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Abstract: The patient in this case is a 58-year-old female who reported: recurrent anterior cardiac pain during activity lasting 2-3 minutes and relieved after a few seconds of rest. Based on the patient’s medical history and relevant test reports, stable angina pectoris was considered as a possible cause. Since the patient had no indication for surgery, he was treated conservatively with medication. After 7 days of medication, the patient’s chest pain symptoms improved significantly and his condition decreased, and the patient expressed satisfaction with the treatment effect.
Basic information】Female, 58 years old
Disease Type】Stable angina pectoris
Hospital】The First Affiliated Hospital of Anhui Medical University
Time of consultation】January 2022
Treatment plan】Medication (aspirin enteric solution tablets, atorvastatin calcium tablets, metoprolol succinate extended-release tablets, isosorbide mononitrate tablets, amlodipine benzoate tablets)
[Treatment period] 7 days of inpatient treatment, 3 months of outpatient follow-up
Treatment effect] Chest pain relieved, no angina after activity, good treatment effect
I. Initial interview
The patient came to our hospital in January 2022 accompanied by her daughter. The patient reported that she had a history of hypertension for more than 10 years and had been taking oral captopril tablets to lower blood pressure, with less blood pressure monitoring. Later, when he took a walk with his family, he also had chest pain with fatigue and sweating when walking slightly faster, which lasted for about 2-3 minutes and was relieved after sitting down and resting for a few seconds. The patient’s blood pressure was 148/82 mmHg, and the ECG showed sinus rhythm and ST-T changes. The patient came to our hospital for insurance reasons. The patient was admitted to the hospital, and further specialized physical examination was performed, but no significant positive signs were found.
(electrocardiogram performance)
II. Treatment history
The patient underwent cardiac ultrasound, chest CT, routine blood tests, biochemistry, troponin, myocardial enzyme profile and other general tests without any significant abnormalities. We explained to the patient and his children that two special tests were needed to further clarify the diagnosis: 1) ECG exercise stress test (this test could not be completed because of the patient’s resistance); 2) coronary angiography or coronary CT angiography, and the patient’s family chose coronary CT angiography. The result of coronary CT angiography: moderate stenosis of the anterior descending branch, so the diagnosis of stable angina was clear. After the diagnosis was confirmed, we explained to the family that there was no indication for surgery for the time being, and firstly treated with aspirin enteric tablets + atorvastatin calcium tablets + metoprolol succinate extended release tablets + isosorbide mononitrate tablets. Later, the antihypertensive drug was adjusted to amlodipine benzoate tablets, and the patient’s chest pain was significantly relieved after 7 days of treatment.
III. Treatment effect
Under the guidance of professional doctors, after 7 days of continuous drug treatment, the patient’s anterior cardiac pain symptoms were significantly relieved, and general physical work, such as walking fast, did not trigger angina pectoris again, the treatment effect was good, and the blood pressure was in a stable and safe state after the review. Before discharge, the patient was instructed to continue oral medication and to review the electrocardiogram regularly at the outpatient clinic. When the frequency of chest pain attacks increases and its degree worsens, it is necessary to seek medical attention immediately to avoid delaying the disease and even affecting life safety.
IV. Precautions
After active treatment, the patient’s discomfort is gradually relieved, and as a doctor, we are truly happy for the patient and his family. After discharge, advise the patient to maintain good living habits, low-salt and low-fat diet, avoid smoking and drinking alcohol, and pay attention to blood pressure monitoring on a daily basis, and control blood pressure below 130/80 mmHg as much as possible. After healing, exercise can be appropriate, exercise will promote the establishment of coronary artery collateral circulation, increase myocardial blood supply, but need to pay attention to the magnitude of exercise should be small, gradual, not strenuous exercise to avoid counterproductive, can choose jogging, walking, Tai Chi and other less intense activities. In normal life, keep a calm state of mind, avoid great joy and grief, and seek medical help if necessary. In addition, pay attention to regular review with outpatient clinics to observe whether there are signs of disease recurrence.
V. Personal insight
Stable angina is a kind of coronary heart disease, often occurs when the exertional load increases, as in the patient of this case, mostly occurs when active, generally the symptoms last for a few minutes, and the pain disappears after rest or containing nitrate drugs, such as nitroglycerin. The frequency, degree, and duration of pain episodes often do not change significantly over several months. This type of coronary lesion is more stable and can often be effectively relieved by early drug therapy. Treatment needs to be accompanied by control of risk factors for atherosclerosis, such as hypertension, hyperlipidemia, and hyperglycemia, to stop or reverse the progression of atherosclerosis and prevent the occurrence of diseases such as acute myocardial infarction.