Patients who have recently come to the outpatient clinic have reported that their previously normally controlled blood pressure has suddenly gone up and down, the number of angina pectoris attacks or the uncomfortable feeling in the chest is more frequent than before, palpitations, palpitation, and edema in the lower limbs are more likely to occur, etc. Increase in cardiovascular symptoms.
Winter is a time of high incidence of myocardial infarction. Research shows that for every 1°C drop in temperature, the risk of myocardial infarction increases by 2%. Every year from November to January of the following year, it is a high-risk time for cardiovascular diseases, especially myocardial infarction. This is because under cold stimulation, human blood vessels constrict and blood pressure rises, which increases the impact on atherosclerotic plaques in blood vessels, which can easily lead to plaque rupture, coronary artery occlusion, and myocardial infarction. With the onset of the cold wave, the temperature difference between morning and evening and indoor and outdoor temperature gradually increases. Especially on days when the temperature drops greatly, the alternating feeling of cold and warmth is more obvious. This is the time when myocardial infarction is easy to occur.
In the past, it was believed that myocardial infarction usually occurred in older patients, but recent clinical studies have found that myocardial infarction is also showing an obvious trend in younger patients. In the past half month, we have continuously treated two young patients with acute myocardial infarction. Their common characteristics are heavy smoking and irregular living habits. One of the patients had sudden severe chest pain after drinking a lot of alcohol in the early morning. After admission, examination showed a large-scale myocardial infarction. Because young patients often have no symptoms of angina before myocardial infarction, myocardial ischemia is not compensated. If not treated in time, the consequences will be very serious.
The following moments are high-risk moments for myocardial infarction in winter.
Get up early in the morning. The time between 6 a.m. and 11 a.m. every morning in winter is known as the “devil time” for cardiovascular and cerebrovascular diseases. The human cardiovascular wall is most vulnerable in the early morning, and 70% to 80% of sudden cardiovascular and cerebrovascular diseases occur at this time. When people sleep at night, various systems of the body are in a semi-dormant state. Just after waking up in the morning, the heart rate changes from slow to fast, which increases the amount of substances that cause blood vessels to constrict and coagulate, making blood clots more likely to occur. If you stand up suddenly after waking up, your blood pressure will not rise immediately, and you will have symptoms of orthostatic hypotension such as dizziness, nausea, and weakness in the limbs. Especially for patients with hypertension, coronary heart disease, arteriosclerosis, and blood vessel stenosis, getting up suddenly is most likely to cause accidents. It is recommended that you do not get up after opening your eyes in the morning, lie down and move your limbs and head, and then get up after 3 minutes.
Straining to defecate. Clinically, it is not uncommon for elderly people to have myocardial infarction caused by straining to defecate during constipation. When straining to defecate, intra-abdominal pressure increases, blood pressure rises rapidly, and heart rate accelerates, thus causing myocardial infarction. It is recommended that patients with coronary heart disease or middle-aged and elderly people should not exert too much force when defecating. If defecation is difficult, medication can be used to assist. You should usually eat more high-fiber foods (such as vegetables, potatoes, fruits, etc.) to promote gastrointestinal peristalsis.
Emotional. In states such as anger, anger, tension, etc., the sympathetic nerves are excited and the catecholamines in the blood increase, causing an increase in blood pressure and easily leading to myocardial ischemia; at the same time, the accelerated heart rate can aggravate myocardial ischemia or lead to plaque rupture, thrombosis, and induce Myocardial infarction. Maintaining a calm mind is one of the important ways to protect the heart. Relax, control emotions, avoid impatience, and avoid anger.
Overeating. After overeating, a large amount of blood flows to the gastrointestinal tract, the blood supply to the heart is relatively reduced, and coronary ischemia will be aggravated; on the other hand, alcohol will cause excitement in the brain, accelerate the heart rate, increase blood pressure, increase myocardial oxygen consumption, and easily induce Coronary artery spasm predisposes to myocardial infarction. In addition, after eating a large amount of high-fat and high-calorie foods, blood lipid levels suddenly rise, blood viscosity increases, blood flow slows down, and thrombosis is easily formed, causing acute myocardial infarction.
Take a bath in the sauna. When bathing, blood vessels throughout the body dilate, blood flow to the skin and muscles increases, and blood flow to the heart is relatively insufficient. In addition, being in a closed environment for a long time can easily cause hypoxia in the human body. In winter, do not take a bath after a full meal or when you are hungry. The water temperature should not be too high, which is equivalent to body temperature or comfortable; the time should not be too long, and the bathroom should be properly ventilated. People with heart disease should avoid saunas.
In winter, especially for people with chronic diseases such as hypertension, diabetes, and hyperlipidemia, if symptoms such as chest pain occur, especially after strenuous activity, emotion, or cold, chest pain, squeezing pain, etc. If it feels like a big stone is placed on the chest, and may be accompanied by symptoms such as difficulty breathing and sweating, which last for more than half an hour and cannot be relieved by resting or taking nitroglycerin, Suxiao Jiuxin Pills, etc., acute myocardial infarction should be highly suspected. At this time, time is of the essence and prompt medical treatment is required. “Opening the coronary arteries early, reducing the infarct area, and saving the dying myocardium” is the principle of treatment for acute myocardial infarction. For such patients, the diagnostic method is not complicated, and the electrocardiogram can often prompt the diagnosis. If the venous blood is drawn to test for markers of cardiac damage, the diagnosis can be confirmed.
I would like to remind everyone that it is very important to control blood pressure, blood sugar, and blood lipids during the cold weather, and you must quit smoking and limit alcohol consumption. If there are elderly people at home with chronic diseases such as hypertension, diabetes, and hyperlipidemia, or if you have ever had symptoms of angina pectoris, you should always have emergency medicines such as nitroglycerin or Suxiao Jiuxin Pills at home to prepare for rainy days.
(Authors: Zhou Boda and Zhang Ping are respectively deputy chief physician, vice president and director of the cardiovascular center of the Department of Cardiovascular Medicine, Tsinghua Chang Gung Memorial Hospital, Beijing)