"Heart protecting talisman" from cardiologists
2022-06-13
During the prevention and control of the COVID-19, some patients with cardiovascular diseases may not be able to go to the hospital in time or keep in touch with cardiovascular physicians due to various reasons. In order to prevent the recurrence and aggravation of the disease, the self-management of patients is more important during the epidemic prevention and control period. At present, many data show that people with chronic basic diseases such as cardiovascular disease (CVD) have a higher risk of complications or death if they suffer from COVID-19. How do they take care of themselves in special periods? The reporter interviewed the expert team of cardiovascular medicine in the Third Hospital of Peking University and sorted out the home guide for common heart diseases. About coronary heart disease During the epidemic prevention and control period, can the drugs taken for a long time be reduced or stopped? Experts said that patients with coronary heart disease often need to take a variety of drugs, including anti angina pectoris, lipid regulation, antiplatelet drugs, etc. These are the basic drugs of coronary heart disease, which should be used for a long time, and should not be reduced or stopped due to the epidemic situation or inconvenience. For patients who have undergone stent implantation, the duration of dual antiplatelet therapy recommended in the guidelines is 1 year, but it still needs to be determined individually according to the specific situation of the patient and the location and length of the stent. Therefore, when the patient has been implanted with the stent for 1 year, he must remember to consult the surgeon. During the period of taking antiplatelet drugs, observe whether there is bleeding tendency. If it is gum bleeding, local skin ecchymosis, self-treatment epistaxis, and very small conjunctival bleeding during tooth brushing, observe first; In case of dark stool color, bloody stool, hematuria, hematemesis or intractable epistaxis, seek medical attention immediately, find out the cause of bleeding and adjust the application plan of antiplatelet drugs. Do not stop taking antiplatelet drugs for fear of bleeding, stomach injury or skin ecchymosis. Patients after stenting need to strengthen condition observation and self-management monitoring, and timely identify the danger signals of deterioration of the condition. For example, if chest pain continues to not alleviate after stenting, or chest pain occurs with symptoms such as sweating and syncope, emergency treatment is required as soon as possible. At the same time, blood pressure and heart rate are measured at home. If blood pressure is normal and chest pain persists, nitroglycerin can be taken under the tongue. Wear a mask for personal protection, and carry the medical records (especially the recent ECG) and the drugs taken. About hypertension For patients with hypertension, they need to monitor their blood pressure for a long time, and pay more attention to their own blood pressure during the epidemic prevention and control period. For patients with newly diagnosed or unstable blood pressure, it is recommended that the family self measure their blood pressure for 7 consecutive days, once in the morning and once in the evening every day; After blood pressure is stable, it should also be measured 1-2 times a week. Morning blood pressure should be measured in sitting position after getting up and urinating. It is recommended to use a certified upper arm electronic sphygmomanometer and sit in a chair with a back for 5 minutes. The lower edge of the sphygmomanometer cuff is 2cm away from the cubital fossa. After the cuff is tied, it is appropriate to just insert a finger. Measure blood pressure for 2~3 times, with an interval of 1~2 minutes, and take the average value as the final result of this measurement. It is best to record the blood pressure results of each measurement in a form. Generally speaking, the blood pressure in the family is lower than that in the consulting room. The reference value of the upper normal limit of family self-measured blood pressure is 135/85mmhg, that is, the family blood pressure of general hypertensive patients should be lower than 135/85mmhg; The family blood pressure of patients aged 65~79 years should be lower than 140/90mmhg; The elderly over 80 years old should be reduced to below 150/90mmhg; The blood pressure target of diabetes patients is lower than 130/80mmhg; For elderly patients with hypertension or other diseases, it is recommended to control their blood pressure according to the standards previously determined by doctors. Hypertensive patients need to take antihypertensive drugs for a long time even if they have no symptoms and their blood pressure is normal. During the epidemic prevention and control period, it is more necessary to take drugs regularly. Sudden withdrawal of drugs will lead to serious "rebound" phenomenon, causing fluctuations in blood pressure and heart rate, and even cardiovascular events. If you are running out of antihypertensive drugs, you can go to a nearby