冠状动脉疾病 - 症状与病因 - 妙佑医疗国际

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冠状动脉疾病

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概述

当向心脏供血的主要血管受损或发生病变时，就会出现冠状动脉疾病。冠状动脉疾病通常可以归咎于冠状动脉中含有胆固醇的沉积物（斑块）和炎症。冠状动脉给心脏供应血液、氧气和营养物质。斑块的堆积会令使这些动脉狭窄，减少到达心脏的血流量。最终，血流量减少可能会导致胸部疼痛（心绞痛）、呼吸短促或其他冠状动脉疾病的体征和症状。冠状动脉完全阻塞可能导致心脏病发作。由于冠状动脉疾病往往历经数十年形成，因此直到您出现明显的动脉堵塞或出现心脏病发作，才可能注意到有问题。但您可以采取措施预防和治疗冠状动脉疾病。健康的生活方式可能有很大作用。

What is coronary artery disease A Mayo Clinic cardiologist explains

Stephen Kopecky, M.D., talks about the risk factors, symptoms and treatment of coronary artery disease (CAD). Learn how lifestyle changes can lower your risk. 请参见副本供视频使用 What is coronary artery disease A Mayo Clinic cardiologist explains {Music playing} Stephen Kopecky, M.D., Cardiovascular Disease, Mayo Clinic: I'm Dr. Stephen Kopecky, a cardiologist at Mayo Clinic. In this video, we'll cover the basics of coronary artery disease. What is it? Who gets it The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Coronary artery disease, also called CAD, is a condition that affects your heart. It is the most common heart disease in the United States. CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Cholesterol deposits, or plaques, are almost always to blame. These buildups narrow your arteries, decreasing blood flow to your heart. This can cause chest pain, shortness of breath or even a heart attack. CAD typically takes a long time to develop. So often, patients don't know that they have it until there's a problem. But there are ways to prevent coronary artery disease, and ways to know if you're at risk and ways to treat it.

Who gets it

Anyone can develop CAD. It begins when fats, cholesterols and other substances gather along the walls of your arteries. This process is called atherosclerosis. It's typically no cause for concern. However, too much buildup can lead to a blockage, obstructing blood flow. There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease. First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup. Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you're at a greater risk. All these factors together can paint a picture of your risk for developing CAD.

What are the symptoms

When coronary arteries become narrow, the heart doesn't get enough oxygen-rich blood. Remember, unlike most pumps, the heart has to pump its own energy supply. It's working harder with less. And you may begin to notice these signs and symptoms of pressure or tightness in your chest. This pain is called angina. It may feel like somebody is standing on your chest. When your heart can't pump enough blood to meet your body's needs, you might develop shortness of breath or extreme fatigue during activities. And if an artery becomes totally blocked, it leads to a heart attack. Classic signs and symptoms of a heart attack include crushing, substernal chest pain, pain in your shoulders or arms, shortness of breath, and sweating. However, many heart attacks have minimal or no symptoms and are found later during routine testing.

How is it diagnosed

Diagnosing CAD starts by talking to your doctor. They'll be able to look at your medical history, do a physical exam and order routine blood work. Depending on that, they may suggest one or more of the following tests: an electrocardiogram or ECG, an echocardiogram or soundwave test of the heart, stress test, cardiac catheterization and angiogram, or a cardiac CT scan.

How is it treated

Treating coronary artery disease usually means making changes to your lifestyle. This might be eating healthier foods, exercising regularly, losing excess weight, reducing stress or quitting smoking. The good news is these changes can do a lot to improve your outlook. Living a healthier life translates to having healthier arteries. When necessary, treatment could involve drugs like aspirin, cholesterol-modifying medications, beta-blockers, or certain medical procedures like angioplasty or coronary artery bypass surgery.

What now

Discovering you have coronary artery disease can be overwhelming. But be encouraged. There are things you can do to manage and live with this condition. Reducing cholesterol, lowering blood pressure, quitting tobacco, eating healthier, exercising and managing your stress can make a world of difference. Better heart health starts by educating yourself. So don't be afraid to seek out information and ask your doctors about coronary artery disease. If you'd like to learn even more about this condition, watch our other related videos or visit Mayoclinic.org. We wish you well.

