Angina Pectoris

Angina, myocardial infarction, cerebral infarction, and cerebral hemorrhage that occur in the heart are all caused by blood vessel arteriosclerosis and poor blood pressure and blood flow control.

The heart is an organ that acts as a pump to circulate blood throughout the body. By the movement of the heart, the blood circulates throughout the body, supplying oxygen and nutrients to our body tissues and carrying carbon dioxide and waste products into each tissue. On the other hand, a special blood vessel called coronary artery is located around the heart. The coronary artery is named because it surrounds the heart like a crown on the head. It is responsible for supplying oxygen and nutrients to the heart.

Angina is a pain in the chest caused by inadequate blood supply to the heart muscle due to obstruction, narrowing, or convulsions in the coronary arteries. Angina is a name given because it causes tightness and stiff pain as if the chest is narrowed. The symptoms of angina may sometimes feel like indigestion and pain may be felt in the shoulders, arms, back, neck, or chin.

Angina is the main symptom of coronary artery disease, the most common heart disease. Coronary artery disease occurs when plaques of fat and inflammatory cells are deposited in the coronary arteries that supply blood to the heart, reducing blood supply to the heart.

Meanwhile, all chest pain or discomfort is not angina. However, if you have these chest pains, you should see your doctor.

Definition

1. What is angina?

Angina is a medical term that refers to chest pain or discomfort caused by coronary artery disease. It is a condition caused by ischemia of the heart muscle.

Myocardial ischemia is when you don’t get as much blood and oxygen as your heart muscle needs. This myocardial ischemia occurs when one or more arteries that supply blood to the heart muscle become blocked or narrowed. As a result, insufficient blood supply results in ischemia.

Angina, although rare, can also occur in heart valve disease, hypertrophic cardiomyopathy, and uncontrolled hypertension.

Typical symptoms of angina may be uncomfortable pressure, tightness, squeezing or chest pain in the center of the chest, which may be felt in the form of stretching to the shoulders, arms, back, neck, or chin.

On the other hand, this type of chest discomfort does not necessarily mean an association with angina, but chest pain may also be caused by burning of the chest due to gastro-esophageal reflux, infection or inflammation of the lungs. However, because angina can be a sign of a sudden heart attack or sudden death,
If you have chest pain or discomfort that may indicate angina, you should see a doctor.

2. When does angina occur?

Angina often occurs when the heart needs more blood supply. For example, if you are just walking as usual, you may have an anxiety if you suddenly run to ride the bus you missed, or if you are exercising hard. It can also occur when excited, or even in high or low temperature situations. On the other hand, angina can also be caused by convulsions in the coronary arteries even while resting.

3. Types of Angina

Angina is divided into three categories: stable angina, unstable angina, and heteroangular angina.

Unstable angina is the most dangerous because chest pain may be out of the ordinary and irrelevant to the physical activity of the body, and pain or restlessness may not occur with rest or medication and cause a heart attack in the near future.

1) Stable angina

Stable angina is the most common form of angina, and chest discomfort in patients with these symptoms is usually predictable.

Symptoms of stable angina usually result from exercise or severe emotional stress, such as climbing stairs or running. And these symptoms are ameliorated by drugs such as rest or nitroglycerin.

Safe angina is caused by a narrowing of the coronary arteries and a decrease in blood supply to the heart muscle. Blood supply decreases when the coronary arteries become partially narrowed by blood debris or when blood vessels contract abnormally excessively. Stable angina can also be caused by an infection or inflammatory disease.

If you have this chest discomfort, you should see your doctor and get appropriate tests. You may need to check your doctor, chest radiography, electrocardiogram, etc. In some cases, special tests such as exercise-loaded electrocardiograms and electrocardiograms may be needed.

2) Unstable angina

In unstable angina, chest pain occurs during unforeseen rest. If your chest discomfort is worse than your typical angina or first-time symptoms, you should suspect it.

Unstable angina is a disease of acute coronary syndrome that occurs when an unstable plaque ruptures, creating a blood clot on top of it and partially or entirely blocking the narrowed blood vessels. Therefore, there is a high risk of fatal cardiac arrhythmias, such as acute myocardial infarction or ventricular fibrillation, and sudden death due to a heart attack, so you should seek immediate diagnosis and treatment.

3) Dysplastic angina

Dysplastic angina, also known as mutant angina, usually occurs during rest and is different from typical aspects of angina.

