Analysis Of Middle-aged Patients With Chest Pain, Cardiopalmus And Debilion As The Main Clinical Etiological Factor

Coronary heart disease is a serious public health problem of common diseases. Analysis of a large number of coronary heart disease in epidemiological data, people have found that the average age of patients of coronary heart disease is younger than before. Cardiovascular physicians are paying more attention to coronary heart disease in middle aged and young people. The main clinical manifestations of coronary heart disease in middle aged and young people are non-typical chest, heart palpitations and fatigue, similar to viral myocarditis andβ-receptors hyperfunction. Those three diseases may all have cardiac ECG ischemic changes, so while we attach importance to middle-aged coronary heart disease, we must also note with the differential diagnosis between it and viral myocarditis as wellasβ-receptor hyperfunction. Objective: Study characteristics of young patients with atypical chest pain, heart palpitations and fatigue, and approach the disease etiopathogenisis distribution law. Then supply information for the diagnosis, differential diagnosis and treatment of them.Methods: 90 cases who visit cardiovascular department of our hospital during March 2007 ~ March 2009,56 males and 34 females, average (51.1±2.0) years old, all accept coronary angiography (CAG) examination. By Judkins catheter for selective CAG examination, left main, left anterior descending artery, left circumflex artery, right coronary artery and its branches, any of a stenosis≥50% weree CHD, without coronary stenosis were non-CHD. Rule out 10 cases who have the presence of coronary stenosis by CAG confirmed but less than 50%. Divide those 90 cases into three groups: Group 1: CHD group of 40 cases, including 24 males and 16 females, aged between 40 to 59 years, average (51.2±1.9) years old. Group 2: non-CHD group of 40 patients, of which 21 males, 19 females, aged between 40 to 59 years, average (50.2±2.0) years old. Non-CHD group were divided based on whether have the history of past infection (about 1 to 3 weeks with upper respiratory tract infection, diarrhea, infection) into two subgroups: 2a group include 25 patients with history of past infection; 2b group include 15 patients without previous infection history. Group 3: control group of 30 cases of healthy persons, including 17 males and 13 females, aged between 40 to 59 years, average (48.6±2.2) years old. Observation indexes: (1) General Information: including smoking history, history of heavy drinking, unhealthy lifestyle, family history of premature coronary heart disease, history of past infection and blood pressure. ( 2 ) resting electrocardiogram and 24-hour holographic dynamic ECG: ECG ST-T positive change (two adjacent and (or) above the level of ST-segment depression type or the next Oblique≥0.1mv, and (or) to T wave , R wave of lead-based T wave inversion) and the type and incidence of arrhythmia(.3) serum TC, serum TG, serum LDL-C, fasting GLU, serum cTn-I, serum hs-CRP, serum COXV-IgM antibody and myocardial antibodies.Results: (1) General Information: The positive rate of smoking history, history of heavy drinking, bad lifestyle, family history of premature coronary heart disease and hypertension in CHD group is significantly higher than that of non-CHD group and control group (P < 0.05). There is no significant difference in positive rates between Non-CHD group and control group,(P> 0.05). The positive rate of history of past infection in Group 2a is higher than CHD group, Group 2b and the control group (P <0.01). (2) serum TC, serum TG, serum LDL-C and fasting GLU: The serum TC, serum TG, serum LDL-C, fasting plasma GLU concentration of CHD group is different from those of non-CHD group and the control group(P < 0.05). Non-CHD group compared with the control group, no significant differences in those concentration(P> 0.05). (3) resting electrocardiogram and 24-hour ambulatory ECG: The positive rate of ST-T changes in CHD group were 90%, significantly higher than non-CHD group (27%) and the control group (10%)(p < 0.01). There is no significant difference in the incidence of single chamber atrial premature beats between CHD group and non-CHD group(P> 0.05). The coupled rhythm and trigeminy are more common in CHD group than non-CHD group (P <0.01). (4) serum cTn-I levels: CHD serum cTn-I level is higher than the control group but lower than the 2a group(p <0.05). 2a were significantly higher than 2b(P <0.05). While 2b group compared with the control group have no significant difference (P> 0.05). (5) serum hs-CRP levels: CHD serum hs-CRP levels compared with non-CHD group and control group were significantly higher, 2a group were significantly higher compared with the control group, the differences were statistically significant (P <0.05). 2b group compared with the control group no significant difference (P> 0.05). (6) serum COXV-IgM antibody positive rate of heart: CHD group and 2b serum COXV-IgM antibodies and antibody positive rates of heart compared with the control group no significant difference (P> 0.05). 2a serum COXV-IgM antibody and myocardial antibodies was significantly higher than CHD group, 2b group and control group was statistically significant (p <0.05).Conclusion: During the middle aged and young patients with cardinal symptom of atypical chest pain, heart palpitations and fatigue 44.44% are diagnosed as coronary heart disease, 27.78% are diagnosed as viral myocarditis, and 16.7% are diagnosed asβreceptor hyperfuntion syndrome.The ratio of the three disease is 1:0.625:0.375. So when we diagnose the middle aged and young patients with cardinal symptom of atypical chest pain, heart palpitations and fatigue, we should first pay attention to CHD, while we should also not forget viral myocarditis andβreceptor hyperfuntion syndrome. Combined with the patient's general information including smoking history, history of heavy drinking, bad lifestyle, family history of premature coronary heart disease, history of infection and high blood pressure, the consentration of serum TC, serum TG, serum LDL-C, fasting GLU, electrocardiogram, serum cTn-I, serum hs-CRP, serum COXV-IgM antibody and myocardial antibodies may be useful to differential diagnosis.