drugstore or hospital to dispense them in time. If the systolic blood pressure is lower than 100mmhg, accompanied by dizziness, fatigue and other symptoms, it is necessary to reduce the dosage or even stop using it, and timely go through online medical treatment or to the nearest hospital for diagnosis and treatment. What is the situation that requires emergency medical treatment? According to experts, in case of one of the following serious situations, call 120 to contact the emergency ambulance for emergency medical treatment: blurred or lost consciousness; Sudden and significant increase of blood pressure (≥ 180/120mmhg), accompanied by severe headache, nausea and vomiting, blurred vision, or sudden language disorder and / or limb paralysis; Persistent chest and back pain; Edema of lower limbs, dyspnea, or inability to lie flat; Chest tightness, chest pain with sweating or suffocation, which can not be relieved continuously; A large number of foam in urine, or hematuria, or a sudden significant decrease in urine volume without change in drinking water volume; Other serious conditions that affect vital signs, such as blurred consciousness with low or undetectable blood pressure, too slow or too fast heart rate, sudden severe systemic allergic reaction, etc. About arrhythmias "Palpitation" is called "palpitation" in medicine. It is a kind of discomfort to the beating of the heart. Once the heartbeat loses its inherent regularity, people will feel uncomfortable, which is often called "flustered". "Panic" may be a symptom of disease or a normal physiological reaction. The normal heart beats 60-100 times per minute. When the heart beats too fast, too slowly or irregularly, we will feel the discomfort of heart beating. For patients with "palpitation" symptoms, it is recommended to first take self-test of blood pressure and pulse, focusing on the frequency and regularity of their own pulse, which can be measured by electronic sphygmomanometer or by touching the radial artery. If the pulse exceeds 100 times per minute, tachycardia occurs; If the pulse is less than 60 times, it may be bradycardia or frequent ventricular premature beats. Feel whether your pulse rhythm is missing or uneven during measurement. This information will be very helpful to the doctor's diagnosis. If the pulse is measured very quickly (more than 130 times / minute) or very slowly (less than 45 times / minute) in case of "panic" and accompanied by dizziness, chest tightness, chest pain, blackness, shortness of breath, syncope, dyspnea and other symptoms, seek medical attention immediately. If "panic" occurs after emotional excitement, strenuous exercise, heavy drinking, drinking tea and coffee, it is a normal physiological reaction. After removing the above incentives, the symptoms can be relieved by themselves, so there is no need to rush to the hospital. If you have ever suffered from heart diseases such as arrhythmia, such as atrial fibrillation, you must pay attention to the recurrence of "palpitation", and preliminarily judge whether the condition is recurrent by measuring the pulse frequency and rhythm. For patients with recurrent atrial fibrillation, it is recommended to go to the hospital as soon as possible, or use online medical channels to communicate with cardiologists about the drug treatment plan, so as to avoid the secondary complications of stroke caused by atrial fibrillation. About heart failure Heart failure refers to the decline of cardiac systolic / diastolic function caused by various reasons, and the heart can not effectively pump bleeding fluid. The clinical manifestations of heart failure are decreased activity tolerance, dyspnea or fatigue, and fluid retention (pulmonary congestion, systemic congestion, peripheral edema). How do patients with chronic stable heart failure manage themselves well? According to experts, record heart rate and blood pressure, measure body weight every day, maintain normal weight, take medicine according to doctor's advice, eat low salt, limit drinking water and beverages, limit alcohol intake, quit smoking, and exercise moderately indoors. The weight management of heart failure patients is very important, which can be measured and recorded at the same time and under the same conditions every day; Use the same integrated weighing scale; Every morning, fasting and after urination; Wear only small or fixed clothing. What symptoms need attention? Fatigue increased and physical strength decreased significantly; Dyspnea, especially when lying flat or resting; A sharp increase in body weight, with a sudden increase in body weight of more than 2 kg within 3 days; Edema of feet, legs, ankles and abdomen; Aggravation of cough; Anorexia, abdominal distension, decreased urine output; Palpitations, rapid heartbeat. What signals suggest that patients with heart failure must go to the emergency department? Persistent severe dyspnea, often accompanied by sweating; Chest pain with nitroglycerin still not relieved; Tachycardia or near fainting. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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