Dysplastic angina is not caused by exercise or stress, but by temporary spasm of the coronary arteries. The appearance of angina is very painful and usually occurs between late night and early morning.

It is more common in men than in women, and smoking is known to be an important risk factor. It can occur two or three times in a row, and chest pain responds very well to nitroglycerin sublingual tablets.

Two-thirds of these dysplastic angina patients have at least one coronary artery
Has significant atherosclerosis. therefore
Patients suspected of dysplastic angina should also be promptly diagnosed and treated.

Diseases That Cause Chest Pain

1. Ischemic heart disease

‘Ischemia’ refers to a disease or condition caused by a lack of blood supply.

Ischemic heart disease is a collective term for various diseases caused by problems with the blood circulation of the heart. Ischemic heart disease includes “angina”, which causes a temporary disruption in the blood supply to the heart, and “myocardial infarction,” where the ischemic condition of the myocardium is severe or long-lasting and necrosis of the heart muscle.

1) Stable angina

If you experience severe pain, such as tightness of your chest when you are under heavy exercise or stress, and you relax, you may think of stable angina if the pain disappears within minutes. Chest pain does not last longer than 30 minutes and is usually alleviated by sublingual nitroglycerin.

2) Unstable angina

If you have a similar form of chest pain while you’re resting in a patient with your usual stable angina, you’re most likely unstable angina. However, the first symptoms in patients with no symptoms usually appear in the form of chest pain at rest.

3) Dysplastic angina

Chest pain in dysplastic angina usually occurs intensively at bedtime or early in the morning. Even during normal work and hard work, a person who is not sick can suspect dysplastic angina if he or she complains of chest pain at rest or early in the morning. Chest pain may also worsen especially early in the morning after drinking.

4) Acute myocardial infarction

If your chest pain lasts longer than 30 minutes, you should think of acute myocardial infarction. About half of patients with acute myocardial infarction have repeated resting chest pains a few days before acute myocardial infarction. Acute myocardial infarction does not relieve pain by resting or sublingual nitroglycerin, and the pain may worsen. In some patients, a heart attack and impaired pump function can lead to death, requiring emergency treatment.

2. Chest pain in non-ischemic cardiovascular disease

The disease involved is when chest pain occurs in major vascular systems such as the heart or aorta, but the cause of the pain is not due to ischemia.

1) Acute pericarditis

Often, upper respiratory tract infection is preceded and sharp pain radiates to the neck, back, and shoulders, shifting to the left rather than the center. The pain lasts for several hours and does not get worse with exercise. Instead, they worsen when breathing, swallowing, and turning, and reclining forward.

2) Aortic dissection or aortic wall bleeding

It complains of a sudden onset of severe pain, and the intensity of the pain is the greatest starting point for tearing the aorta, so the patient often remembers it.

In many cases, the patient has a history of high blood pressure and the location of the pain depends on which part of the aorta is involved. Invading the ascending aorta complains of anterior thoracic chest pain, and invading the descending thoracic aorta causes pain between the scapula and abdominal pain when invading the abdominal aorta. And if exfoliation is triggered throughout the aorta, pain can be felt in the neck, jaw, face, back, lower back, etc.

Invasion of the aortic valve with an ascending aortic lesion can complain of heart failure symptoms caused by aortic valve insufficiency and audible noise when auscultating. And when blood accumulates in the pericardium, it also shows a clinical picture of cardiac tamponade. It may also block branched blood vessels in the aorta, resulting in stroke, intestinal ischemia, kidney infarction, and lower limb circulation.

3. Chest pain other than heart disease

1) Digestive System Disease

Chest pain caused by the esophagus is the most common confusion with angina.

(1) Esophageal spasms

Esophageal spasms are a condition that causes esophageal cramps and can come in any age group, but they are most common in the 50s. Pain is a sub-sternal area that looks like “burning” or “squeeze” and causes radiating pain in the back, arms, and jaw. It usually occurs during or after meals and lasts for several minutes. Esophageal spasms also respond to nitroglycerin and are prone to confusion with angina. There is no particular problem with exercise, and if pain is caused by swallowing exercise or reflux of food in the stomach, you may suspect esophageal spasms.

(2) Reflux esophagitis

Reflux esophagitis is when acidic substances in the stomach irritate the mucous membranes of the esophagus, causing pain. The pain feels “burning” to the end of the plain or lower sternum, and worsens in lying or forward bowing. Stomach acid reflux wakes you up, it is alleviated with food, antacids, milk, etc., and pain is relieved even with your upper body up.

