冠心病『狹心症』的認識與預防
From Dr Andrew To, Cardiologist, WDHB
認識冠心病 (冠狀動脈疾病)
Understanding Coronary Artery Disease
心血管疾病（冠心病，中風和其他血管疾病）是新西蘭人死亡的主要原因，佔每年死亡人數的40％。每90分鐘就有一個新西蘭人死於冠狀動脈疾病（每天16人死亡）；這當中有許多是過早及可預防的。
Cardiovascular disease (heart, stroke and blood vessel disease) is the leading cause of death in New Zealand, accounting for 40% of deaths annually. Every 90 minutes, a New Zealander dies from coronary heart disease (16 deaths a day). Many of these deaths are premature yet preventable.
心臟肌肉把血液輸送到我們的身體，提供氧氣和營養物質。萬一心臟功能出錯，身體其他部位也會受影響，這就是好好照顧我們心臟的原因 。
The heart muscle pumps blood around our body. The blood provides oxygen and nutrients. If something is wrong with your heart it can affect other parts of your body, which is why it’s important to look after your heart.
心臟是如何運作？
How does our hearts work?
Picture from Wikipedia.org
我們的心臟位於左肺和右肺之間的胸腔 。心臟肌肉不斷輸送血液到身體各部分。心臟可以分為兩邊； 右心輸送血液到肺部，左心輸送血液到身體其他各部位，包括腦，內臟及四肢。心臟每邊再分為兩部分；心房收集血液，心室泵出血液。
Our heart is located in the centre of the chest, between the right and left lungs, under the ribcage. There are two sides to the heart (left and right). The right heart pumps blood to the lungs, whereas the left heart pumps blood to the rest of the body, including the brain, guts and the limbs. Each side of the heart is further divided into two chambers, hence four chambers in total. The atria collect blood. The ventricles contract and pump blood out.
心肌與心瓣的正常的運作依靠冠狀動脈提供養分，以及心臟傳導系統協調心房和心室將血液泵送。
The normal functioning of the heart muscle and valves rely on the normal functioning of the coronary arteries that provide blood supply and nutrients. The conduction system coordinates the pumping of blood in the atria and the ventricles.
冠狀動脈從主動脈分支出來，是主動脈第一個分支。兩條冠狀動脈環繞心臟的外圍，像一頂王冠一樣。左主冠狀動脈再分為左前降冠狀動脈和左迴旋冠狀動脈，供應血液到大部分的左心室。右冠狀動脈供應的右心室和心臟底部。
Coronary arteries branch off the aorta, which is the main artery taking blood away from the heart to the rest of the body. The coronary arteries are the first branches off the aorta. The two coronary arteries wrap around the heart like a crown, hence the name “coronary”. The left main coronary artery gives rise to the left anterior descending artery and the left circumflex artery, supplying the majority of the left ventricle; while the right coronary artery supplies the right ventricle and the underside of the heart.
影片連結 VRI
影片連結 VRI arteries
冠心病 / 缺血性心臟病 / 狹心症
Coronary artery disease
冠狀動脈血管內徑因動脈硬化變狹小，供應心臟的血流量便減少，供氧量與需氧量無法達到平衡時，便會造成心肌缺血而對心臟造成傷害。這就是冠心病。
Coronary artery disease results from the narrowing of the internal diameter of the coronary arteries. The process is called atherosclerosis. This limits the blood supply to heart, so that oxygen supply cannot match the oxygen demand of the heart.
動脈粥樣硬化影響整個身體的動脈。當動脈硬化發生於頭頸動脈時，它可以引起中風。當動脈硬化發生於腎臟動脈時，它可能會導致腎功能衰竭。當動脈硬化發生於腿部，它會導致周圍血管疾病。
Atherosclerosis occurs in the arteries throughout the body. When atherosclerosis occurs in the head and neck arteries, it can cause stroke. When it occurs in the renal arteries, it may cause kidney failure. When it occurs in the legs, it causes peripheral vascular disease.
冠心病診斷與治療
Diagnosis and Treatment of coronary artery disease
認識冠狀動脈疾病的徵兆是最為重要。來自心臟的疼痛，可能是胸部的不適或疼痛，或是手臂，下巴，肩膀，甚至頸部的不適；很多人描述為一個壓力感或燒灼感。有很多病人的症狀可能是很輕微的， 不能容易識別出來而引至延誤治療。
Recognizing the signs of coronary artery disease is most important. Heart pain may present as either a discomfort or pain in the chest region, arms, chin, shoulder or even neck. This is often described as a pressure feeling or a burning sensation. Some of these symptoms may be mild, and is often not identified immediately.
