概述

心脏病描述的是一系列影响您心脏的病症。心脏病包括:

  • 血管疾病,如冠状动脉疾病
  • 心律问题(心律失常)
  • 出生时就存在的心脏缺陷(先天性心脏缺陷)
  • 心脏瓣膜病
  • 心肌疾病
  • 心脏感染

许多形式的心脏病可通过健康的生活方式进行预防或治疗。

症状

心脏病症状因心脏病类型不同而异。

血管中的心脏病症状

脂肪斑块在动脉中堆积,即动脉粥样硬化,可能损伤血管和心脏。斑块堆积可引起血管狭窄或阻塞,导致心脏病发作、胸部疼痛(心绞痛)或脑卒中。

冠状动脉疾病的症状可能会因性别而异。例如,男性更容易出现胸部疼痛。女性则更有可能出现伴随胸部不适的其他体征和症状,例如气短、恶心和极度疲劳。

体征和症状可能包括:

  • 胸部疼痛、胸部紧迫感、胸闷和胸部不适(心绞痛)
  • 气短
  • 当腿部和手臂的血管变窄时,这些身体部位会出现疼痛、麻木感、无力或发冷
  • 颈部、颚、咽喉、上腹部或背部疼痛

可能直到出现心脏病发作、心绞痛、卒中或心力衰竭,才诊断出冠状动脉疾病。请务必注意心血管症状,并与医生讨论您担心的问题。心血管疾病有时可通过定期评估及早发现。

What is coronary artery disease? A Mayo Clinic cardiologist explains.

Stephen Kopecky, M.D., talks about the risk factors, symptoms and treatment of coronary artery disease (CAD). Learn how lifestyle changes can lower your risk.

{Music playing}

Stephen Kopecky, M.D., Cardiovascular Disease, Mayo Clinic: I'm Dr. Stephen Kopecky, a cardiologist at Mayo Clinic. In this video, we'll cover the basics of coronary artery disease. What is it? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available.

Coronary artery disease, also called CAD, is a condition that affects your heart. It is the most common heart disease in the United States. CAD happens when coronary arteries struggle to supply the heart with enough blood, oxygen and nutrients. Cholesterol deposits, or plaques, are almost always to blame. These buildups narrow your arteries, decreasing blood flow to your heart. This can cause chest pain, shortness of breath or even a heart attack. CAD typically takes a long time to develop. So often, patients don't know that they have it until there's a problem. But there are ways to prevent coronary artery disease, and ways to know if you're at risk and ways to treat it.

Who gets it?

Anyone can develop CAD. It begins when fats, cholesterols and other substances gather along the walls of your arteries. This process is called atherosclerosis. It's typically no cause for concern. However, too much buildup can lead to a blockage, obstructing blood flow. There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease. First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup. Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you're at a greater risk. All these factors together can paint a picture of your risk for developing CAD.

What are the symptoms?

When coronary arteries become narrow, the heart doesn't get enough oxygen-rich blood. Remember, unlike most pumps, the heart has to pump its own energy supply. It's working harder with less. And you may begin to notice these signs and symptoms of pressure or tightness in your chest. This pain is called angina. It may feel like somebody is standing on your chest. When your heart can't pump enough blood to meet your body's needs, you might develop shortness of breath or extreme fatigue during activities. And if an artery becomes totally blocked, it leads to a heart attack. Classic signs and symptoms of a heart attack include crushing, substernal chest pain, pain in your shoulders or arms, shortness of breath, and sweating. However, many heart attacks have minimal or no symptoms and are found later during routine testing.

How is it diagnosed?

Diagnosing CAD starts by talking to your doctor. They'll be able to look at your medical history, do a physical exam and order routine blood work. Depending on that, they may suggest one or more of the following tests: an electrocardiogram or ECG, an echocardiogram or soundwave test of the heart, stress test, cardiac catheterization and angiogram, or a cardiac CT scan.

How is it treated?

Treating coronary artery disease usually means making changes to your lifestyle. This might be eating healthier foods, exercising regularly, losing excess weight, reducing stress or quitting smoking. The good news is these changes can do a lot to improve your outlook. Living a healthier life translates to having healthier arteries. When necessary, treatment could involve drugs like aspirin, cholesterol-modifying medications, beta-blockers, or certain medical procedures like angioplasty or coronary artery bypass surgery.

