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Abstract: A 56-year-old female patient reported that she suddenly felt chest tightness, shortness of breath and dyspnea after exertion 1 week ago, with a feeling of suffocation in the precordial region, which appeared after each activity and lasted for 10 minutes before relieving on its own. After systematic examination, she was admitted to the hospital as an outpatient with heart failure, and her condition was controlled with medication.
Basic information】Female, 56 years old
Disease Type】Heart Failure
Hospital】Central South University Xiangya Hospital
Date of consultation】June 2022
Treatment plan】Medication (digoxin tablets, metoprolol tartrate extended-release tablets)
Treatment Period】In-hospital treatment for 5 days, followed by discomfort
Effectiveness of treatment】The condition was controlled, and the symptoms of chest tightness, shortness of breath and dyspnea disappeared
I. Initial consultation
When I first saw the patient in the outpatient clinic, the patient complained that 1 week ago, after each activity, he would experience chest tightness, shortness of breath and dyspnea, with a feeling of suffocation in the precordial region, which lasted for 10 minutes and then relieved on its own. On examination, the patient was found to have severe edema in both lower limbs, scattered wet rales were heard in both lungs, and the electrocardiogram showed that the patient had sinus rhythm, prolonged QTC interval, mild ST-segment downward shift and T-wave changes in some leads, and laboratory tests showed that the level of natriuretic peptide was elevated.
II. Treatment history
I informed the patient that his recent discomfort was due to heart failure. After full communication with the patient, I decided to take medication and nasal catheter oxygen treatment, and the patient indicated that he would take the medication on time and in the right amount. In order to improve the patient’s restricted breathing, the patient was given nasal catheter oxygen therapy and digoxin tablets to improve the patient’s cardiac contraction and ejection capacity and improve cardiac function, thus reducing the patient’s symptoms of chest tightness, shortness of breath and dyspnea, and metoprolol tartrate extended-release tablets to reduce the patient’s cardiac afterload and make the cardiac output and oxygen consumption lower. This reduces the patient’s cardiac afterload, resulting in lower cardiac output and oxygen consumption, thereby improving the patient’s adverse symptoms. For patients with diabetes, renal insufficiency, kidney stones with hydronephrosis, and hypoproteinemia, urology and endocrinology are recommended to follow up.
III. Treatment effect
On the first day of in-hospital medication, the patient reported improvement in chest tightness, shortness of breath, and dyspnea compared to the previous day, and I informed the patient to continue to take medication and oxygen treatment. On the 3rd day of in-hospital treatment, there were no other significant adverse symptoms except for slight chest tightness, shortness of breath, and dyspnea. On the 5th day of in-hospital treatment, the symptoms of chest tightness, shortness of breath and dyspnea disappeared, the vital signs were stable, the mental status was good, and no abnormalities such as scattered wet rales were heard in both lungs during physical examination, and there was no edema in both lower extremities, so the condition was under control and the patient was discharged.
IV. Notes
When the patient was discharged happily, I felt very relieved. At the time of discharge, I advised the patient to pay attention to rest, eat a low-salt, low-fat, low-cholesterol diet, and consume more highly nutritious foods such as soybean skin, milk, fish, dragon fruit, etc. He should usually take good measures to keep warm, combine work and rest, and avoid getting cold or overexerting himself to prevent aggravation of the disease or detrimental to recovery. The drugs prescribed after discharge from the hospital, namely digoxin tablets and metoprolol tartrate extended-release tablets, should be taken in full amount and in full course. If there are obvious adverse symptoms during taking the drugs, the drugs should be stopped immediately and medical consultation should be sought, and I will take the appropriate treatment plan according to the specific situation.
V. Personal insight
When you have persistent chest tightness, shortness of breath and other uncomfortable symptoms, you should seek medical consultation in time, just like the 56-year-old female patient in this case, who was found to be suffering from heart failure after examination. However, the course of heart failure is relatively long, so medication should be used consistently and reasonably.