Uncle Liu is 73 years old this year. For the past six months, he has always felt stuffy in his chest, which can be relieved a little after he breathes out . So my son took him to the hospital to see a doctor.
Uncle Liu's son said: "Usually, there are always quick-acting heart-relief pills at home. Whenever my father feels uncomfortable, he will let him take a few pills, and it will take a long time to recover. However, the symptoms are not cured . If you do n't feel well , doctor, we brought the previous examination records, you can see what is going on?
Listening to the description of the patient's family, coupled with the analysis of the electrocardiogram and dynamic electrocardiogram that Mr. Liu had done before, I suspected coronary heart disease, so I suggested coronary angiography for further confirmation. When Uncle Liu heard it, he directly refused. He said, "It is said that after coronary angiography, the patient will not live long, but I dare not do it."
I explained patiently: "You are too old, and angiography does have certain risks, but as far as your current situation is concerned, only angiography can more accurately judge your condition. We will evaluate your situation and do a good job in Emergency measures to reduce the risk, and then perform an imaging examination.”
Later, after careful evaluation with the interventional treatment team of the Cardiology Department and various emergency measures, we completed coronary angiography for the elderly. The results showed that it was indeed coronary heart disease, and the coronary vessels had stenosis, but the blood flow was not significantly affected, so no treatment such as stent implantation was performed. After appropriate drug treatment, the elderly's condition improved significantly.
Seeing this, everyone must be amazed at the magical effect of coronary angiography. Now I will introduce coronary angiography in detail. And I will explain to you why there are rumors that coronary angiography is done and the patient will not live long.
What is the principle of coronary angiography?
Coronary angiography and coronary heart disease are inseparable , so it is necessary to understand coronary heart disease before understanding the principle of coronary angiography.
Coronary heart disease is referred to as coronary heart disease. The pathogenesis is that coronary atherosclerosis narrows or blocks the lumen, leading to myocardial ischemia and hypoxia, thereby causing coronary atherosclerotic heart disease and coronary heart disease. . Studies have shown that the older the age, the higher the incidence of coronary heart disease. 35-64 years old is the high incidence period of coronary heart disease. In the past 35 years, the incidence and mortality of coronary heart disease in my country have increased rapidly.
The main clinical manifestation of coronary heart disease is chest pain , and the typical symptom is angina pectoris , which is characterized by paroxysmal squeezing or suffocating pain in the chest. The outer side of the right arm and both arms, or the neck and jaw, for a few minutes, with some relief after proper rest.
Coronary angiography is a minimally invasive interventional examination. Through coronary angiography, it is possible to detect whether there is stenosis in the coronary artery and the stenosis , and then according to the actual situation, targeted treatment of the stenosis is carried out. It can be said that coronary angiography is the gold standard for diagnosing coronary heart disease!
With the improvement of the level of science and technology, people's daily life level and cognitive level of medical knowledge are gradually improved, coronary angiography has been known to more and more people. Compared with cardiovascular and cerebrovascular CT images, dynamic detection electrocardiograms, etc., coronary angiography is more convincing in judging the disease.
For patients with chest pain, especially those with coronary heart disease risk factors such as hypertension, hyperlipidemia, diabetes, etc., coronary angiography is more inclined.
In coronary angiography, the patient first needs to lie supine on the operating bed of the catheterization room. Most of the patients choose the right radial artery as the puncture point. After local anesthesia, the radial artery is punctured, and a very thin catheter is inserted through the entrance of the radial artery. Go to the root of the aorta, find the opening of the coronary artery, inject the contrast agent into the coronary artery through the catheter, and see whether the coronary artery is narrowed or blocked under the X-ray.
During the examination, the patient was fully conscious (except for those who were unconscious before surgery), and the pain was mild. Pain usually occurs when local anesthetics are injected, and the operation of catheters in blood vessels generally does not cause discomfort.
As the number of patients suffering from coronary heart disease increases year by year, improving the accuracy of coronary heart disease diagnosis has become a very important prerequisite for coronary heart disease treatment. At present, coronary angiography has been widely used in the diagnosis and treatment of coronary heart disease. Although it can significantly improve the accuracy of the diagnostic results, there will also be some adverse reactions, which will endanger the life and health of patients to a certain extent.
After coronary angiography, the patient will live soon?
At the beginning of the article, it was mentioned that Uncle Liu refused to do coronary angiography because he believed that he would not live long after coronary angiography. In fact, this statement is too exaggerated, but it is undeniable that coronary angiography does have some harm, but it can be avoided if you pay attention.
1. Allergies
Non-ionic contrast agent is a commonly used contrast agent in coronary angiography. Studies have shown that non-ionic contrast agent is used more and more widely in the diagnosis of coronary heart disease, but the incidence of allergic reactions caused by it is gradually increasing. Increase.
The reason why allergic reactions occur is mainly because as the patient ages, the patient's ability to resist allergic substances becomes weaker and weaker , and it is easy to cause adverse reactions. In addition, due to the long duration of coronary angiography , it is easier to aggravate the patient's anxiety, resulting in abnormally elevated levels of adrenaline and allergic reactions.
When a patient has an allergic reaction, it is often accompanied by redness, swelling and itching on the skin surface, and a rash may occur . Different patients may have different allergic reactions. Once these problems are discovered, it is necessary to respond in time to avoid causing greater damage to the body.