What now?

Discovering you have coronary artery disease can be overwhelming. But be encouraged. There are things you can do to manage and live with this condition. Reducing cholesterol, lowering blood pressure, quitting tobacco, eating healthier, exercising and managing your stress can make a world of difference. Better heart health starts by educating yourself. So don't be afraid to seek out information and ask your doctors about coronary artery disease. If you'd like to learn even more about this condition, watch our other related videos or visit Mayoclinic.org. We wish you well.

心跳异常(心律不齐)引起的心脏病症状

您的心跳可能过快、过慢或不规则。心律失常的体征和症状可能包括:

  • 胸部颤动
  • 心跳加快(心动过速)
  • 心跳缓慢(心动过缓)
  • 胸部疼痛或不适
  • 气短
  • 头重脚轻
  • 头晕
  • 昏厥(晕厥)或接近昏厥

由心脏缺陷引起的心脏病症状

出生时就有的严重心脏缺陷(先天性心脏缺陷)通常在出生后不久就会被发现。儿童心脏缺陷体征和症状可能包括:

  • 皮肤呈灰白或蓝色(发绀)
  • 腿部、腹部或眼部周围区域肿胀
  • 婴儿在进食过程中出现气短,导致体重增长缓慢

不太严重的先天性心脏缺陷往往直到童年后期或成年期间才得以诊断。通常不会立即危及生命的先天性心脏缺陷的体征和症状包括:

  • 运动或活动中很容易出现呼吸短促
  • 运动或活动中很容易疲劳
  • 手、脚踝或脚肿胀

由心肌病变(心肌病)引起的心脏病症状

在心肌病早期,您可能没有症状。随着状况加重,症状可能包括:

  • 活动或休息时呼吸困难
  • 腿部、脚踝和足部肿胀
  • 疲劳
  • 不规律心跳,感觉心跳加速、剧烈或颤动
  • 头晕、头重脚轻和昏厥

心脏瓣膜问题(心脏瓣膜病)引起的心脏病症状

心脏有四个瓣膜,主动脉瓣、二尖瓣、肺动脉瓣和三尖瓣,通过打开和闭合引导血液流过心脏。许多因素可能会损害心脏瓣膜,导致其变窄(狭窄)、渗漏(反流或闭合不全)或闭合不当(脱垂)。

根据不能正常发挥功能的瓣膜类型,心脏瓣膜病的体征和症状一般包括:

  • 疲劳
  • 气短
  • 心律不齐
  • 足部或踝部肿胀
  • 胸部疼痛
  • 昏厥(晕厥)

何时就诊

如果您出现以下这些心脏病体征和症状,请寻求急救医疗服务:

  • 胸部疼痛
  • 气短
  • 昏厥

如果您认为自己可能心脏病发作,务必致电 911 或紧急医疗救助。

心脏病在早期发现时更容易治疗,因此请告诉医生您对心脏健康的担忧。如果担心发生心脏病,请告诉医生您能够采取哪些措施降低患心脏病的风险。如果您有心脏病家族史,这点尤其重要。

根据出现的新体征或症状,如果您觉得自己可能患有心脏病,请进行约诊。

病因

心脏病的病因取决于具体的心脏病类型。心脏病有多种不同类型。要了解心脏病的病因,需要了解心脏如何工作。

心脏工作原理

您的心脏是一台泵。它是一个约拳头大小的肌肉器官,位于胸部中间偏左的位置。您的心脏分为左右两部分。

  • 心脏右侧由右心房和右心室组成,通过肺动脉将血液泵至肺部。
  • 肺部给血液补充新鲜氧气。肺部同时还呼出废弃物二氧化碳。
  • 富氧血随后进入由左心房与心室组成的左侧心脏。
  • 心脏左侧通过主动脉(体内最大动脉)泵出血液,为全身组织提供氧气和营养物质。

心脏瓣膜

四个心脏瓣膜仅在需要时朝同一方向打开,从而使血液以正确方式流动。为正常发挥功能,瓣膜须形态完好,朝同一方向打开,闭合时则紧密无渗漏。四个瓣膜为:

