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Tang Li
Cardiology
About me
Beijing Boai Hospital, Cardiovascular Department, attending physician, has been engaged in clinical work in cardiac internal medicine for many years, with rich clinical experience in the diagnosis and treatment of cardiovascular diseases.
Proficient in diseases
Specializes in the diagnosis of common cardiovascular diseases such as coronary heart disease, hypertension, arrhythmia, atrial fibrillation, paroxysmal supraventricular tachycardia, heart failure, myocarditis, congenital heart disease, cardiomyopathy, and atrial septal defect.
Voices
Pulmonary hypertension is treated by which department?
Pulmonary arterial hypertension is a common clinical condition with complex causes, and depending on the cause, patients may visit different departments. The common causes of pulmonary arterial hypertension include the following. The first type is venous pulmonary hypertension, which is caused by diseases of the left heart system. Patients with this condition need to visit the department of cardiology, mainly to control heart failure. The second type is chronic thromboembolic pulmonary hypertension. The main reasons include thromboembolism in the proximal or distal pulmonary arteries, or due to tumors, parasites, foreign bodies, etc., leading to pulmonary embolism. Diseases of this type require visits to the respiratory department. Additionally, chronic pulmonary heart disease, such as heart failure caused by chronic obstructive pulmonary disease, interstitial lung disease, sleep breathing disorders, and hypoventilation lesions, also lead to pulmonary arterial hypertension and should be treated in the respiratory department. Furthermore, some rheumatic immune diseases and congenital heart diseases can also cause pulmonary arterial hypertension. As pulmonary arterial hypertension has gradually received more attention, some hospitals have established specialized outpatient clinics for pulmonary arterial hypertension.
What are the symptoms of pericarditis?
Fibrinous pericarditis is primarily characterized by precordial pain, similar to that seen in acute nonspecific pericarditis and infectious pericarditis. Tuberculous or neoplastic pericarditis that develops slowly may not show obvious pain symptoms. The nature of the pain can be sharp and related to respiratory movements. It is often exacerbated by coughing, deep breathing, changing body position, or swallowing. The pain is located in the precordial area and may radiate to the neck, left shoulder, left arm, and left scapula, and can also reach the upper abdomen. The pain can be compressive and located behind the sternum. The most prominent symptom of exudative pericarditis is dyspnea, which may be associated with bronchopulmonary compression and pulmonary congestion. In severe cases of dyspnea, the patient may sit up to breathe, leaning forward, with rapid and shallow breathing and pale complexion. There may be hepatomegaly, as well as compression of the trachea and esophagus causing dry cough, hoarseness, and difficulty swallowing. Rapid pericardial effusion can lead to acute cardiac tamponade, presenting with significant tachycardia and decreased blood pressure. Reduced pulse pressure and increased venous pressure, if the cardiac output significantly drops, can lead to shock. If the fluid accumulates slowly, it could lead to subacute or chronic cardiac tamponade, characterized by systemic venous congestion and distended jugular veins.
Can medication be taken for atrial septal defect?
Patients with small atrial septal defects and no related symptoms, pulmonary hypertension, or ventricular enlargement generally do not need specific medication. If symptoms do occur, interventional or surgical treatment should be chosen. Medication is necessary only if there is accompanying heart failure, pulmonary infection, or arrhythmias such as atrial fibrillation. In the case of infections like pneumonia or infective endocarditis, appropriate antibiotics or antiviral medications should be actively used. When heart failure occurs, medications to control arrhythmias, such as vasodilators, diuretics, and agents to control ventricular rate, are required.
Can atrial fibrillation cause cerebral infarction?
Patients with chronic atrial fibrillation have a relatively high incidence rate of embolism. For instance, those with a history of embolism, valvular disease, hypertension, diabetes, elderly patients, left atrial enlargement, and coronary artery disease are at increased risk of embolism. Atrial fibrillation is an independent risk factor for stroke. As age increases, the incidence of stroke in patients with atrial fibrillation also increases annually; atrial fibrillation doubles the mortality rate of stroke and significantly increases the disability rate. At the same time, atrial fibrillation also significantly increases the risk of recurrent stroke. Studies show that the incidence of stroke within the first year after a stroke is 6.92% in patients with atrial fibrillation, compared to 4.7% in those without atrial fibrillation. Therefore, anticoagulation therapy is the primary strategy for managing atrial fibrillation.
Can someone with an atrial septal defect get pregnant?
Whether patients with atrial septal defects can become pregnant depends on the following factors: 1. Whether the patient normally has symptoms. 2. Whether the echocardiography indicates heart enlargement or pulmonary hypertension. 3. The size of the atrial septal defect. 4. Whether there is a combination of arrhythmias such as atrial flutter or atrial fibrillation, and complications such as pulmonary hypertension or heart failure. For those without symptoms, and where the defect does not cause pulmonary hypertension or right heart enlargement, choosing to become pregnant is possible. Complications are not common in pregnant women with isolated atrial septal defects without pulmonary hypertension. Studies have shown that the incidence of complications in pregnant women, whether the defect is repaired or not, is relatively low. If the patient has related arrhythmias and complications, it should be closely monitored, because the cardiovascular system of the mother undergoes changes during pregnancy, leading to increased cardiac workload and a higher burden on the heart, which in turn can increase the incidence of arrhythmias. For women who are already at high risk of atrial flutter or fibrillation, this risk can increase further. Additionally, pregnant women are in an older physiological state, making it easier to form blood clots, and for those with atrial septal defects, the risk of paradoxical thrombosis increases.
