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Abstract: An elderly male with anterior chest pain, accompanied by panic, weakness and chest tightness, frequently occurred during exercise in the past six months. The symptoms disappeared after he stopped sitting and rested for 5-6 minutes, and then when he continued to exercise, he again had the above symptoms. After consultation, myocardial ischemia was detected by electrocardiogram, and further coronary angiography was performed, which revealed vascular occlusion and diagnosed unstable angina. After surgery and medication, the symptoms disappeared and daily activities and exercise were no longer restricted.
Basic information】Male, 63 years old
Type of disease】Unstable angina pectoris
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】February 2022
Treatment plan] Minimally invasive coronary stenting + medication (Rosuvastatin calcium tablets + aspirin enteric tablets + Tegretol tablets + Nicorandil tablets)
Treatment period】5 days of hospitalization, 1 month of postoperative review
Effectiveness of treatment】No recurrence of symptoms and no restriction of daily activities
I. Initial consultation
In the past six months or so, the patient often experienced anterior chest pain and discomfort, accompanied by panic, weakness, chest tightness and other symptoms during daily activities and exercise. The patient had an electrocardiogram at the community hospital and was diagnosed with myocardial ischemia, and also took oral medications such as compound salvia tablets, but the symptoms still came on from time to time, adding to the patient’s worries and causing him to stop his daily exercise. After the patient’s outpatient visit, after detailed and comprehensive consultation, the patient was initially considered to have coronary artery disease and angina pectoris, and further examination of resting ECG revealed typical extensive myocardial ischemia. Therefore, he was admitted to the ward with the diagnosis of unstable angina pectoris for continued treatment.
II. Treatment history
After the patient was admitted to the hospital, chest X-ray, myocardial enzymology, glucose, lipids, and cardiac ultrasound were again improved, and no contraindication was found. The patient was then subjected to coronary angiography. Coronary angiography is a minimally invasive test that confirms severe stenosis of the anterior descending vessels of the coronary arteries, which may progress to myocardial infarction at any time and is therefore a high-risk lesion. After informing the patient’s family of the seriousness of the disease and obtaining consent, minimally invasive coronary stenting was performed, and one coronary stent was successfully implanted, which resulted in the opening of the lesion at the site of severe stenosis and restoration of blood flow. After the operation, the patient returned to the ward on his own and did not complain of any more painful episodes in the precordial region.
III. Treatment effect
The patient was discharged on the second postoperative day with no symptoms of discomfort, and was hospitalized for 5 days in total. The patient was discharged on the second postoperative day, and was hospitalized for 5 days. He was instructed to take oral treatment with Rosuvastatin calcium tablets, aspirin enteric-coated tablets, Tegretol tablets and Nicorandil tablets outside the hospital. The repeat electrocardiogram, myocardial enzymology, and cardiac ultrasound did not reveal any abnormal changes, indicating that this interventional technique does not have any sequelae on the heart.
IV. Notes
We are glad that the patient recovered effectively from the symptoms after effective treatment. However, it is still necessary to advise patients to pay attention to the following items in their daily treatment.
1, coronary artery disease, angina after implantation of coronary stents, is not the end of the treatment of this disease, need to have the psychological preparation of long-term medication.
2, this disease has a lot to do with high blood pressure, high blood lipids, high blood sugar, as well as smoking and alcohol abuse, so in the daily treatment, must maintain blood pressure, blood lipids, blood sugar in a reasonable range, and need to quit smoking, quit drinking.
3. Patients should communicate well with their doctors and go to the hospital for regular review. If any substandard items are found, they should be corrected immediately.
V. Personal insight
Unstable angina is a common type of coronary heart disease, more often because of the formation of plaque in the coronary vessels blocking the blood vessels, resulting in reduced blood flow in the coronary vessels, when the myocardium ischemia will appear symptoms of anterior heart area pain. In this case, the patient may be suffering from the disease if he has precordial pain related to the amount of exercise in daily life, and the pain presents boring, compressive or suffocating pain, as well as the pain relieves itself after rest. At this time, coronary angiography should be actively performed at the hospital, and in order to avoid deterioration into myocardial infarction, cardiac coronary artery stenting treatment is recommended.