(3) Peptic ulcer

Pain from peptic ulcer may be similar to angina, but it is associated with food as the end of the pain and is alleviated with antacids.

(4) Acute pancreatitis

Pain in acute pancreatitis can be similar to myocardial infarction. However, the location of the pain is at the end of the tooth, can be relieved in a squat posture and suspected in patients with alcoholism or gallbladder disease.

2) Neurological and musculoskeletal disorders

(1) Thoracic Outlet Syndrome

This is caused by pain in the nerves and blood vessel structures that are pressed by the ribs or muscles and can cause confusion with angina. The pain manifests itself in the head, neck, shoulder and armpit areas, usually accompanied by pain inside the arm. The nerves that go to the arm are depressed, which is associated with paresthesia with pain that is not related to exercise, and it helps to diagnose if the pain is triggered when taking a certain position.

(2) Osteochondritis

Inflammation of the cartilage (costal cartilage) connected to the ribs can also cause pain. Complains of sharp chest pain, which is exacerbated by the movement of the upper body or by a large breath, and the compression of the area of ​​the costal cartilage causes pain. In some cases, the pain of polychondritis may occur simultaneously in several places. The pain usually improves within a few days or weeks, but in some patients it may last for months.

(3) Degenerative arthritis

Degenerative arthritis of the cervical and thoracic vertebrae causes band-like pain in the chest, neck, and back and is caused by upper body movements, certain postures, coughing, and sneezing.

(4) Shingles

Herpes zoster complains of band-shaped pain in the chest, paresthesia in the affected area, and typical shingles blisters are observed 4-5 days after the onset of pain.

3) Chest pain caused by lung disease

(1) Pulmonary embolism

Pain from pulmonary embolism is due to acute pulmonary arterial hypertension, which can be confused with myocardial infarction due to low cardiac output. The pattern of pain may be similar to ischemic chest pain or pleural pain, but it occurs suddenly at rest, and sharp pain is accompanied by shortness of breath, poor breathing, cyanosis, and anxiety. Clinical conditions, such as postpartum or postoperative conditions, heart failure with limb edema, venous thrombosis, prosthetic valve surgery, and lying on the bed for a long time, can also help diagnose.

(2) Pneumothorax / pneumonia / pleurisy

Pneumothorax, pneumonia, and pleurisy are also a cause of chest pain, but are usually unilateral, pleural pain that occurs sharply when you inhale deeply, and is accompanied by symptoms of shortness of breath or other respiratory disorders that are easy to diagnose.

4) Mental causes

Anxiety is the number one cause of chest pain, and patients often complain of a “scaling stab” pain that lasts a few seconds to less than a minute. But sometimes our pain can last from hours to days.

The location of the pain is characteristic of the apex, or under the left breast, and is not related to exercise and occurs when you do nothing at the end of the day, not at work, especially when you are under stress.

Patients often complain of symptoms such as “breathing, dizzy, or beating heart” at once, accompanied by symptoms such as hyperventilation, numbness around the mouth, helplessness, numbness, sighing, and hysteria.

Symptoms

Typical symptoms of angina may be uncomfortable pressure in the center of the chest, a feeling of tight chest, or a squeezing or chest pain.

The typical symptoms of angina usually occur when the body moves a lot, such as when walking fast, climbing stairs, exercising, or lifting heavy things. As mentioned above, although there are some differences depending on the type of angina, the symptoms of angina usually include severe chest pain in the center of the chest that extends to the jaw or arms and is accompanied by difficulty breathing. However, these chest pains last three to five minutes and then disappear when they stabilize.

On the other hand, the symptoms of angina are cold weather, pain more often after meals, and pain tends to develop better in the morning.

1. Location of angina attacks

Typically, the middle of the chest seems to be heavy and tightening, but the symptoms spread to the inside of the left shoulder or left arm. Sometimes it goes to the right shoulder or the face of the arm, jaw or neck, but it is not necessarily so. In rare cases, pain in the back and upper abdomen may occur.

2. Condition of seizures

It’s common for a typical pain to develop or feel painful and tight when the chest is stuffy and heavy, pressing or squeezing. Sometimes your left face feels cold and your chest feels burning, or your jaw or tooth hurts so you can go to the dentist.

