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Abstract: Acute non-ST-segment elevation myocardial infarction is among the common types of acute myocardial infarction, which can lead to sustained worsening of impaired cardiac function if left untreated. A 69-year-old female patient presented with episodic precordial vague pain with left posterior back discomfort 5 days ago, took medication on her own without consultation, and her condition worsened today, so she came to our hospital and was diagnosed with acute myocardial infarction after examination, and was given antithrombotic and reperfusion therapy for 1 week, and her symptoms improved and her condition was stable.
Basic information】Female, 69 years old
Disease Type】Acute myocardial infarction
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】June 2022
Treatment plan】Oral drugs (aspirin enteric solution, clopidogrel sulfate tablets, morphine sulfate tablets) + intravenous injection (heparin sodium injection, recombinant streptokinase for injection)
Treatment period】Inpatient treatment for 1 week, long-term follow-up
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient had episodes of vague precordial pain with left posterior back discomfort at rest for the past 5 days, each lasting about 10-20 minutes. The episodes were accompanied by weakness of the left upper limb, acid reflux and heartburn, and no tightness in the throat. A week ago, at 2:00 a.m., the patient again experienced discomfort during sleep, which lasted until 10:00 a.m. The discomfort was relieved by taking nitroglycerin tablets on his own. He came to our hospital for further treatment. The electrocardiogram showed sinus rhythm, ventricular rate of 77 bpm, complete right bundle branch block, q waves in leads III and avF, and q waves in leads V-V6. TnT test results showed 268 ng/L; proBNP test results showed 2295 pg/mL. Combined with the test results, the initial diagnosis was acute non-ST-segment elevation myocardial infarction, and the patient was admitted to the hospital for treatment.
II. Treatment history
After admission, the patient was advised to rest in bed, limit activities, monitor ECG and blood pressure, and closely observe changes in condition. After communication with the patient, the antithrombotic and reperfusion treatment plan was determined. The patient was instructed to take anticoagulant aspirin enteric tablets, clopidogrel hydrogen sulfate tablets, and heparin sodium injection to improve hemodynamics and prevent thrombosis. Intravenous drip injection of recombinant streptokinase for injection was used for thrombolytic therapy to unblock the blood vessels blocked by the thrombus, and attention was paid to observe whether there were chills, fever and other allergic reactions. During the period, the patient again developed vague pain in the precordial region, and morphine sulfate tablets were given for analgesia when nitroglycerin was not effective.
III. Treatment effect
Before treatment, the patient had episodes of precordial vague pain with left posterior back discomfort, lasting about 10-20 minutes each time, with weakness of the left upper limb during the episodes. After 1 week of antithrombotic and reperfusion treatment, the pain disappeared and there were no other uncomfortable symptoms. TnT and proBNP were rechecked and the results were within the normal range. The electrocardiogram showed sinus rhythm, no abnormality in right bundle branch conduction, and p wave in avF lead. Coronary angiography was performed and showed successful thrombolysis. He was discharged from the hospital and continued to take aspirin enteric tablets and clopidogrel hydrogen sulfate tablets, and should come to our hospital for review if his symptoms worsen.
IV. Notes
After the patient’s condition improved, I was also happy for him, and for the patient’s better recovery, I did not forget to emphasize that the following points should be noted after treatment.
1, after discharge from the hospital, follow the doctor’s instructions to take medication on time and in accordance with the dosage, do not increase or decrease the dosage or stop medication on your own, so as not to aggravate the disease.
2.Stable people can do low-intensity aerobic exercise every day, it is recommended to choose walking, tai chi, etc., each time should be controlled to about 30 minutes, in order not to feel tired principle.
3, the diet should be light and easy to digest, with sufficient vitamins, proteins and other nutrients, avoid high salt, high fat and spicy stimulating diet, so as not to increase the load on the heart and trigger the disease.
V. Personal insight
The typical symptoms of acute non-ST-segment elevation myocardial infarction are pain or stuffiness in the precordial region, which occurs in the early morning, and some patients may also experience chest tightness, shortness of breath, coughing and breathlessness. Once the above symptoms appear, you should seek medical attention promptly. If the symptoms are more severe, you can first take nitroglycerin tablets under your tongue and call the emergency number. In this case, the patient came to the doctor five days after the onset of the disease, during which the symptoms worsened. Fortunately, the symptoms were reduced after medication, otherwise it may lead to adverse consequences.