A few nights ago, an emergency patient in his fifties arrived at the emergency department, clutching his upper abdomen and complaining of "stomach pain" that had persisted for two days. Initially, the pain was intermittent, coming in waves. He assumed it was a recurrence of his longstanding stomach ailment and self-treated with some stomach medication, hoping to tough it out.
The next day, the pain intensified, and he began to sweat profusely, feeling chest tightness and congestion. Only then did he hurry to the hospital. Upon performing an electrocardiogram, it was diagnosed as acute myocardial infarction.
Even after being diagnosed, he still couldn't believe it: "I clearly had a stomachache, how could it be a heart attack?"
Actually, when this patient first started experiencing paroxysmal upper abdominal pain two days ago, it was likely already an episode of angina pectoris - the first "alarm" sent by the body. Unfortunately, he mistook it for a stomach ailment and ignored it, ultimately leading to a fatal myocardial infarction.
What is the relationship between coronary heart disease, angina pectoris, and myocardial infarction? What is the difference between angina pectoris and myocardial infarction? Professor Zheng Yin, Vice President of Hainan Chengmei Hospital and a cardiovascular expert, will explain it all in one go!
I. First, let's clarify the relationship: the big tree, its branches, and the fruits
Many people mistakenly believe that angina pectoris is coronary heart disease, or that myocardial infarction is a severe form of coronary heart disease. While these beliefs are not incorrect, they are not entirely accurate.
In simple terms: Coronary heart disease is the "root cause", while angina pectoris and myocardial infarction are the "different fruits" that grow from this root.
Coronary heart disease (CHD) is a broad category. It refers to problems with the "coronary artery" that supplies blood to the heart - plaques form on the artery wall, causing narrowing of the lumen and impeded blood flow. As long as this "disease root" exists, whether you feel it or not, it is considered CHD.
Both angina pectoris and myocardial infarction are acute manifestations triggered by this underlying condition at varying degrees of severity.
To illustrate, consider the coronary artery as a water pipe supplying water to the heart. Coronary heart disease is akin to rust and scale (plaque) buildup on the pipe wall, narrowing the pipeline. Angina pectoris is akin to a temporary shortage of water flow (such as during peak water usage), but the pipe is not completely blocked. By turning down the faucet, the water flow can be restored. Myocardial infarction, on the other hand, is akin to the pipe being completely blocked, preventing any water from passing through. Consequently, the downstream machinery (myocardium) begins to "burn out" (necrosis) due to lack of water.
This is the relationship among the three: coronary heart disease is the "background", while angina pectoris and myocardial infarction are the "events".
II. What is the difference between angina pectoris and myocardial infarction?
This is the most common confusion among people. The core difference lies in two points: whether the ischemia is temporary and whether the myocardial necrosis occurs.
Temporary "warning signals" of angina pectoris
Vascular status: Severe stenosis of the coronary artery but not completely blocked, or temporary spasm. The blood flow is merely "insufficient", not "interrupted".
Myocardial injury: Myocardial ischemia is temporary and reversible, without causing myocardial cell necrosis.
Pain characteristics: a sense of pressure, dull pain, and constriction in the chest, like being weighed down by a heavy object. It may also manifest as upper abdominal pain, toothache, and shoulder soreness, just like the brother mentioned - atypical symptoms are the most deceiving. It usually lasts for 3-5 minutes, rarely exceeding 15 minutes.
Relief method: After resting or taking nitroglycerin sublingually, relief can be significantly achieved within a few minutes.
Consequences: Angina pectoris itself is not directly fatal, but it serves as a red alert from the body, indicating that the coronary artery stenosis has reached a certain degree. If left unintervened, it will inevitably progress to myocardial infarction.
Myocardial infarction - a fatal "disaster event"
Vascular status: Complete occlusion of the coronary artery (usually due to thrombosis following plaque rupture), resulting in complete interruption of blood flow.
Myocardial injury: When myocardial ischemia persists for more than 20 minutes, irreversible necrosis begins to occur. The longer the duration, the larger the extent of necrosis.
Pain characteristics: Severe crushing pain, like a heavy rock pressing on the chest, or like the severe "stomachache" accompanied by heavy sweating and a sense of chest tightness and congestion as in the case of the elder brother. It persists for more than 20 minutes, or even several hours without relief.
