Treatment protocols for coronary heart disease and arrhythmias: prevention and treatment of angina pectoris and tachycardia, along with general medical knowledge.

Middle-aged men with coronary heart disease should adopt comprehensive treatment measures, including appropriate physical activity, a reasonable diet, and active treatment of related diseases such as hypertension, diabetes, and hyperlipidemia. For patients experiencing angina, arrhythmia, myocardial infarction, or heart failure, appropriate medications should be selected based on their specific conditions, and necessary treatment measures should be taken. There are increasingly more medications available to stop angina attacks. In addition to sublingual nitroglycerin, tablets, patches, capsules, and sustained-release tablets of isosorbide dinitrate (Isosorbide dinitrate), isosorbide mononitrate (Lunan Xinkang, Long-acting Nifedipine-20), and nifedipine (Nifedipine) are available. Other options include diltiazem (Tian Er Xin, Thiazide), Suhexiang pills, and Di'ao Xinxuekang, or nifedipine pills and quick-acting nifedipine pills. Inhalation of muscarine aerosol and nifedipine inhalers are also effective. To prevent angina attacks, medications such as pentylenetetrazol (long-acting nitroglycerin), compound nitroglycerin, isosorbide dinitrate, nifedipine, verapamil, and dipyridamole can be selected based on the patient's condition. For variant angina, often caused by coronary artery spasm, nifedipine or verapamil are more suitable. For angina accompanied by a rapid heart rate, propranolol can be used. Hyperbaric oxygen therapy, using a gas mixture containing 80% oxygen at 2 atmospheres absolute pressure, can also be used to treat coronary heart disease. Intravenous infusion of dextran 40 (low molecular weight dextran) also has some efficacy. Variant angina is a special type of angina, mostly caused by coronary artery spasm, without a fixed narrowing or blockage of the coronary arteries themselves. Patients with variant angina are prone to acute myocardial infarction; therefore, middle-aged men should pay attention to the treatment of variant angina. For middle-aged men experiencing variant angina, nitroglycerin 0.3–0.6 mg can be administered sublingually. If relief is not achieved after 5–10 minutes, nitroglycerin can be repeated once. Alternatively, nifedipine (Adalat) 10 mg can be chewed and dissolved sublingually. For recurrent attacks or those accompanied by arrhythmias, verapamil (Isoptin) 5 mg can be considered, administered intravenously in 20–40 ml of 10% glucose solution. For patients with frequent variant angina attacks, taking verapamil, Adalat, etc., can prevent, alleviate, or even eliminate coronary artery spasm. Enteric-coated aspirin, dipyridamole (Persantine), etc., can also help prevent coronary artery thrombosis and acute myocardial infarction. A heart rate exceeding 100 beats per minute is defined as tachycardia. Common types of tachycardia include sinus tachycardia, paroxysmal supraventricular tachycardia, supraventricular tachycardia, atrial tachycardia, and ventricular tachycardia. Sinus tachycardia is often caused by fever, emotional excitement, hyperthyroidism, etc. If the underlying cause is treated, sinus tachycardia can be largely cured, or sedatives or tranquilizers may be used. Paroxysmal supraventricular tachycardia is characterized by sudden onset and repeated episodes. If left untreated, it can lead to heart failure; therefore, frequent and prolonged episodes often require emergency treatment. For tachycardia, oxygen inhalation is usually administered first to stimulate the throat, inducing nausea and vomiting. Alternatively, the patient can be instructed to take a deep breath, hold it as long as possible, and then forcefully exhale when the breath becomes unbearable. This usually stops the episode in most patients. When the above methods are ineffective, the patient's blood pressure should be closely monitored to prevent hypotension, and a doctor should be consulted promptly. Treatment options may include verapamil (Isoptin), digoxin (Digitalis), propranolol (Inderal), or amiodarone (Amiodarone). If drug treatment is ineffective, synchronized direct current cardioversion may be used if conditions permit. To prevent recurrence, radiofrequency ablation is currently recommended, which involves ablating the accessory pathway system causing paroxysmal supraventricular tachycardia to terminate the episode. Ventricular tachycardia is a serious arrhythmia that can develop into ventricular fibrillation and sudden death. Once a diagnosis is confirmed, close monitoring and aggressive treatment are essential. In patients with acute myocardial infarction, the presence of paroxysmal ventricular tachycardia indicates a serious condition with the potential for sudden change. Lidocaine or procainamide should be administered immediately, and further emergency treatment should be prepared before the patient is promptly transported to the hospital for emergency treatment.