3. Period of seizures

Seizures occur when there is a lack of oxygen in the muscles of the heart or when more oxygen is needed due to exercise. The duration of a seizure is usually within 1 to 2 minutes, or 15 minutes or less. If it lasts longer, a large coronary artery may be blocked and a myocardial infarction may be suspected.

4. Situation of seizures

Angina occurs when exercise or activity exceeds the capacity of the heart or coronary arteries. So it’s easy to get up when you’re climbing stairs, when you’re lifting heavy objects, and when you’re walking quickly.

It often occurs not only in physical overwork, but also during mental strain and excitement. It can also happen when you watch sports broadcasts or reach the best excitement in a marital relationship. It can come when you overeat, suddenly be exposed to a cold climate early in the morning, do something big, relax from overwork or tension.

Left breast pain, esophagitis, peptic ulcers, and cardiomyopathy may have similar symptoms, so care must be taken in the diagnosis, but it is possible to distinguish them by accurate examination and examination.

5. Is all chest pain angina?

Most chest pains in angina are characteristic but chest pain should not all be mistaken for angina.

Many people who complain of chest pain may have symptoms of emotional anxiety or nervousness. For example, if the left chest hurts with a needle or knife for a few seconds, the left frontal chest hurts for hours for a few hours, or if you feel pain when you move your left arm or bend or stretch your chest, Symptoms such as frustration and tightening but disappearing when they are busy are not angina.

Most chest pains caused by angina appear when physically overcrowded, and slowly settle down when stable. However, dysplastic angina, unlike ordinary angina caused by exercise, develops chest pains periodically at night or at dawn, and is caused by spasms of the coronary arteries.

Diagnoses

When you see a doctor, your doctor will first ask you about your chest pain after undergoing basic tests such as blood pressure, pulse rate, and temperature. Your doctor will ask you about the following tests to help you identify chest pain from angina and other causes, including the location of the chest pain, the symptoms of chest pain, and other symptoms associated with chest pain.

1. Electrocardiogram

Electrocardiogram testing involves recording the electrical activity of the heart through electrodes attached to the chest and limbs.

If there is damage to the heart muscle, normal electrical stimulation is not conducted, so you can check whether the heart is damaged by electrocardiogram, and you can check various diseases such as angina pectoris, myocardial infarction and arrhythmia.

However, in the case of angina pectoris disappears after symptoms disappeared in many cases, the cardiac muscle is not an ischemic state, the most unusual cases on the ECG can not be found. For this reason, an exercise-loaded electrocardiogram, such as taking an electrocardiogram with the patient running on a treadmill or using medication to increase heart rate, is performed.

2. Chest radiograph

Chest radiographs show the size and shape of the heart as well as the state of the major blood vessels, as well as the lungs. Doctors can provide vital and basic information to rule out many other diseases.

3. Blood test

When heart cells are necrotic, such as myocardial infarction, enzymes inside the damaged heart cells flow into the blood, increasing the concentration in the blood.

These substances, which are elevated by heart damage, include CK-MB and troponin.
In the case of angina pectoris, the necrosis of the heart muscle has not yet appeared, so normal levels can be shown, but in the case of myocardial infarction, the blood levels of these enzymes increase, so it is very useful to check myocardial infarction in chest patients.

4. Load inspection

A load test is a test that looks at how the heart and blood vessels respond by artificially loading contractile movements into the heart.

The most common form of load test is the “exercise load electrocardiogram”, which measures the ECG as you run on a treadmill. This test deliberately raises the patient’s heart rate and increases the heart’s oxygen consumption, which can lead to characteristic abnormalities that were not seen on the ECG when the blood supply to the heart was not smooth, such as narrowing of the coronary arteries.

There is also a drug load test that measures the ECG after intravenous administration of a drug similar to exercise. These load tests may also be linked to methods of echocardiography or imaging using radioisotopes.

5. Echocardiography

Echocardiography is a very useful test that can identify overall heart function, heart wall movement, structural and functional abnormalities of the valves, any abnormalities in the heart, and even some aortic and pulmonary artery diseases. This can be used to discriminate the causes of chest pain.For example, in myocardial infarction, the cardiac muscle necrosis can be used to identify local dyskinesia of the heart wall through echocardiography. There is no obstacle. Therefore, the combination of the load test and echocardiography introduced above is used to diagnose angina.

