(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient was a 63-year-old male who usually had no physical discomfort, but 20 days ago he suddenly developed anterior heart pain with recurrent episodes, mostly induced by activity, and had been diagnosed with coronary heart disease at a local hospital and underwent related treatment, but the symptoms still occurred from time to time, so he came to our hospital. After completing relevant examinations, the patient was considered to have unstable angina pectoris, and was treated with drugs and surgery, and his chest pain disappeared and his condition improved.
Basic information】Male, 62 years old
Disease Type】Unstable angina pectoris
Hospital】The First Affiliated Hospital of Anhui Medical University
Date of consultation】January 2022
Treatment plan】Medication (aspirin enteric tablets + Tegretol tablets + Atorvastatin calcium tablets + Isosorbide mononitrate for injection + Metoprolol succinate extended-release tablets + Pantoprazole sodium enteric capsules) + Surgery (stent implantation)
[Treatment period] Hospitalization for 10 days, regular review
Treatment effect] Chest pain improved, no further attacks, good recovery
I. Initial consultation
The patient is a 62-year-old male who reported that 20 days ago, while taking a walk in the evening, he suddenly developed chest pain with a significant feeling of suffocation, accompanied by nausea and sweating, as well as significant panic. He had been treated at a local hospital, and myocardial enzyme profile and troponin were not found to be abnormal. The electrocardiogram showed sinus rhythm with T-wave inversion, and the cardiac ultrasound did not show any abnormality. Combined with the characteristics of chest pain and ECG performance, the patient was initially considered to have unstable angina pectoris and was admitted to the hospital for treatment.
After the patient was admitted to the hospital, no abnormality was found in the physical examination, and no significant abnormality was found in the reexamination of troponin, cardiac enzyme spectrum and cardiac ultrasound, but the reexamination of ECG still indicated sinus heart rate and T-wave inversion.
II. Treatment history
After the patient was admitted to the hospital, we communicated with the patient and his children about his condition, and the patient expressed his willingness to actively follow the medical prescription for treatment. First of all, he was given oral aspirin enteric-coated tablets + tegretol tablets for antiplatelet therapy, atorvastatin calcium tablets for lipid regulation and plaque stabilization, metoprolol succinate extended-release tablets for heart rate control and oxygen consumption reduction, pantoprazole sodium enteric-coated capsules for prevention of gastric bleeding, and isosorbide mononitrate for injection for coronary artery dilation and improvement of chest pain symptoms. As the results of coronary angiography indicated 85% stenosis of the anterior descending branch and 40% stenosis of the gyrus branch, the patient was given stent implantation with the consent of the family and one stent was placed in the anterior descending branch.
III. Treatment effect
The patient was admitted to the hospital, and through systematic and reasonable drug treatment, the frequency and degree of chest pain were relieved, but the chest pain still came on occasion. Until the patient finished coronary angiography and stent placement, the patient had a clear sense of relaxation, chest pain and suffocating sensation were relieved, and continued to take medication, and the chest pain did not recur. After 10 days of hospitalization, the patient was in good physical condition, and the electrocardiogram was normal on review, so he was discharged from the hospital. Before discharge, the patient was advised to adhere to long-term medication treatment, and to adjust the relevant medication and review the ECG at the outpatient clinic regularly.
(ECG performance)
IV. Notes
We are glad that the patient’s discomfort disappeared and his body was in normal condition after medication and surgery. After discharge, patients should strictly control risk factors, such as smoking and alcohol consumption, and carry out planned and appropriate exercises, such as jogging, brisk walking, badminton, etc., but need to pay attention to the exercise should be moderate. Avoid overexertion, diet and rest should be regular, and fresh fruits and vegetables, such as tomatoes, spinach, apples and oranges, are recommended to replenish the required vitamins and keep the bowel movement smooth. Patients with unstable angina can usually carry nitroglycerin or quick-acting heart pills with them in case of another attack of pain, and come to the hospital in time if necessary to avoid delaying the condition.
V. Personal insight
Unstable angina is a relatively serious type of coronary heart disease, if not treated in a timely manner, coupled with the induction of risk factors, may lead to acute myocardial infarction, or even sudden death, we should pay special attention. In the present case, the patient’s pain symptoms were consistent with the characteristics of angina pectoris at the onset and were more severe than exertional angina pectoris, but there were no significant changes in myocardial enzymology and no dynamic evolution of electrocardiogram. Therefore, timely surgical treatment is necessary when drug therapy does not relieve or has unknown effect.