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Abstract: A 66-year-old patient with chest pain for about 1 week and sometimes numbness in the fingertips as well as the tip of the tongue had been diagnosed with hypertension, took oral irbesartan tablets to lower blood pressure on weekdays, had no other bad habits on weekdays, and had insomnia. After hospitalization, it was found that the patient did not have obvious coronary stenosis, and coronary CT and ultrasound were done, and the diagnosis was coronary atherosclerosis, hypertension, carotid atherosclerosis, and cardiac neurosis. After giving the patient the appropriate medication, the patient’s chest pain symptoms were significantly relieved.
Basic information】Male, 66 years old
Disease Type】Coronary atherosclerosis, hypertension, carotid atherosclerosis, cardiac neurosis
Hospital】Harbin First Hospital
Date of Consultation】June 2022
【Treatment plan】Medication (benzofibrate tablets + eszopiclone tablets + aspirin enteric dissolved tablets + trimetazidine hydrochloride tablets + shuxin injection)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The chest pain disappeared and the discomfort was basically relieved or disappeared
I. Initial consultation
Through detailed communication, we learned that the patient had been diagnosed with hypertension more than ten years ago, and his blood pressure could be controlled below 140/90 mmHg with regular oral Irbesartan tablets. The patient had no other hobbies, but had frequent insomnia and was anxious. After settling down, the patient’s blood pressure and heart rate were measured, blood pressure: 130/70 mmHg heart rate: 57 beats/min, ultrasound examination: double carotid plaque formation, left ventricular diastolic hypofunction, preliminary diagnosis: coronary atherosclerosis, hypertension, carotid atherosclerosis, cardiac neurosis.
II. Treatment history
Since the patient’s blood pressure is still under control, there is no need to adjust the antihypertensive drug use scheme at present. First of all, the possibility of coronary artery disease should be excluded, and the patient was suggested to perform coronary CT examination, to which the patient agreed. The coronary CT showed that: the lumen of the left anterior descending branch mixed plaque is slightly stenosed, and coronary artery disease can be excluded after examination. Coronary artery atherosclerosis. The patient was advised to take oral benzofibrate tablets to lower triglycerides, oral estradiol tablets to improve sleep, and oral aspirin enteric solution tablets and trimetazidine hydrochloride tablets in combination with sedation of Shuxin injection to improve circulation.
III. Treatment effect
After 7 days of systematic treatment in the hospital, the patient’s chest pain symptoms were basically relieved and disappeared. At the time of discharge, the electrocardiogram was reviewed and the myocardial ischemia was significantly improved. The patient’s numbness of the tongue and fingertips was improving, and the poor sleep was largely relieved after taking oral eszopiclone tablets. At follow-up lipid tests, triglycerides were reduced to below 1.7 mmol/l. The patient was able to sleep for about 6-8 hours per night, and the rest of the indicators had improved significantly.
IV. Notes
The patient recovered well, and we are happy for him. It is recommended that the patient should be more relaxed and develop regular habits as much as possible, pay attention to a low-salt and low-fat diet, exercise to lose weight, eat more fresh fruits and vegetables, increase the intake of whole grains in daily life, pay attention to the balance of nutrition, and ensure at least 5 days of exercise per week, preferably not less than 30 minutes per exercise. Take regular oral medication to prevent disease progression and improve symptoms. Take care to have a systematic physical examination at least once a year, after all, there is hypertension, and regular physical examinations help to better detect complications related to hypertension and clarify whether the blood pressure is well controlled.
V. Personal insight
For patients with the presence of chest pain, especially in the elderly population with underlying diseases, attention must first be paid to investigating whether it is due to coronary atherosclerotic heart disease. Some patients with chest pain may only have coronary atherosclerosis and have not yet reached the level of coronary atherosclerotic heart disease, such as the patient in this case, whose chest pain was accompanied by insomnia. Other patients may suffer from poor blood pressure control and anxiety, which may cause chest pain. In patients with simple coronary atherosclerosis with chest pain, care should be taken to remove the causative factors and carefully search for the essential causes that may trigger the chest pain.