Relief methods: Rest or sublingual administration of nitroglycerin is basically ineffective. Accompanying symptoms: profuse sweating, nausea and vomiting, difficulty breathing, dizziness and fatigue, and even a strong sense of impending doom.
Consequences: This is a life-threatening emergency. Failure to seek immediate medical attention can lead to malignant arrhythmias, heart failure, and even sudden death.
Summary: Angina pectoris is an "alarm", while myocardial infarction is a "disaster". If the alarm is ignored, the disaster will come sooner or later.
III. Can angina pectoris turn into myocardial infarction?
Yes, it is quite common. The initial case mentioned by the elder brother serves as the most typical example - transitioning from paroxysmal "stomach pain" (angina pectoris) to persistent severe "stomach pain" accompanied by profuse sweating (myocardial infarction).
Angina pectoris itself is "ironclad evidence" that the coronary artery has become significantly narrowed. If you continue to disregard it after experiencing angina pectoris - by continuing to smoke, taking medication irregularly, and not controlling the "three highs" (high blood pressure, high blood sugar, and high cholesterol) - the narrowing of the blood vessels will continue to worsen. What's even more alarming is that those "soft plaques" on the blood vessel wall may suddenly rupture one day, instantly inducing thrombosis and completely blocking the blood vessel. This is a myocardial infarction.
Therefore, angina pectoris is the last "decent" warning signal your body gives you. If you seek medical attention at this time, it may only require intensive medication and lifestyle intervention; however, if you delay treatment and it progresses to myocardial infarction, you will face the challenges of emergency rescue, stent implantation, and even a life-and-death situation.
Remember: If you experience frequent episodes of angina, it is essential to seek evaluation from a cardiologist as soon as possible. Do not just "hold back" and hope it goes away!
IV. How to identify myocardial infarction? Call 120 immediately if you notice 3 signals!
If any of the following situations occur, it is highly suspected to be a myocardial infarction. Do not hesitate, do not hold on, and do not drive yourself to the hospital. Immediately call 120!
Signal 1: Characteristics of pain
Severe crushing pain and constriction in the chest, like being pressed down by a huge rock, with pain radiating to the left shoulder, back, chin, and even the inner side of the left arm. Or it may manifest as severe "stomach pain", "toothache", or "tightness in the throat" - atypical symptoms that require greater vigilance! The pain persists for more than 20 minutes without relief, and taking nitroglycerin orally is also ineffective.
Signal 2: Accompanying Symptoms
While experiencing chest pain, one may suddenly break out in a cold sweat (with the whole body wet and cold), feel nauseous and vomit, have difficulty breathing, feel dizzy and fatigued, and even have a sense of impending doom, as if "they are about to pass away".
Signal 3: Atypical manifestations in special populations
Be especially vigilant! Some elderly people, diabetics, and women may experience no pain at all when a myocardial infarction occurs. Instead, they may exhibit atypical symptoms such as sudden shortness of breath, extreme weakness, cold sweat, or inexplicable palpitations, nausea, and upper abdominal discomfort. These symptoms are often mistaken for "stomach problems" or "excessive fatigue," which can easily delay emergency treatment!
Lastly, let me emphasize once again that there is a "golden time window" for myocardial infarction rescue, specifically within the "golden 120 minutes" after onset - this is the optimal period for opening blood vessels and saving myocardial tissue. Every minute of delay results in the death of a large number of myocardial cells, which are non-renewable.
Seeking medical attention one minute earlier can bring one more chance of survival and reduce the likelihood of sequelae!
Expert Introduction
Zheng Yin, Chief Physician
Vice President, Professor
Master's supervisor, scholar studying in the United States
Outstanding experts with outstanding contributions in Hainan Province
Medical expertise
Specialized in the prevention, diagnosis, treatment, rehabilitation, and health management of cardiovascular and cerebrovascular diseases as well as geriatric diseases. Conduct cardiac rehabilitation for patients with hypertension, coronary heart disease, arrhythmia, heart failure, metabolic syndrome, post-stent implantation, and post-bypass surgery, including guidance on medication, exercise, nutrition, and sleep disorders.