6. Nuclear Imaging Scan

This test involves injecting a small amount of radioactive isotopes into a vein and then taking blood flow to the heart and lungs through a special camera. If you have angina or myocardial infarction that narrows the blood vessels of the heart, these diseases can be diagnosed by a decrease in blood flow in the area.

7. Computed Tomography (CT)

In the past, CT has been used only as a test to show cross-sectional images of the human body. Recently, however, advances in CT technology have enabled accurate imaging and diagnosis of the pulsating heart and coronary arteries.

In addition, CT is used as an important test method to check the degree of calcium deposited in the coronary arteries and to clarify the degree and state of coronary artery stenosis.

8. Coronary Angiography

This type of cardiovascular angiography is one of the most important tests in the evaluation of coronary artery disease. Coronary angiography can identify the location and extent of coronary artery stenosis.

Usually, a thin tube is inserted along the artery through the femoral vein, then a contrast agent is injected and the coronary artery narrowed. If the coronary artery is clogged or there is a narrowing, this test can be done. At the same time, direct treatment, such as placing a balloon in the narrowed area to expand the vessel or inserting a stent, may be done at the same time as the diagnosis.

9. Other

As a cause of chest pain, abdominal ultrasound may be used to distinguish other organ diseases other than the heart, such as stomach, esophagus, and gastrointestinal endoscopy, gallbladder, and pancreatic diseases.

Treatments

The first treatment for angina is to avoid the risk of atherosclerosis. Representative risk factors include high blood pressure, diabetes, hyperlipidemia, smoking, obesity, and family history of heart disease. Therefore, proper blood pressure and blood sugar management are essential, smokers must quit smoking, diet and exercise therapy to maintain weight management and proper cholesterol levels. If you have high blood pressure and diabetes that are not controlled by lifestyle improvements, you must maintain proper blood pressure and blood sugar with medication and take cholesterol-lowering drugs called statins to manage your hyperlipidemia. If you do not respond to these conservative treatments, coronary interventions are performed with balloon dilatation and stent implantation, which expand the narrowed area of ​​the coronary artery into the balloon. Finally, coronary artery bypass surgery, which bypasses the narrowed area of ​​the coronary artery and connects the aorta to the coronary artery, is performed when the lesion is so severe that interventional treatment is not available.

1. Medical Treatment of Angina

1) Lifestyle therapy

The most basic treatments for angina patients should be smoking cessation, proper aerobic exercise, and a low fat diet. This should help you maintain proper weight and lower blood cholesterol levels to prevent plaque buildup and increase in blood vessel walls. If you have high blood pressure and diabetes, this lifestyle regimen will help you keep your blood pressure and blood sugar down, as well as medication if needed. Should be adjusted.

2) Drug therapy

(1) Aspirin

Aspirin prevents blood clotting by disrupting platelet aggregation, which prevents blood clots from forming in narrowed blood vessels. In most patients in the high risk group of heart attack and cardiovascular disease, aspirin is a recommended drug. If you cannot take it because of side effects or allergies, you may want to consider clopidogrel.

(2) Nitroglycerin

Nitroglycerin is used in the treatment of angina because it improves the supply of blood through narrowed blood vessels through vasodilation.

(3) Beta blockers

This medication lowers the heart’s oxygen demand by lowering the heart rate and blood pressure and reducing the contractile force of the heart muscle. Therefore, it is effective in relieving pain and minimizes myocardial damage during heart attack and prevents recurring heart attack.

(4) Calcium channel inhibitors

Also called calcium antagonist, it is a drug that reduces the heart’s oxygen demand through the action of reducing the contractile force of the heart muscle, expanding blood vessels and lowering blood pressure. Therefore, the drug is recommended for pain relief following beta-blockers. In ankylosing angina, it is a drug that is administered to prevent coronary spasms.

(5) Angiotensin Converting Enzyme Inhibitor / Angiotensin Receptor Blocker

Drugs in this class may lower blood pressure, prevent secondary heart attacks, and may be considered for administration because they have a beneficial effect on the remodeling of the heart, especially in patients with diabetes or poor heart pumping. .

(6) Statins

Statin, a representative hyperlipidemia treatment, not only lowers bad cholesterol in our body but also inhibits the progression of atherosclerosis and stabilizes plaque through anti-inflammatory, antioxidant and anti-proliferative effects.