What are the symptoms of bradycardia?
The normal heart rate for an adult is between 60-140 beats per minute. If it falls below 60 beats per minute, it is generally referred to as bradycardia. Most patients with bradycardia may not have symptoms, but those who do should be closely monitored. The symptoms of bradycardia mainly arise from a reduced cardiac output, leading to insufficient blood supply to the heart and brain, thereby causing symptoms. Patients may experience dizziness, fatigue, poor mental performance, and other symptoms. Some patients may experience dizziness, transient blackouts before the eyes, fatigue, palpitations, chest tightness, and shortness of breath. In severe cases, patients may also experience fainting.
Is hyperlipidemia fatty liver disease?
Hyperlipidemia and fatty liver are actually two different concepts. Hyperlipidemia is essentially dyslipidemia, which refers to abnormal quality and quantity of lipids in the plasma. The tests for blood lipids include total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. With our medical history, physical signs, and laboratory tests, diagnosing hyperlipidemia is not difficult. The current diagnostic criteria are mainly based on the 2017 Chinese guidelines for the prevention and treatment of dyslipidemia in adults, where low-density lipoprotein greater than 4.14 mmol/L suggests elevated low-density lipoprotein. Fatty liver, on the other hand, refers to excessive fat accumulation within liver cells due to various reasons, and is a common pathological change in the liver, rather than an independent disease. Patients with hyperlipidemia are prone to fatty liver.
Causes of arteriosclerosis
The etiology of arteriosclerosis has not been fully determined, and studies indicate that arteriosclerosis is a multifactorial disease, caused by multiple factors acting at different stages, which are referred to as risk factors. The primary risk factors include the following: First, age and gender. Clinically, it is more common in middle-aged and elderly people over forty years old. After the age of forty-nine, the progression is fast, but early arteriosclerotic changes have also been found in autopsy of some young adults and even children. In recent years, clinical onset age tends to be younger. Compared to men, the incidence rate in women is lower, because estrogen has a protective effect against arteriosclerosis. Therefore, the incidence rate in women increases rapidly after menopause. Age and gender are unchangeable risk factors. Second, abnormal lipid levels, with abnormal lipid metabolism being the most important risk factor for arteriosclerosis. Third, hypertension, as the incidence of arteriosclerosis in patients with hypertension is significantly higher. Sixty to seventy percent of patients with coronary arteriosclerosis have hypertension, and patients with hypertension are three to four times more likely to have arteriosclerosis compared to those with normal blood pressure. Fourth, smoking, as the incidence and mortality rate of coronary arteriosclerosis in smokers are two to six times higher than in non-smokers, and it correlates positively with the number of cigarettes smoked daily. Secondhand smoke is also a risk factor. Fifth, diabetes and glucose intolerance, where not only is the incidence of arteriosclerosis in diabetic patients several times higher than in non-diabetics, but the progression of the disease is also rapid. Sixth, obesity, defined as being more than twenty percent over the standard weight or a BMI greater than twenty-four. Obesity is also a risk factor for arteriosclerosis. Seventh, family history, where a family history of coronary heart disease, diabetes, hypertension, and hyperlipidemia significantly increases the incidence of coronary heart disease. Various theories have been proposed to explain the pathogenesis of coronary arteriosclerosis from different perspectives. These include the lipid infiltration theory, thrombosis theory, and smooth muscle cell clonal theory. In recent years, the endothelial damage response theory has gained more support, suggesting that the disease results from various risk factors ultimately damaging the arterial intima, and the formation of arteriosclerosis lesions is an inflammatory, fibro-proliferative response of the arteries to endothelial damage.
Treatment of Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy, due to unknown causes and often related to genetic factors, is difficult to prevent. It is important to guide patients on how to lead their lives, reminding them to avoid intense physical activities, heavy lifting, or breath-holding to reduce the incidence of sudden death. Avoid using drugs that enhance myocardial contractility and reduce cardiac capacity load, such as digoxin and nitrates, to decrease the aggravation of left ventricular outflow tract obstruction. The treatment principle for this disease is to slow down the hypertrophy of the myocardium, prevent tachycardia, and maintain normal sinus rhythm. It also aims to relieve the narrowing of the left ventricular outflow tract and counteract arrhythmias. Currently, the use of beta blockers and calcium channel blockers is advocated. For severe obstructive patients, interventional and surgical treatments can be carried out, including the implantation of a dual-chamber DTD pacemaker, and the ablation or removal of hypertrophied interventricular septum myocardium.
What are the clinical considerations for acute pericarditis?
The treatment and prognosis of acute pericarditis mainly depend on the cause, and are also related to whether it is diagnosed and treated correctly early on. For various types of pericarditis, if constrictive syndrome occurs, pericardiocentesis should be performed immediately to relieve symptoms. In cases like tuberculous pericarditis, if not treated aggressively, it can usually progress to chronic constrictive pericarditis. Acute nonspecific pericarditis and post-cardiac injury syndrome may lead to recurrent attacks of pericarditis after the initial episode, known as recurrent pericarditis, with an incidence rate of about 20%-30%. This is one of the most difficult complications of acute pericarditis to manage. Clinically, it generally presents similar to acute pericarditis, with recurrent attacks months or years after the initial episode, accompanied by severe chest pain. Most patients should be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering over several months until the medication can be stopped. If ineffective, corticosteroid treatment may be administered; in severe cases, intravenous methylprednisolone may be given, and symptoms in most patients may improve within a few days. However, it is important to note that symptoms often reappear during steroid tapering.