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Abstract: Coronary atherosclerotic heart disease is usually caused by atherosclerotic lesions in the coronary arteries. The patient presented to the clinic with paroxysmal chest tightness, which is more likely to occur after exertion or emotional agitation, and was diagnosed with coronary atherosclerotic heart disease after examination.
Basic information】Male, 50 years old
Disease Type】Atherosclerotic heart disease of coronary arteries
Hospital】Harbin First Hospital
Date of consultation】May 2022
Treatment plan】Medication (isosorbide nitrate injection + sodium phosphate for injection + aspirin enteric dissolved tablets + risuvastatin calcium tablets + metoprolol tartrate tablets + amlodipine benzoate tablets + isosorbide mononitrate tablets)
Treatment Period】7 days of hospitalization
Treatment effect】The condition was well controlled and all indicators were improved
I. Initial consultation
The patient has been suffering from paroxysmal chest tightness for more than 1 month, and the symptoms of chest tightness have worsened in the past 1 week, each attack lasts 3-5 minutes, and can be relieved after sitting down and resting or taking nitroglycerin during chest tightness attacks. His blood pressure was basically under 140/90 mmHg, and his resting heart rate was about 70-80 beats per minute. After understanding the general situation, the patient was given an electrocardiogram, which showed sinus rhythm ST-T changes and myocardial ischemia, but it was not very serious.
II. Treatment history
The patient’s symptoms and electrocardiogram were diagnosed as coronary artery atherosclerotic heart disease, and he was given isosorbide nitrate injection and sodium phosphate for injection. The blood pressure could be basically controlled below 130/80 mmHg and the heart rate could be controlled around 60 beats/min. The patient’s chest tightness basically disappeared after the systematic adjustment of medication. Further improvement of coronary CT examination, coronary CT results showed moderate stenosis of the lumen of the left anterior descending branch mixed plaque and moderate stenosis of the lumen of the right coronary artery mixed plaque. The patient was further diagnosed as coronary artery atherosclerotic heart disease through coronary CT examination. The patient had no severe stenosis in the coronary vessels, and oral drug treatment was sufficient, and isosorbide nitrate was discontinued after the condition was stabilized, and oral isosorbide mononitrate tablets were used instead. It is suggested that the patient should come to the hospital for physical examination and review regularly after discharge.
III. Treatment effect
After good treatment of vasodilatation, antiplatelet, lipid lowering, plaque stabilization as well as blood pressure stabilization and ventricular rate control, the patient’s chest tightness basically disappeared, and the heart rate and blood pressure reached the ideal heart rate as well as blood pressure range for patients with coronary heart disease after adjusting the medication, and the blood pressure could be controlled below 130/80 mmHg, and the heart rate could be controlled around 60 beats/min, and the electrocardiogram also improved significantly compared with the previous one. The patient was discharged after 7 days of hospitalization. Before discharge, the blood lipid was rechecked and the LDL decreased from 3.9mmol/L to 3.1mmol/L, which was improved but not reached, and the patient should be controlled below 1.8mmol/L as much as possible.
IV. Notes
We are glad that the patient’s symptoms improved after treatment. For patients with coronary atherosclerotic heart disease, it is very important to pay attention to take relevant secondary prevention medications to prevent disease progression by mouth on a regular basis, especially such medications as aspirin enteric soluble tablets and rasuvastatin calcium tablets. In addition, we should pay attention to lifestyle interventions, such as low salt and low fat diet, regular work and rest, avoiding straining and staying up late, quitting smoking and alcohol, increasing the intake of whole grains, and regularly monitoring heart rate and blood pressure, paying attention to keeping blood pressure below 130/80 mmHg and heart rate at 55-60 beats per minute. In addition, pay special attention to LDL and keep it below 1.8 mmol/L as much as possible.
V. Personal insight
Coronary atherosclerotic heart disease is a common and frequent disease among cardiovascular diseases, especially among the elderly. For patients with coronary atherosclerosis, in fact, most of them do not need coronary intervention, but the prerequisite is to pay attention to actively take relevant oral antiplatelet, lipid-lowering and plaque stabilizing drugs, and to remove the risk factors that trigger or cause the progression of atherosclerosis, for example, to pay attention to quit smoking, quit drinking, avoid straining and staying up late, and to keep the blood pressure, blood lipid, blood sugar, serum, uric acid, homocysteine, etc. Homocysteine, which are independent risk factors for atherosclerosis, should be controlled to the standard. The emergence of coronary atherosclerotic heart disease at the age of 54 is highly correlated with long-term smoking and high blood pressure and hyperlipidemia. To better prevent coronary atherosclerotic heart disease, it is important to take care of the little things in life, especially for those who are getting older, to pay attention to regular medical check-ups to detect problems early, diagnose them early and treat them early.