2. Percutaneous coronary dilation

1) Method

A stent that allows the balloon to be expanded through the femoral or cuff arteries into the narrowed coronary artery, and then expands the balloon to expand the narrowed vessel or prevent the expanded vessel from narrowing again. Insert a Stent). Only balloon dilatation was possible in the pre-stent era, but stent implantation has become commonplace because of recent advances in second-generation drug-release stents and bioabsorbable scaffolds that disintegrate and disappear within about two years.

2) Indications and Limitations

Despite sufficient medication, percutaneous coronary intervention is effective when symptoms of angina continue, especially when there is an objective basis for cardiac ischemia in the load test. This method is primarily used when a single or two coronary arteries are narrowed, and in patients with trivascular or multivessel disease, in which all three coronary arteries are narrowed, the patient’s condition, comorbidity (with or without diabetes), and the characteristics of the lesion. You should consider performing a coronary artery bypass graft. Percutaneous coronary interventions have limitations such as intra-stent restenosis and stent thrombosis, which has resulted in the development of drug-release stents and the development of various drugs to prevent these complications. Currently, less than 10% restenosis rate and less than 1% stent thrombosis incidence Is showing.

3. Coronary Artery Bypass Graft (CABG)

If the coronary arteries are narrowed or blocked, surgery is done to make a detour to the distal lesion using blood vessels from other parts of the body. Coronary artery bypass grafts are determined by considering the severity of symptoms, the anatomical characteristics of the coronary arteries, the characteristics of the lesion, and the cardiac function. Surgical treatment may be considered if:

• Severe angina that does not respond to medical treatment
• Patients with 2- or 3-vascular disease and symptomatic triple-vascular disease with left main branch lesion
• Patients with Percutaneous Coronary Dilation Failure

1. Prevention of Angina

First, it is important for people with high blood cholesterol levels to take hyperlipidemic drugs (statins) and to eat a lot of plant foods, such as low cholesterol foods and vegetables.

Second, regular exercise is important. Exercises that help harden the arteries are not temporary exercise, but aerobic exercise such as jogging, skipping rope, climbing light, swimming and aerobics. It is important that you choose the type and intensity of exercise that suits your physical condition and strength.

Third, if you are obese, lose weight and have high blood pressure, or if you have diabetes, you should control your blood pressure and blood sugar.

Fourth, if you smoke, you must quit.

Fifth, it is recommended to avoid excessive stress over a long period of time. As a way to reduce stress, it’s important to do your favorite sports or spend your hobbies on weekends and holidays to relieve stress for a week and get back on a new week. Of course, it is not advisable to drink alcohol to relieve stress.

Frequently Asked Questions

1. Frequently Asked Questions About Diet

1) What are the principles of diet that promote good health?

Adhering to a healthy diet will normalize your weight, lower your cholesterol and improve your blood pressure. However, maintaining a healthy diet requires a lot of attention and self-control. Once you start this healthy diet, many of your patients start to feel lighter and more comfortable.

• Have a habit of eating a variety of healthy foods.
• Eat lots of fruits, vegetables, grains (such as brown rice), and eat nonfat or low-fat milk, fish, legumes, poultry (chicken), and low-fat meat.
• Maintain proper weight.
• High calories and less nutrients to eat less sugar products, walk or exercise steadily to consume more calories.
• Do not raise cholesterol and fat in the blood.
• Reduce saturated fat and cholesterol intake.
• Instead, increase the intake of unsaturated fatty acids in grains, vegetables, fish, and beans.
• Maintain blood pressure properly.
• Limit salt (less than 6 gm / day), alcohol and maintain standard weight.

2) When should I start and maintain this healthy diet?

It is better to start as early as possible. Although there were no symptoms of vascular disease in the blood vessels of adolescent students who died in a traffic accident or young soldiers who died on the battlefield, it has been proven that there are significant changes in early arteriosclerosis.

Even if you’ve already had arteriosclerosis and narrowed blood vessels, this healthy diet can help improve your blood flow.

3) What foods should I eat to reduce fat and cholesterol intake?

Even if you only eat lean meat without fat, it is not a good idea to eat a lot of meat because it contains some fat. If you already have cardiovascular disease, you can reduce nutrients by reducing meat and adding vegetarian-based meals and soy products (such as tofu).

Eating more soy reduces cholesterol and triglycerides, and the US Food and Drug Administration has officially announced in 1999 that eating more than 25 gm of soy protein a day can help prevent heart disease.