穩定型心絞痛通常在運動或勞累的時候發生。
If one has stable angina, these symptoms tend to come on during exercise or exertion. If one experiences these symptoms at rest, this may be a sign of a heart attack. Often, people experience sweating, breathing difficulties, nausea, or vomiting.
心臟專科醫生的主要職責包括：
The main roles of cardiologists in coronary artery disease include
- 診斷 Diagnosis
- 治療 Treatment
- 預防 Prevention
冠狀動脈疾病的診斷，可能需要不同的測試。其中一些包括：
Diagnosing coronary artery disease may require the use of a number of investigations. Some of these include:
心電圖記錄心電活動，對心臟健康提供線索和資訊。
Electrocardiogram (ECG/EKG) records the electrical activities of the heart and gives clues towards heart health.
運動檢驗增加心臟對氧氣的需求，比休息時的評估更加準確。
Exercise testing increases the oxygen demand of the heart and is more accurate than resting assessment in diagnosing coronary artery disease.
超聲心動圖(心臟迴聲動態檢查/心臟超音波檢查/心臟B超) 探討心臟肌肉和瓣膜的功能，是心臟專科醫生的主要工具之一。在冠心病，超聲心動圖辨認因動脈阻塞而心肌缺血的影響。
Echocardiogram gives information about the heart muscle and valve functions and its one of the main tools in Cardiology. In coronary artery disease, echocardiogram identifies the effect of the blocked arteries on the damaged heart muscle.
影片連結 Echocardiogram
心臟血管造影是一種侵入性的測試，通過導管將顯影劑注入冠狀動脈， 識別動脈粥樣硬化斑塊的位置，範圍，嚴重程度和特徵；從而了解個別病人問題的根源。
Coronary angiography is an invasive test that images the status of the coronary arteries. With the use of contrast media injected into the coronary arteries via catheters, cardiologists are able to identify the location, extent, severity and characteristics of the atherosclerotic plaque causing the problem in each individual patient.
影片連結 Coronary Angiography
有一些患者，血管修復和支架的放置便可以治療硬化的斑塊，對其狹窄病變進行擴張及疏通。
In some patients, lesions can be treated with angioplasty and placement of a stent.
其他的病人可能需要冠狀動脈搭橋手術（繞道手術），利用身體其他動脈/靜脈引導血液流向缺血的區域。
Others may require coronary artery bypass grafting, which is open heart surgery utilizing other arteries/veins in the body to restore blood flow to occluded areas.
兩種新的心臟科測試也是值得一提。
Two new cardiological tests are worth mentioning.
心臟電腦斷層造影不需要侵入性的在心臟內放置導管便可以掃描冠狀動脈，現越來越多地用於被懷疑有冠狀動脈疾病的病人。
CT coronary angiography images coronary arteries non-invasively without the need of placing catheters inside the heart. It is increasingly used to investigate patients with suspected coronary artery disease.
心臟磁共振造影是一種先進的成像技術，提供詳細的心結構評估。在冠狀動脈疾病，對心肌梗塞受損的心臟肌肉，評估血管疏通後的可存活能力。
Cardiac magnetic resonance is an advanced imaging technique that provides detailed anatomical assessment of the heart. In coronary artery disease, it assesses the viability of damaged heart muscle from heart attacks after revascularization.
預防冠心病
Prevention of coronary artery disease
要預防冠狀動脈疾病，必先了解它的成因 – 動脈粥樣硬化。
To prevent coronary artery disease, one needs to understand its cause – atherosclerosis.
動脈粥樣硬化是常見的， 每一個人可能都有某程度上的動脈硬化，但是病變的速度和程度就取決於各種危險因素。
Atherosclerosis is common and is probably observed in everyone, though the speed and extent are determined by various risk factors.
不可更改的危險因素 Non-modifiable risk factors
- 高年齡 Advanced age
- 男性 Male gender
- 家族病歷 Family history
- 個人病歷 Personal history
可更改的危險因素 Modifiable risk factors
- 高血壓 High blood pressure
- 高膽固醇 High cholesterol
- 吸煙 Smoking
- 糖尿病 Diabetes
- 肥胖症 Obesity
- 缺乏活動 Physical inactivity
雖然我們會在稍後的日期，分別討論這些危險因素，這時我想指出的五個最有效控制血壓的方法：
While we will discuss these risk factors separately at a later date, it is important to point out the five most effective ways of controlling blood pressure.
- 減少體重 Reduce weight
- 多運動 More Exercise
- 減少食鹽 Reduce Salt
- 減少酒精 Reduce Alcohol
- 藥物治療 Medications
