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Abstract: The patient, Auntie He, came to our hospital for treatment of chest tightness and shortness of breath that had been present for 4 years and worsened in the last 1 week. I diagnosed the patient with chronic heart failure by examining the patient’s clinical symptoms and cardiac ultrasound findings. After obtaining the patient’s consent, he was hospitalized with medication for anti-heart failure treatment. After 9 days of hospitalization, the patient’s chest tightness and shortness of breath were relieved and her condition was stabilized, and she was discharged.
Basic information】Female, 56 years old
Disease Type】Chronic heart failure
Hospital】Sonya Hospital of Central South University
Date of consultation】June 2022
Treatment plan】Intravenous injection (torasemide injection, nitroglycerin injection, digoxin injection) + oral medication (clopidogrel sulfate tablets, atorvastatin calcium tablets, spironolactone tablets, eprazole enteric coated tablets)
Treatment period] 9 days in hospital
Treatment effect] Stable condition, relief of chest tightness and shortness of breath
I. Initial consultation
The patient, Auntie He, came to our hospital for treatment of chest tightness and shortness of breath for 4 years, which had worsened in the past 1 week. The patient complained of chest tightness and shortness of breath after exertion 4 years ago, with a feeling of holding in the precordial region, which could be relieved on its own after a few 10 minutes, without fear of cold, fever, chest pain, palpitations and other discomforts, and she often visited the local clinic (specific treatment is not known). 4 years ago, the symptoms recurred, and there was no significant change in the symptoms of chest tightness and shortness of breath. After resting, the symptoms were not relieved significantly, so he came to our hospital for diagnosis and treatment. I found that the patient’s body temperature was normal, but his blood pressure was high, his breath sounds were coarse in both lungs, and scattered wet rales were heard in both lower lungs, but there were no pleural friction sounds. The heart rate was fast and both lower extremities were heavily edematous. After cardiac ultrasound examination, it was suggested that the left heart was enlarged, the left ventricular wall motion was diffusely reduced, the mitral and tricuspid valves were mildly incompetent, pulmonary hypertension was mildly suspected, and the left ventricular systolic and diastolic function measurements were reduced, so the patient was diagnosed as chronic heart failure and admitted to the hospital.
II. Treatment history
I suggested that the patient should be treated with symptomatic medication to relieve the symptoms, and that the patient should be monitored in hospital and the dose of medication should be adjusted according to his condition. The patient agreed, and was given torasemide injection, nitroglycerin injection, digoxin injection, clopidogrel sulfate tablets, atorvastatin calcium tablets, spironolactone tablets, and eprazole enteric-coated tablets to treat the patient with anti-heart failure, heart rate control, anti-platelet aggregation, and gastric mucosa protection. After 9 days of treatment, the patient was discharged with stable condition and was instructed to pay attention to review in 1 month.
III. Treatment effect
Before treatment, the patient had severe chest tightness and shortness of breath, and severe edema of both lower limbs, but the patient’s symptoms were reduced after 1 day of hospitalization. After 9 days of treatment, the patient’s symptoms of chest tightness and shortness of breath were relieved and were not accompanied by other uncomfortable symptoms such as chest pain and palpitations. I found that the patient’s body temperature and blood pressure were normal, the respiratory sounds of both lungs were clear, no dry rales were heard, and the edema of both lower limbs disappeared, indicating that the patient had recovered well and could be discharged home for recuperation.
IV. Precautions
I am happy that the patient’s condition has improved and he can be discharged home for recuperation, but at the same time, in order to help the patient avoid the development of the disease, we need to remind the patient to pay attention to the following matters.
1, after discharge from the hospital, we need to pay attention to rest, avoid excessive activity or exertion, which may increase the burden on the heart and aggravate heart disease, leading to recurrent symptoms of chest tightness and shortness of breath.
2. In terms of diet, attention needs to be paid to a low-salt diet to reduce the intake of sodium so as not to increase the load on the heart. Need to consume more easily digestible, nutrient-rich food to maintain a comprehensive nutrition, which is beneficial to health.
3, daily life also need to pay attention to keep warm, try to avoid the emergence of infections and other conditions, which can easily affect breathing and aggravate the symptoms of chest tightness and shortness of breath.
V. Personal insight
Chronic heart failure is commonly caused by coronary atherosclerotic heart disease, hypertension and heart valve disease, which result in overloading of the heart and reduction of cardiomyocytes, causing the same symptoms as the patient in this case, including reduced exercise tolerance and chest tightness and shortness of breath after activity. The patient’s symptoms can be relieved by administering medication, but if medication is not effective, surgical treatment may be required. Since the disease cannot be completely cured, patients usually need long-term medication combined with a regular healthy lifestyle to maintain stability and avoid recurrence of symptoms such as chest tightness and shortness of breath.