4) Are oils or seeds safe?

All oils are 100% fat. Especially when frying, trans fatty acids are produced, which raises bad cholesterol (LDL) and decreases good cholesterol (HDL), which adversely affects blood vessels. This trans fatty acid does not exist in nature and is found in processed foods (fried, margarine, crackers, sweets). Vegetable oils also contain a lot of saturated fat, so it is better to refrain from it as much as possible, and there is a myth that olive oil is good for the cardiovascular system, but this is because olive oil is used to reduce the intake of olive oil instead of fat. There is no reason to eat.

Seeds (nuts: walnuts, pine nuts, peanuts) also contain some fat, which is bad for blood vessels when eaten a lot. Of course, healthy people do not need to follow these principles, but those who want to actively protect their blood vessels should follow this diet.

5) What is the optimal level of cholesterol in the blood?

Should be kept below 200 mg / dL of total cholesterol. According to a report published in the United States, a 50-year follow-up has shown that every 1% increase in cholesterol levels of blood cholesterol above 150mg / dL increases the risk of heart disease by 2% .The lower the cholesterol, the less the cardiovascular disease. It can be said that it takes. Based on the well-known LDL cholesterol criteria that are known to be harmful to blood vessels, there are some differences depending on the number of risk factors that accompany it: 160 if there are no risk factors or one, 130 if more than two, diabetes, or have cardiovascular disease If present, it is recommended to keep it below 100 mg / dL. Recent studies have shown that lowering LDL cholesterol to below 70 mg / dL continues to lower cardiovascular disease incidences, so efforts to maintain as low levels as possible in high-risk groups for cardiovascular disease are needed.

6) Are people with low blood cholesterol safe to eat a lot of cholesterol?

It’s not like that. Eating cholesterol-rich foods also increases the risk of heart disease for people with low blood cholesterol.

7) Should vegetarian meals be supplemented with calcium or iron?

It’s not like that. Reducing protein intake results in less calcium in the urine (50% reduction), so vegetarians have less osteoporosis. And people who eat vegetarian foods do not come up with iron deficiency. Vitamin C has the effect of improving the absorption of iron.

8) Is “Cholesterol Free” food really free of cholesterol?

You will often see cookies or food that says “No Cholesterol.” However, these foods do not have cholesterol, but often contain a lot of saturated fat, and these saturated fats are converted into cholesterol in the body, so be careful.

9) If you eat vegetarian-based meals, do you think you are deficient in protein?

If you are concerned about protein deficiency, you can eat egg whites or skim milk. For reference, egg whites do not have cholesterol at all. Skim milk or yogurt is low in fat and can be a good source of vitamins.

For reference, 50% of milk calories are usually from fat, and even low-fat milk comes with 38% of calories.

10) How healthy is fiber and how much should I eat?

Complex carbohydrates are high in fiber and contain a lot of vitamins and minerals. Eating more grains, brown rice, vegetables, and fruits has been shown to reduce LDL cholesterol and reduce cardiovascular disease. Ingestion of fiber also makes you feel fuller, which can help you lose weight.

2. Frequently Asked Questions About Exercise Therapy

1) Which muscle strength exercise or aerobic exercise is best to prevent vascular disease?

In order to prevent vascular disease, strength exercise and aerobic exercise are performed in parallel. For people with vascular disease, high intensity exercise can be dangerous. Strength training compresses peripheral arterial blood vessels, increasing overall peripheral resistance and decreasing muscle perfusion. To restore muscle perfusion, the sympathetic nervous system becomes more active and cardiac output increases, increasing blood pressure. The response of the increase in blood pressure to this strength exercise is proportional to the exercise intensity and the muscle mass used. Therefore, high-strength strength training can be dangerous in people with high blood pressure or cardiovascular disease who have never had strength training, and low-power rhythmic strength training can reduce risk and increase health-related effects. These aerobic exercises include walking, biking, jogging, yoga, swimming and jumping rope. The easiest thing to do is to walk. Above all, walking is a movement in which bones, muscles, and nerves all work in harmony, which also helps blood circulation. It’s best to walk at least 30 minutes 3-4 times a week to see the effects.

2) Can excessive exercise be dangerous for vascular health?