症状

如果冠状动脉变窄，它们将无法为您的心脏输送充足的富氧血液，尤其是当心脏快速跳动时，例如在锻炼期间。起初，血流减少可能不会引起任何症状。不过，随着斑块在冠状动脉中不断堆积，您可能会出现冠状动脉疾病的以下体征和症状：胸部疼痛（心绞痛）。您的胸部可能产生压迫感或紧绷感，就好像有人站在您的胸口上。这种被称为心绞痛的疼痛通常出现在胸部的中间或左侧。心绞痛通常由身体压力或情绪压力引起。疼痛通常在停止压力性活动后的几分钟内消失。对于某些人，尤其是女性，这种疼痛可能非常短暂或剧烈，并出现在颈部、手臂或背部。气短。当心脏不能泵出足够血液来满足身体的需要时，您可能气短或者在活动时感到极度疲劳。心脏病发作。冠状动脉完全堵塞可导致心脏病发作。心脏病发作的典型体征和症状包括胸部承受极大的压力、肩部或手臂疼痛，有时还伴有气短和出汗。与男性相比，女性更容易出现不太典型的心脏病发作体征和症状，例如颈部或颚部疼痛。她们还可能出现其他症状，例如气短、疲劳和恶心。当心脏病发作时，有时不会出现任何明显的体征或症状。

何时就诊

如果认为自己出现心脏病发作，请立即拨打 911 或当地的急救电话。如果无法获得紧急医疗服务，让人开车送您去最近的医院。只有在万不得已的情况下，才可自己驾车前往。如果您有冠状动脉疾病的风险因素，如高血压、高胆固醇、吸烟、糖尿病、肥胖症以及严重的心脏病家族史，请告诉医生。医生可能会检查您是否患有冠状动脉疾病，特别是当您有动脉狭窄的症状或体征时。申请 Mayo Clinic 预约

病因

动脉粥样硬化的发展打开弹出式对话框关闭

动脉粥样硬化的发展

如果血液中的胆固醇颗粒过多，胆固醇可能会聚集在动脉壁上。最终，可能形成称为斑块的沉积物。这些沉积物可能会导致动脉狭窄或阻塞。这些斑块也可能会破裂，导致形成血凝块。冠状动脉疾病被认为开始于冠状动脉内层的损害或损伤，有时早在儿童时期就会发生。损害可能由各种因素造成，包括：抽烟高血压高胆固醇糖尿病或胰岛素抵抗不活动（久坐的生活方式）一旦动脉内壁受损，由胆固醇和其他细胞废物组成的脂肪沉积物（斑块）就会积聚在损伤部位。这一过程称为动脉粥样硬化。如果斑块表面破裂，被称为血小板的血细胞就会在该部位积聚，试图修复动脉。这种团块会阻塞动脉，导致心脏病发作。

