風險因素 [3]
- 缺乏運動
- 吸煙或吸入二手煙
- 不良飲食習慣,高壓生活、情緒緊張
- 45歲或以上男士 、55歲或以上女士
- 糖尿病
- 高血壓
- 高膽固醇
- 超重
- 家族有心血管病患史
確診方法 [5]
- 心電圖
- 血液檢查
- 心臟血管造影
- 心臟超聲波檢查
- 心臟電腦掃描
治療方法
急性冠狀動脈綜合症患者一旦病發,情形往往非常緊急,必須立即送院救治。治療分為兩部分─手術及藥物治療:[5]
- 手術治療:
– 冠狀動脈成形術 (俗稱「通波仔」),它是一種血管成形微創手術,用以打開被血栓阻塞的血管
– 冠狀動脈旁路移植術 (俗稱「搭橋」),醫生會以取自於患者的胸腔或腿部血管連接正常的冠狀動脈,繞過已阻塞的冠狀動脈,令血液能正常流動。 - 藥物治療:「雙抗血小板藥物治療」,以穩定血栓及防止血小板在手術期間過份活躍,從而提高手術的成功率。[6]
冠狀動脈成形術 (「通波仔」手術) [5]
冠狀動脈旁路移植術 (「搭橋」手術) [5]
適用於多條冠狀動脈出現阻塞,以及不適合進行「通波仔」的患者。手術期間,醫生會以取自於患者的胸腔或腿部血管連接正常的冠狀動脈,繞過已阻塞的冠狀動脈,令血液能正常流動。
由於ST段上升型心肌梗塞患者病發時的情況非常緊急最好在90分鐘內[7]打開血管。因此,抗血小板藥的藥力必須能在短時間內生效,才可促進整個救治過程。
搭橋後注意事項 [13]
接受「搭橋」手術後,患者仍有復發風險,故須持續服用抗血小板藥及降血脂藥物。此外,根據個別病情,患者或須使用以下藥物:
- β受體阻斷劑
- 血管收縮素轉代酶抑制劑
患者亦要緊密觀察血壓及血脂等指標,如有需要,醫生或會調校以上藥物的劑量。
預防復發小貼士
- 定期覆診
- 定時服藥, 切勿自行停藥
- 良好的 飲食習慣
- 良好的 運動習慣
- 體重管理
- 情緒管理
- 戒煙
- 留意復發警號,以及早求診
- 戒酒
參考資料
- Richard Armour. Sirens to Scrubs: Acute Coronary Syndromes, Part One – Beyond Door-to-Balloon. Available from https://canadiem.org/acute-coronary-syndrome-beyond-door-to-balloon/ (Last accessed: 8 Aug 2019)
- NHS. Arterial thrombosis. Available from https://www.nhs.uk/conditions/arterial-thrombosis/ (Last accessed: 8 Aug 2019)
- National Heart, Lung, and Blood Institute. Ischemic Heart Disease. Available from https://www.nhlbi.nih.gov/health-topics/ischemic-heart-disease (Last accessed: 8 Aug 2019)
- NHS. Heart attack: Symptoms. Available from https://www.nhs.uk/conditions/heart-attack/symptoms/ (Last accessed: 8 Aug 2019)
- Hospital Authority. Coronary Heart Diseases. Available at http://www21.ha.org.hk/smartpatient/SPW/en-us/Disease-Information/Disease/?guid=f9899bdc-ad84-460b-825a-6fdd85a079d6 (Last accessed: 16 Sep 2019)
- Heart and Stroke Foundation of Canada. Antiplatelets. Available at https://www.heartandstroke.ca/heart/treatments/medications/antiplatelet-medications (Last accessed: 16 Sep 2019)
- Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients With Acute Myocardial Infarction). J Am Coll Cardiol 2004;44:671–719.
- Knuuti J, Wijns et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal, ehz425, https://doi.org/10.1093/eurheartj/ehz425.
- Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. Circulation. 2016;134(10):e123-e155.
- National Institute for Health and Care Excellence. Ticagrelor for preventing atherthrombotic events after myocardial infarction. Available from https://www.nice.org.uk/guidance/ta420/resources/ticagrelor-for-preventing-atherothrombotic-events-after-myocardial-infarction-pdf-82604656973509 (Last accessed: 19 Aug 2019).
- Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36(19):1163-1170.
- Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015 May 7;372(19):1791-800.
- Kulik A. Secondary Prevention After CABG Surgery. Available from https://www.acc.org/latest-in-cardiology/articles/2018/12/04/08/26/secondary-prevention-after-cabg-surgery (Last accessed: 13 Dec 2019).