization rates.
This procedure involves inserting a catheter to perform balloon angioplasty or place a stent in the obstructed coronary artery. It is minimally invasive, with short operation time, suitable for single-vessel disease or acute myocardial infarction. Modern drug-eluting stents reduce restenosis rates but require dual antiplatelet therapy for at least one year.
Risks include vascular puncture complications or stent thrombosis, but success rates exceed 90%. Complex lesions may require adjunct techniques such as rotational atherectomy or thrombectomy to improve blood flow restoration.
This open-heart surgery is indicated for multi-vessel disease or left main coronary artery disease. Surgeons harvest autologous veins or internal thoracic arteries to bypass obstructed segments and restore blood flow. Long-term studies show better prognosis for patients with poor left ventricular function.
Risks include stroke or renal dysfunction, but five-year survival rates are superior to untreated patients. Complex cases may require extracorporeal circulation support, with close postoperative monitoring of heart rhythm and renal function.
Lifestyle modifications are fundamental, reducing recurrence risk by 40-50%. Smoking cessation can decrease cardiovascular event risk by 50%, as nicotine induces coronary artery constriction. Dietary control should focus on low-fat, high-fiber intake, such as adopting a Mediterranean diet with saturated fat intake below 10% of total calories daily.
Aerobic exercises like jogging or swimming for 150 minutes weekly can enhance cardiac metabolic adaptation. Stress management, including mindfulness meditation, has been shown to lower blood pressure and cortisol levels, recommended for 10-15 minutes daily. Weight management aims to maintain BMI between 22-25, with a 5% weight reduction improving insulin resistance.
Gene therapy is under development, targeting endothelial cell repair or promoting angiogenesis. For example, adenoviral vectors delivering VEGF genes have shown promise in animal studies to improve myocardial blood flow. Stem cell therapy, such as bone marrow mesenchymal stem cell transplantation, can promote myocardial repair but faces technical challenges related to cell survival and differentiation.
Artificial intelligence applications in treatment planning are increasingly common. Machine learning models can accurately predict blockage locations based on coronary angiography and biomarkers. Wearable devices like continuous ECG monitors can detect arrhythmias in real-time and trigger alerts, with future integration into telemedicine platforms.
Seek immediate medical attention if experiencing new chest pain, rest angina, or worsening symptoms. If patients develop shortness of breath, lower limb edema, or unexplained fatigue despite treatment, re-evaluation for heart failure is necessary. Diabetic patients with triple-vessel disease should undergo coronary angiography every six months for monitoring.
In the following situations, seek emergency care within 24 hours:
Doctors decide based on the degree of vessel blockage, symptom severity, and overall health status. Mild blockages without acute symptoms may be managed with antiplatelet drugs or vasodilators; if blockage exceeds 70% or angina or myocardial infarction occurs, procedures like coronary angioplasty or bypass surgery may be necessary. Regular cardiac function assessment is crucial.
Is long-term medication necessary after surgery?Yes, most patients require long-term use of antiplatelet agents, lipid-lowering drugs, or antihypertensives. Surgery relieves the obstruction but does not alter the underlying atherosclerotic process. Regular monitoring of lipids, blood glucose, and blood pressure, along with medication adherence, is vital for disease control.
What dietary principles are most effective in preventing disease progression?A low-salt, low-fat, high-fiber diet is recommended. Increasing intake of whole grains, deep-sea fish, and vegetables rich in phytochemicals, while limiting trans fats and refined sugars, is advised. The Mediterranean diet, rich in Omega-3 and antioxidants, has been shown to significantly reduce secondary event risks.
How does stress management improve the condition?Psychological stress increases adrenaline secretion, leading to faster heart rate and peripheral vasoconstriction, which worsens myocardial oxygen demand. Long-term stress also promotes inflammation and thrombosis, accelerating atherosclerosis. Techniques like mindfulness meditation or cognitive-behavioral therapy can help reduce stress and indirectly lower cardiovascular risk.
How is exercise intensity assessed for patients undergoing cardiac rehabilitation?Rehabilitation specialists evaluate safe exercise ranges through cardiopulmonary testing. Initial exercises typically include walking or aquatic activities, gradually increasing intensity to 60-80% of target heart rate. Exercise plans should be tailored to the patient's medical history and monitored periodically with stress tests to prevent overexertion that could trigger angina.
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