风险因素

冠状动脉疾病的风险因素包括：年龄。年龄的增长会增加动脉损伤和狭窄的风险。性别。一般情况下，男性冠状动脉疾病的患病风险更大。但女性在绝经后的患病风险会增加。家族史。有心脏病家族史的人罹患冠状动脉疾病的风险较高，尤其是近亲在年轻时患心脏病的人。如果您的父亲或兄弟在 55 岁之前或者您的母亲或姐妹在 65 岁之前被诊断出患有心脏病，那么您的患病风险是极高的。抽烟。吸烟者患心脏病的风险会显著增加。吸入二手烟也会增加冠状动脉疾病的患病风险。高血压。未经控制的高血压可导致动脉硬化和增厚，从而使血液流动的通道变窄。高血胆固醇水平。血液中的高胆固醇水平可增加形成凝块和动脉粥样硬化的风险。高胆固醇是由高水平的低密度脂蛋白（LDL）胆固醇，即所谓的“有害”胆固醇引起的。低水平的高密度脂蛋白（HDL）胆固醇，也被称为“有益”胆固醇，也会促进动脉粥样硬化的发展。糖尿病。糖尿病与冠状动脉疾病的风险增加有关。2 型糖尿病与冠状动脉疾病都有类似的风险因素，例如肥胖症和高血压。超重或肥胖症。体重超重通常会加剧其它风险因素。体育活动。缺乏运动也与冠状动脉疾病和某些其它风险因素有关。压力大。生活中未得到缓解的压力可能损伤您的动脉，并加剧冠状动脉疾病的风险因素。不健康的饮食。摄入过多含有大量饱和脂肪、反式脂肪、盐和糖份的食物会增加冠状动脉疾病的患病风险。风险因素经常同时发生，并且一个因素可能引发另一个。例如，肥胖症可能引发 2 型糖尿病和高血压。如果多种风险因素一起出现，某些因素将使您更易患上冠状动脉疾病。例如，代谢综合征（包括高血压、高甘油三酯、HDL也就是“好”胆固醇的含量低、高胰岛素水平和腰部脂肪过多在内的一系列症状）会增加冠状动脉疾病的患病风险。有时冠状动脉疾病的发生没有任何典型的风险因素。研究人员正在研究其他可能的风险因素，包括: 睡眠呼吸暂停。这种紊乱会导致您在睡眠时反复停止并开始呼吸。睡眠呼吸暂停期间，血氧水平的突然下降会导致血压升高，增加心血管系统负荷，很可能导致冠状动脉疾病。超敏 C 反应蛋白（hs-CRP）。当您的身体某处出现炎症时，这种蛋白的含量会高于正常水平。高 hs-CRP 水平可能是心脏病的一大风险因素。人们认为，随着冠状动脉逐渐变窄，您的血液中会含有更多的 hs-CRP。高甘油三酯。这是存在于您血液中的一种脂肪（脂类）。高水平的甘油三酯可能会增加患冠状动脉疾病的风险，尤其是对女性而言。同型半胱氨酸。同型半胱氨酸是一种人体用于产生蛋白并建立和维持组织的氨基酸。但是高水平的同型半胱氨酸可能会增加您患冠状动脉疾病的风险。子痫前期。这种病症会在怀孕期间发生，导致高血压和尿蛋白含量较高。它会导致年龄较大时患心脏病的风险增加。酗酒。过量饮酒会导致心肌损伤。此外，还会加剧冠状动脉疾病的其他风险因素。自身免疫病。类风湿关节炎和狼疮（以及其他炎症）的患者有更高的动脉粥样硬化患病风险。

并发症

冠状动脉疾病可导致：胸部疼痛（心绞痛）。当您的冠状动脉狭窄时，您的心脏在需求量最大时（尤其是在身体活动期间）可能得不到足够的血液。这可能导致胸部疼痛（心绞痛）或呼吸急促。心脏病发作。如果胆固醇斑块破裂并形成血块，心脏动脉完全堵塞可能会引发心脏病发作。心脏血流不足可能会损害心肌。损伤的程度在一定程度上取决于能否及时接受治疗。心力衰竭。如果由于血流减少而使心脏的某些区域长期缺乏氧气和营养，或者如果心脏因心脏病发作而受损，则心脏可能变得虚弱而无法泵出足够的血液来满足身体的需求。这种疾病称为心力衰竭。心律异常（心律不齐）。心脏供血不足或心脏组织受损会干扰心脏的电脉冲，导致心律异常。

预防

用于辅助治疗冠状动脉疾病的生活方式习惯也同样适用。健康的生活方式可帮助您保持动脉强劲并清除凝块。为了改善您的心脏健康，请遵循以下建议：戒烟。控制高血压、高胆固醇和糖尿病等病症。保持身体活跃。摄入低脂、少盐的饮食，多吃水果、蔬菜和全谷类食物。保持健康体重。减少和管理压力。

来自妙佑医疗国际员工在 Mayo Clinic 治疗申请 Mayo Clinic 预约诊断与治疗 June 05, 2020 打印 Share on: FacebookTwitterWeChat

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