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Abstract: A 60-year-old female patient presented with persistent chest pain, back and throat pain with palpitations, sweating, nausea, vomiting and diarrhea without any cause 5 hours ago, and a preliminary diagnosis of cardiac hypertrophy, i.e. hypertrophic cardiomyopathy, was made in combination with electrocardiography. The cause of the disease was not clear, but may be related to genetic mutation factors. After giving medication and general care, the condition was basically stable and the symptoms completely disappeared.
Basic information】Female, 60 years old
Disease Type】Heart hypertrophy
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】January 2022
Treatment plan】Oral medication (atenolol tablets, amiodarone hydrochloride tablets, aspirin enteric solution tablets, valsartan tablets)
Treatment Period】Hospitalization for 7 days, review after 1 month
Treatment effect】The condition was basically stable, and the patient’s chest pain, palpitations, sweating and other symptoms disappeared
I. Initial interview
When we first saw the patient, he had a painful face and a clear consciousness. He reported that he had sustained chest pain with palpitations, pharyngeal and back pain, sweating, nausea, vomiting and diarrhea without any obvious cause 5 hours ago. The patient was asked about the history of hypertension for more than 10 years, with a maximum blood pressure of 200/120 mmHg, a history of hypertension for many years, no abnormality on coronary angiography, a diagnosis of hypertrophic cardiomyopathy, paroxysmal atrial fibrillation, and out-of-hospital drug therapy. The patient was given a physical examination, which showed no augmentation in the precordial region, no enlargement of the cloudy heart border, a heart rate of 83 beats/min, an irregular rhythm, unequal heart sounds, an audible diastolic murmur in the first auscultatory region of the aorta, and no pericardial friction sounds, a pulse of 66 beats/min and a short pulse, and a blood pressure of 147/66 mm Hg. The patient was given an electrocardiogram, which showed atrial fibrillation, hypertrophic cardiomyopathy, left ventricular hypertrophy, and secondary hypertension. The patient was admitted to the hospital with cardiac hypertrophy, hypertrophic cardiomyopathy, left ventricular hypertrophy, and secondary ST-T segment changes, taking into account the patient’s clinical symptoms and previous investigations.
II. Treatment history
After the patient was admitted to the hospital, we determined that conservative treatment was the best option, taking into account the patient’s age, physical condition, and relevant examination results, and after obtaining the patient’s consent, we actively started drug treatment. First, the patient was given amiodarone hydrochloride tablets to reduce the occurrence of paroxysmal atrial fibrillation, and was also advised to take atenolol tablets to improve the ventricular contraction rate and relieve myocardial ischemia and hypoxia. The anticoagulant drug aspirin enteric coated tablets was given to improve hemodynamics and avoid thrombosis causing vascular embolism. Valsartan tablet drug was continued to dilate the blood vessels to control the blood pressure at the level.
III. Treatment effect
When the patient underwent regular drug treatment as well as general conditioning, on the 3rd day of admission, the patient’s sweating symptoms disappeared, but chest pain, palpitations and sweating symptoms still existed, and blood pressure was basically in the normal range. On the 7th day of admission, the patient complained that the symptoms of discomfort basically disappeared, and physical examination: blood pressure was normal and no other discomfort was seen. The treatment effect was good, and the patient was more satisfied, and was discharged from the hospital. After discharge, the patient still needed to take the above drugs regularly. 1 month after discharge, the patient’s condition was stabilized and drug treatment was continued.
IV. Precautions
I am very happy that the patient’s condition was basically controlled after regular medication and general care, but I still need to pay attention to the following matters.
1, the patient still needs to take the medication regularly after discharge, so as to better control the disease, and avoid stopping or reducing the dosage by themselves, which may aggravate the patient’s condition.
2, patients need to regularly go to the hospital to review, give electrocardiogram, blood tests and other tests to clarify the changes in the condition.
3, in regular medication, also need to pay attention to the daily diet light, low-salt food, avoid stimulating food. At the same time, pay attention to rest, when the physical condition allows, you can also choose to properly carry out physical activities, such as tai chi, walking, etc., can enhance physical fitness.
V. Personal insight
For patients with cardiac hypertrophy, clinical symptoms may not be specific, such as the patient in this case, with chest pain, back as well as throat pain as the main symptoms. If myocardial ischemia and hypoxia are severe, it may easily lead to syncope due to brain hypoxia, which is relatively dangerous for the patients themselves and can usually be diagnosed by electrocardiogram examination. Therefore, if patients have symptoms such as chest pain and palpitations, they should actively go to the hospital for corresponding examination and timely treatment to inhibit further development of the disease.