  • 三尖瓣
  • 二尖瓣
  • 肺动脉瓣
  • 主动脉瓣

心跳

跳动的心脏处于不停的挤压(收缩)与扩张循环中。

  • 在收缩过程中(收缩期),心室挤压得很紧,迫使血液进入连通肺部和身体其他组织器官的血管。
  • 在扩展过程中(舒张期),心室充满来自上部腔室(左右心房)的血液。

电生理系统

心脏的“电线”使心脏保持搏动,从而控制富氧血与缺氧血不断交换。这种交换维持着人类生命。

  • 电信号首先在右上腔(右心房)上部产生,然后通过特定的路径到达心室,从而传递信号使心脏收缩泵血。
  • 该系统使心脏以正常、协调的节律保持跳动,同时维持血液流动。

冠状动脉疾病的病因

动脉中脂肪斑块的积聚(动脉粥样硬化)是冠状动脉疾病的最常见原因。不健康的生活方式,例如不良饮食、缺乏运动、体重超重和抽烟,可能导致动脉粥样硬化。

心律不齐的诱因

心律失常或导致心律失常病症的常见原因包括:

  • 冠状动脉疾病
  • 糖尿病
  • 药物滥用
  • 过度使用酒精或咖啡因
  • 出生时就存在的心脏缺陷(先天性心脏缺陷)
  • 高血压
  • 吸烟
  • 某些非处方药、处方药、膳食补充剂和草药
  • 压力
  • 瓣膜性心脏病

对于一个拥有正常健康心脏的健康人来说,如果没有电击或使用非法药物等外部诱因,不太可能发生致死性心律失常。但是,患病或畸形心脏可能无法正常发出电信号,或电信号无法穿过心脏,从而增大发生心律失常的可能性。

先天性心脏缺陷的病因

先天性心脏缺陷通常发生于胎儿出生前。怀孕后一个月左右,心脏缺陷会随着心脏发育而出现,心脏的血流随之改变。心脏缺陷的致病原因可能包括某些医学病症、药物和基因。

心脏缺陷也可出现在成人身上。随着年龄的增长,心脏结构会发生变化,继而导致心脏缺陷。

心肌病的诱因

心肌病、心肌增厚或肥大的诱因可能取决于下列疾病类型:

  • 扩张型心肌病。这种最常见的心肌病类型的诱因往往是未知的。这种疾病常常导致左心室扩大。扩张型心肌病可能由心脏病发作、感染、毒素和特定药物(包括治疗癌症的药物)产生的损伤导致的心脏血流减少(缺血性心脏病)引起。也可能遗传自父母一方。
  • 肥厚型心肌病。这种类型的心肌病通常是家族遗传病,也可能会随时间推移因高血压或衰老而出现。
  • 收缩型心肌病。这种最不常见的心肌病类型可以由未知原因引起,会导致心肌变硬且弹性降低。它也可能由结缔组织病或异常蛋白质积聚(淀粉样变性)等疾病引起。

心脏感染的原因

当细菌接触心肌时,会导致心脏感染,例如心内膜炎。心脏感染最常见诱因包括:

  • 细菌
  • 病毒
  • 寄生虫

心脏瓣膜病的病因

许多因素都可导致心脏瓣膜病。您可能出生就伴有瓣膜性疾病,或瓣膜可能受到医疗状况损伤,例如:

  • 风湿热
  • 感染(感染性心内膜炎)
  • 结缔组织病

风险因素

导致心脏病的风险因素包括:

  • 年龄。年龄增长会增大发生动脉损伤和狭窄以及心肌变弱或增厚的风险。
  • 性别。一般情况下,男性患心脏病的风险更大。女性在绝经后患心脏病的风险会增加。
  • 家族史。心脏病家族史会增加患冠状动脉疾病的风险,特别是在父母中有一方在早年就患有心脏病的情况下(兄弟或父亲等男性亲属在 55 岁之前患病;母亲或姐妹等女性亲属在 65 岁之前患病)。
  • 抽烟。尼古丁可收缩血管,一氧化碳可损伤血管内皮,使它们更容易发生动脉粥样硬化。心脏病发作在抽烟者中比在非抽烟者中更为常见。
  • 不良饮食。高脂肪、高盐、高糖和高胆固醇饮食可能导致心脏病发作。
  • 高血压。未经控制的高血压可能引起动脉变硬和变厚,从而致使让血流通过的血管变窄。
  • 高血胆固醇水平。血液中的高胆固醇水平可能增大斑块形成和动脉粥样硬化的风险。
  • 糖尿病。糖尿病可增大患心脏病的风险。这两种状况有着相似的风险因素,例如肥胖症和高血压。
  • 肥胖症。体重超重通常会加剧其他心脏病风险因素。
  • 缺乏运动。缺乏运动也与许多形式的心脏病及其某些其他风险因素有关。
  • 压力。压力若得不到缓解,可能会损伤血管,并加剧其他心脏病风险因素。
  • 牙齿健康状况差。一定要经常刷牙并用牙线清洁牙齿和牙龈,并定期检查牙齿。如果牙齿和牙龈不健康,病菌可能进入血液并进入心脏,引起心内膜炎。