Regular exercise helps to maintain blood vessel health, but excessive exercise that does not take into account your physical condition can harm your health. Particularly in the case of poor blood vessel health, excessive exercise can increase blood pressure, which is dangerous. Every type of exercise raises blood pressure, which depends on the type of exercise. Exercise can be divided into aerobic exercise such as walking, biking and yoga, and anaerobic exercise such as short distance running, weightlifting and sit-ups. In particular, anaerobic exercise is an exercise that requires explosive energy in a short time without oxygen and can excite the sympathetic nerves and give pressure to blood vessels. Therefore, if the vascular health is not good, exercise that can be practiced steadily without great effort is good. Rather than exercising too hard, you can lower your blood pressure and blood sugar by exercising lightly for 30 minutes a day or at least four days a week. Even if you spend more than 30 minutes in total, you can do the same, so if you don’t have time, it’s a good idea to use your spare time.

3. Other Questions About Angina

1) Do you have angina or myocardial infarction as you get older?

As you age, your risk of developing angina or myocardial infarction increases, so it is important to manage and treat other risk factors (hypertension, diabetes, hyperlipidemia, smoking, family history, etc.) or if you have typical symptoms. Traditional risk factors for cardiovascular disease, including angina or myocardial infarction, can be divided into controllable and uncontrollable factors. Factors that can be controlled include hypertension, diabetes, hyperlipidemia, and smoking. Factors that can’t be controlled include family history, sex, and age of coronary artery disease at a relatively young age. In other words, the development of angina or myocardial infarction increases with age, which is due to structural and functional changes in blood vessels. In other words, as age increases, blood vessels become harder, lose elasticity, and diminished ability to expand blood vessels, resulting in increased risk of vascular disease. In addition, as the age increases, the traditional risk factors for the controllable cardiovascular diseases listed above. In other words, the prevalence of hypertension, diabetes, hyperlipidemia, etc. increases, which increases the risk of vascular disease. Eventually, the effects of aging on the blood vessels themselves and other risk factors added to them increase the risk of vascular accidents such as angina pectoris and myocardial infarction. On the other hand, in older age after the age of 70, women have a higher incidence of cardiovascular disease. The increased incidence of cardiovascular disease in women at this time is due to the significant reduction of female hormone secretion due to menopause. Estrogens help protect the heart by balancing bad cholesterol (LDL cholesterol) and good cholesterol (HDL cholesterol) levels. When estrogen secretion decreases, the levels of good cholesterol (HDL cholesterol), which prevents atherosclerosis, drop dramatically and blood pressure This is going to cause vascular health problems.

2) Are smoking and drinking important for developing angina?

Smoking and excessive drinking are bad habits for the prevention and management of geriatric diseases, which have a detrimental effect on risk factors for cardiovascular disease, and in particular, smoking directly or indirectly increases the risk of coronary artery disease, including angina. However, for a small amount of drinking, a clear causal relationship with angina has not yet been identified. Angina is a disease caused by an imbalance between the amount of oxygen needed by the heart and the amount of oxygen actually supplied. Atherosclerosis is the most common and important cause of this, and smoking is a very important factor that makes arteriosclerosis worse. Because smoking causes and increases the inflammatory response, which plays the most important role in the progression of atherosclerosis, as well as the toxicity of smoking itself, it is the decisive role in inducing angina by causing a decrease in the internal diameter of the vessels due to the increase of atherosclerotic plaques called plaques. Will be It also affects the stability of plaque, which is known to contribute to inducing acute coronary syndrome because smoking plays an important role in the progression of fragile plaques that tend to rupture under stable plaque conditions. In the case of drinking alcohol, it has been suggested in the past that an adequate amount of drinking would benefit cardiovascular disease. It has been argued that certain alcohols in certain regions, such as the French paradox, play a role in reducing cardiovascular events. However, the findings are limited to a few studies, and overall there is no evidence that a modest amount of drinking plays a positive role in preventing or treating cardiovascular events. Alcohol is decomposed in the body and converted into acetaldehyde, a toxic substance associated with various side effects. The acetaldehyde is decomposed in the body by an enzyme called acetaldehyde dehydrogenase, which is known to have many variations in acetaldehyde dehydrogenase. It is reported up to approximately 50%. In these variants, enzyme function decreases, causing acetaldehyde to accumulate in the body, which in turn can cause spasm in the coronary arteries. There are many reports that people who have excessive side effects after drinking alcohol should avoid excessive drinking. In conclusion, smoking is a very important risk factor for developing angina, and drinking may also contribute to cardiovascular events, including angina, in some people.