1) Disease Description (Causes and Symptoms)
- Definition and causes
- A group of diseases in which the coronary artery lumen becomes narrowed due to atherosclerosis of the coronary arteries or becomes blocked by a blood clot, resulting in insufficient blood supply (oxygen and nutrients) to the myocardium (including angina pectoris, unstable angina, and acute myocardial infarction).
- Acute coronary artery occlusion (plaque rupture + thrombus formation) is the primary cause of acute myocardial ischemia and necrosis.
- Key pathophysiology
- Symptoms are likely to occur when coronary artery stenosis is 70% or greater, and with complete occlusion, the myocardium in the affected coronary territory may become necrotic within several hours (generally around 6 hours).
- Ischemia makes the myocardium electrically unstable and increases the risk of various arrhythmias and cardiac arrest.
- Main symptoms
- Chest pain (pressure or squeezing sensation in the chest), radiating pain (to the left arm, jaw, back, etc.), shortness of breath, cold sweats, nausea, fainting or dizziness, and anxiety.
- Stable angina occurs during exercise or stress and disappears with rest. Unstable angina/myocardial infarction causes chest pain that persists even at rest and typical acute symptoms.
2) Treatment Methods and Precautions
- Acute-phase treatment (when myocardial ischemia or myocardial infarction is suspected)
- Emergency evaluation: Perform an electrocardiogram (ECG) immediately, assess hemodynamic stability, and conduct blood tests (including troponin).
- Reperfusion: When possible, primary percutaneous coronary intervention (PCI, target door-to-balloon time ≤90 minutes) is preferred. If PCI is unavailable or delayed and indicated, consider thrombolytic therapy (such as tPA) within the golden time.
- Medication according to the pathophysiology, including antiplatelet agents (aspirin immediately), P2Y12 inhibitors (such as clopidogrel/ticagrelor), and anticoagulants (such as heparin).
- Maintenance and secondary prevention treatment
- Antiplatelet therapy: aspirin + a P2Y12 inhibitor (the duration is adjusted according to the type of stent and risk level).
- Statins: achieve the LDL target with a high-intensity statin (e.g., atorvastatin or rosuvastatin).
- Use medications for managing heart failure, hypertension, and diabetes, such as beta blockers (reducing myocardial oxygen demand), ACE inhibitors/ARBs (inhibiting myocardial remodeling), and diuretics.
- Modification of cardiovascular risk factors: smoking cessation, diet (low-salt and low-saturated-fat), regular aerobic exercise, weight management, and control of blood pressure, blood glucose, and lipids.
- Procedures/surgery
- Percutaneous coronary intervention (PCI, stent insertion); coronary artery bypass grafting (CABG) may be considered for multivessel disease, complex lesions, left main coronary artery disease, and similar conditions.
- Precautions and risk of complications
- Risks include bleeding due to antiplatelet and anticoagulant therapy, arrhythmias (ventricular fibrillation), heart failure and cardiogenic shock, myocardial rupture and pericarditis, and left ventricular aneurysm and thrombosis.
- Do not stop antiplatelet agents on your own (especially after stent insertion). If acute chest pain, shortness of breath, or fainting occurs, immediately visit an emergency room.
3) Outpatient Visit Checklist (Items to Bring and Records) — Including Sample Questions
- Recommended items to bring
- A list of all medications currently being taken (including dosage and dosing times), as well as medication bags or prescriptions
- Records and a timeline of allergies, previous surgeries, and procedures (stent or CABG) (a summary document, if possible)
- Recent test results (ECG, cardiac enzymes/troponin, chest X-ray, echocardiogram, and blood tests including lipids, blood glucose, and kidney function)
- Symptom diary: frequency and duration of chest pain, triggers, and relieving factors (exercise, rest, response to nitroglycerin, etc.)
- Lifestyle information: smoking status, alcohol use, amount of exercise, and eating habits
- Examples of questions to prepare in advance for the outpatient visit (record them yourself)
- When did the symptoms begin, and what are their characteristics (initial occurrence and progression)?
- To what extent do the symptoms limit activity when chest pain occurs (e.g., does it occur after climbing stairs)?
- Have you recently undergone a procedure (stent or surgery), and how well have you been adhering to your medications?
4) Examples of General Questions to Ask the Doctor
- "What tests are necessary or recommended for my current condition (such as an echocardiogram, coronary CT, or exercise stress test)?"
- "What are the main side effects and precautions of the medications I am taking?"
- "How long do I need to take antiplatelet agents? How serious is the risk if I stop taking them?"
- "What is the most important lifestyle change I should make first to reduce the risk of recurrence?"
- "When can I start exercising, and to what extent is it safe? Can I engage in strenuous exercise?"
5) Examples of Disease-Specific Questions
- Regarding stents and procedures
- "What type of (stent/CABG) procedure did I undergo, and what is the remaining risk of restenosis? How likely is it that I will need additional revascularization?"
- "If a drug-eluting stent (DES) was inserted, for how many months should I continue dual antiplatelet therapy (DAPT)? How should it be adjusted if I have an individual bleeding risk?"
- Regarding responses to acute symptoms
- "If chest pain recurs, what emergency measures can I take immediately (e.g., how to use nitroglycerin and when to call 119 or visit an emergency room)?"
Note: The information above is a summary based on general guidelines. Treatment and recommendations may vary depending on your individual condition (medical history, test results, allergies, coexisting diseases, etc.), so consult specifically with your healthcare provider during your visit.