并发症

心脏病的并发症包括:

  • 心力衰竭。心力衰竭是心脏病最常见的并发症之一,当心脏不能泵出足够血液来满足身体的需要时就会发生。心力衰竭可由许多形式的心脏病引起,包括心脏缺陷、心血管疾病、瓣膜性心脏病、心脏感染或心肌病。
  • 心脏病发作。如果血凝块在为心脏提供营养的血管中阻断血流,会引起心脏病发作,并可能损伤或破坏部分心肌。动脉粥样硬化可导致心脏病发作。
  • 卒中。导致心血管疾病的风险因素也可引起缺血性脑卒中,当通向大脑的动脉变窄或被阻塞,从而导致脑供血不足时会发生这类卒中。卒中是一种急症,在发生卒中的短短几分钟内脑组织就开始死亡。
  • 动脉瘤。动脉瘤是可能发生在身体任何部位的一种严重并发症,表现为动脉壁的凸起。动脉瘤破裂可能会导致危及生命的内部出血。
  • 外周动脉疾病。如果罹患外周动脉疾病,四肢(通常是腿部)往往出现供血不足。这会引起一些症状,最明显的是走路时腿痛(跛行)。动脉粥样硬化也可引起外周动脉疾病。
  • 心搏骤停。突发性心搏骤停表现为心脏功能、呼吸和意识的突然意外丧失,经常由心律失常引起。心搏骤停属于一种急症,如不及时治疗,会导致心源性猝死。

预防

某些类型的心脏病(例如心脏缺陷)无法预防。但是,可以缓解心脏病的生活方式改变也可能有助于预防心脏病,包括:

  • 请勿抽烟。
  • 控制其他健康状况,例如高血压、高胆固醇和糖尿病。
  • 每周尽量做到大多数日子至少运动 30 分钟。
  • 保持低盐和低饱和脂肪饮食。
  • 保持健康体重。
  • 减少和管理压力。
  • 养成良好的卫生习惯。

在 Mayo Clinic 治疗

Aug. 29, 2022
  1. What is cardiovascular disease? American Heart Association. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease. Accessed Oct. 30, 2020.
  2. Heart-healthy living. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-healthy-living. Accessed Oct. 30, 2020.
  3. Riggin EA. Allscripts EPSi. Mayo Clinic. Oct. 24, 2020.
  4. Ferry AV, et al. Presenting symptoms in men and women diagnosed with myocardial infarction using sex-specific criteria. Journal of the American Heart Association. 2019; doi:10.1161/JAHA.119.012307.
  5. Symptoms, diagnosis and monitoring of arrhythmia. American Heart Association. https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis--monitoring-of-arrhythmia#.WQ0yvWnyt0w. Accessed Oct. 30, 2020.
  6. Overview of congenital cardiovascular anomalies. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/overview-of-congenital-cardiovascular-anomalies. Accessed Oct. 30, 2020.
  7. Congenital heart defects. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/chd. Accessed Oct. 30, 2020.
  8. What is cardiomyopathy? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/cm#. Accessed Oct. 30, 2020.
  9. What is heart inflammation? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-inflammation#. Accessed Oct. 30, 2020.
  10. Heart failure. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-failure. Accessed Nov. 17, 2020.
  11. Bonow RO, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Oct. 30, 2020.
  12. Grundy SM, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; doi:10.1161/CIR.0000000000000625.

相关

Mayo Clinic 新闻