2. Kidney disease
In recent years, with the wide application of coronary diagnosis and treatment technology, the use of contrast agents has been increasing. Iodine contrast agent is a very common contrast agent. The contrast agent is very viscous and excreted through the kidneys, which will increase the burden on the kidneys. For patients with abnormal basic renal function itself, coronary angiography may lead to contrast agent nephropathy.
Contrast-induced nephropathy refers to an increase in serum creatinine of 44.2 μmol/L within 48-72 hours after the use of contrast media, or an increase in serum creatinine greater than 25% from the baseline after excluding other renal damage factors. Studies have shown that contrast-induced nephropathy has become one of the main causes of current acquired acute renal failure, and the incidence in patients with coronary heart disease is 10%-15%.
Contrast agents have direct cytotoxic effects on vascular endothelial cells and renal tubular epithelial cells, resulting in decreased glomerular filtration rate and renal (especially medulla) ischemia. In addition, contrast media causes osmotic diuresis, increases fluid excretion, increases renal tubular reabsorption (increased reabsorption of the ascending branch of the loop), and therefore increases oxygen consumption, which results in increased ischemia and hypoxia in the medulla.
If there is an increase in urine after coronary angiography, more foam in the urine, weakness and other symptoms, it is necessary to check the liver function in time to eliminate hidden dangers.
3. Inflammation at the puncture site
An essential step in coronary angiography is vascular puncture, which is a strong test for the professionalism of medical staff. Some patients are born with thin blood vessels, or because of the thick subcutaneous fat, the blood vessels are not easy to be found, and the puncture failure is likely to occur. Improper operation during this process can cause inflammation at the puncture site.
Once inflammation is induced, symptoms such as bleeding, redness, and pain at the puncture site usually occur . Therefore, postoperative care is very important. It is recommended that patients pay more attention to their physical conditions after surgery. If they have symptoms of discomfort, they should also report to the medical staff in time.
4. Contrast media extravasation
In coronary angiography, a large amount of contrast agent is used, and there is usually a small amount of extravasation of the contrast agent. The contact of the contrast agent with the skin may cause allergic dermatitis . In this case, the doctor will deal with it in time, and the patient does not need to overdo it. Worry.
However, there are also special circumstances, such as improper operation by the doctor or abnormality of the patient's own body, which will lead to a large amount of contrast medium extravasation rate, causing pain and swelling in the patient's body. tissue necrosis.
Therefore, the use of contrast media is very important in coronary angiography , and medical staff should also strengthen the study of professional knowledge, improve the level of operation skills, and avoid causing harm to patients.
For the above hazards, people may be a little "intimidated" by coronary angiography. In fact, through scientific and effective methods, these potential hazards can be mitigated or avoided.
Doctor's Tip: To reduce the harm of coronary angiography, do the following
First of all, there must be effective communication before surgery. Treat patients with enthusiasm, patience and love for medical staff, so that patients feel valued and paid attention to, and initially reduce the patient's tactile feeling. degree.
Medical staff should understand the patient's past medical history, allergy history, etc., and conduct targeted psychological counseling to keep the patient's emotional state stable, so as to ensure that the patient's physiological state is stable during the examination process, so as to its physiological tolerance and overall physiological state. Stability will be improved and the incidence of intraoperative complications will be reduced.
Second, strengthen postoperative care. The contrast agent has a certain effect on the patient's nervous system, and the patient is prone to panic after surgery. Therefore, nurses should pay attention to the care of patients, inform patients of the knowledge of allergic reactions, and guide patients to do effective psychological adjustment.
At the same time, postoperative nurses should strengthen the observation of the patient's skin color to observe whether the patient has a rash . And patiently listen to the patient's complaints, once the patient's skin is itchy, should immediately report to the attending physician and take active measures.
Finally, risk-averse patients. Patients with underlying renal insufficiency, acute exacerbation of heart failure, patients who cannot lie supine, and patients whose mental illness has not been effectively controlled should be cautious. However, if the above-mentioned patients suffer from severe acute myocardial infarction, not immediately performing coronary angiography and implanting stents will put the patient's life at risk. At this time, the attending physician should comprehensively evaluate the patient's situation, weigh the pros and cons, and make the most beneficial decision for the patient. s Choice.
Summarize
Coronary heart disease is a high-incidence disease among middle-aged and elderly people in my country, and its morbidity and mortality have been increasing in recent years, so everyone should pay attention. Coronary heart disease and coronary angiography are inseparable. Coronary angiography can detect whether there is stenosis in the coronary arteries and the situation of stenosis, which is helpful for doctors to make further judgments on the condition.
Although coronary angiography has certain harms to the health of patients, for example, it may cause kidney disease, cardiovascular and cerebrovascular diseases, allergic reactions, local inflammation, etc., but it can be effectively alleviated as long as you pay attention. This requires medical staff to effectively improve their professional level, strengthen communication with patients, popularize basic medical knowledge, strengthen postoperative care, and escort the life safety of patients.
References:
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[2] Chen Congying. Nursing intervention of coronary angiography in elderly patients with coronary heart disease [J]. Primary Medicine Forum, 2007(06):245-246.
[3] Wang Yanli, Zhao Hongye. The role of the combination of coronary angiography and electrocardiography in the teaching of coronary heart disease [J]. Jilin Medicine, 2010,31(14):2130-2131.
[4] Xu Yali, Zhang Hongge, Pu Yun. Nursing experience of coronary angiography in patients with diabetes and coronary heart disease [J]. Journal of Henan Staff Medical College, 2010, 22(04): 499-500.
