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Abstract: The most important cause of ischemic heart disease is coronary atherosclerotic heart disease, which is a series of problems that occur when the coronary arteries become narrowed or even occluded due to atherosclerosis, resulting in insufficient blood supply to the heart, and is commonly seen in middle-aged and elderly men. This patient was diagnosed with ischemic heart disease, coronary heart disease, and acute coronary syndrome through examination at the hospital due to chest tightness and pain that occurred recently during heavy activity, and the symptoms were relieved by giving medication and surgical treatment.
[Basic information] Male, 31 years old
Disease Type】Ischemic heart disease, coronary artery disease, acute coronary syndrome
Hospital】Wuhan University People’s Hospital
Date of consultation】June 2021
Treatment plan】Surgical treatment (coronary artery stenting) + medication (aspirin enteric tablets + tegretol tablets + low molecular weight heparin calcium injection + resuprastatin calcium tablets + ezetimibe tablets + metoprolol succinate extended release tablets + isosorbide mononitrate extended release tablets)
[Treatment Period] 8 days of inpatient treatment, 1 year of outpatient follow-up
Treatment effect] No recurrence of chest pain
I. Initial consultation
In the last six months, the patient occasionally felt chest tightness with pain in the middle of the chest during heavy activities, which would improve on its own within a few minutes each time. Since he usually did not have many physical activities and had few episodes, and since he thought he was young and in good health, he had not seen a doctor. Until the last 3 days, I felt that this symptom would come on even when I was not active, and the frequency and severity were worse than before, with a maximum of about half an hour before it resolved, so I came to my clinic. Repeatedly asking the patient about his medical history and habits, the patient denied chronic diseases and had healthy habits, not smoking or drinking, only the nature of his work required frequent night shifts. Blood pressure was measured at 150/95 mmHg, which was above the normal range. Although there were indeed few risk factors, the patient belonged to a low-risk group for cardiovascular disease, and considering that the symptoms of myocardial ischemia were typical, the patient was prescribed an electrocardiogram and three tests for heart attack. The electrocardiogram showed partial lead ST-segment depression, while the infarct triple test showed troponin 1.26 ng/ml, which was significantly above the normal range, suggesting the presence of myocardial injury, and the patient was admitted to the hospital for treatment.
II. Treatment history
Based on the results of the three infarcts and the typical symptoms, the diagnosis of ischemic heart disease, coronary artery disease and acute coronary syndrome was basically clear. After admission, the patient was given routine blood, blood biochemistry, coagulation function, N-terminal brain natriuretic peptide precursors and other indicators for a comprehensive assessment, and it was good that these indicators were within the normal range. The patient was given aspirin enteric solution and tegretol tablets for antiplatelet therapy, low molecular weight heparin calcium injection for subcutaneous anticoagulation, resuprastatin calcium tablets and ezetimibe tablets for intensive lipid lowering and plaque stabilization, and metoprolol succinate extended release tablets and isosorbide mononitrate extended release tablets for anti-ischemia, and the patient’s chest pain symptoms were basically stabilized. I told the patient and his family that his chest pain was caused by acute myocardial infarction due to the lack of blood supply to the myocardium caused by blockage of coronary arteries, which belongs to ischemic heart disease. In addition to medication, coronary angiography is needed to find the blocked blood vessels and stent implantation to open them up if necessary. After the patient and his family understood the condition, they decided to undergo the procedure. The imaging results showed severe stenosis of the left main trunk body and end with aneurysmal dilatation, occlusion of the mouth of the left anterior descending branch, and moderate stenosis of the proximal segment of the gyral branch; and severe stenosis of the middle segment of the right crown. Considering the complexity of the lesion and the fact that the left vessel was the offender vessel of this infarction, priority was given to the left vessel for difficult treatment: one stent was placed in the left main stem, one stent was placed in the proximal segment of the gyral branch, and one stent was placed in the anterior descending branch.
III. Treatment results
The post-stenting angiography showed that the left main stem and the gyrus branch, which were originally severely stenosed, were thickened again, and the originally occluded anterior descending branch reappeared. The patient’s symptoms also improved significantly, with no further episodes of chest pain and no other specific discomfort, and he was discharged at the end of his 8-day hospital stay. He returned to work after 1 month of rest after discharge and came to the clinic every 2 months for medication review and was in good condition. At 1 year postoperatively, a coronary CTA was reviewed to assess the condition of the vessels, and the results were very surprising. Not only was the vessel in which the stent was implanted very patent, but also the severe stenosis of the right coronary, which was not treated at that time, was significantly improved, indicating that the patient responded relatively well to the medication.
IV. Notes
We are glad that the patient’s symptoms have improved after the treatment. Although the patient’s symptoms improved very quickly with medication and stenting, the patient is still reminded that there is a greater risk of myocardial injury whenever it exists, so it is important to take rest, avoid straining and staying up late, maintain a low-salt, low-fat diet, and avoid foods that are too stimulating in the short term after surgery. In addition, the patient’s blood pressure measured during the outpatient and inpatient periods was slightly higher than the normal range, and since the patient already had ischemic heart disease and belonged to a very high cardiovascular risk group, attention should be paid to blood pressure control after discharge, and in addition, attention should be paid to regular follow-up reviews.
V. Personal insight
Ischemic heart disease is a heart disease caused by myocardial ischemia for various reasons, and the main cause is coronary heart disease, which is caused by atherosclerosis of the coronary arteries that supply blood to the heart, resulting in narrowing or even occlusion, causing insufficient blood supply to the heart, which can lead to angina pectoris and even myocardial infarction. Coronary heart disease is common in middle-aged and elderly men, especially those who have bad habits such as smoking and drinking, or have cardiovascular risk factors such as hypertension, diabetes, and hyperlipidemia. The patient in this case is still living a relatively healthy life and has no other bad habits except for night shifts due to work. This case also reminds us that even if we encounter young patients with chest pain with few risk factors, we should pay attention to the possibility of ischemic heart disease and perform appropriate screening and treatment when necessary.