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Abstract: A 66-year-old female patient came to the hospital a week ago because of intermittent chest tightness and chest pain. She had previously had a stent placed in her heart vessel, and after admission, she had an angiogram indicating severe stenosis of the left anterior descending branch and underwent stent treatment again, and had her medication adjusted, and the patient was discharged from the hospital in good condition. In order to solve the problem at the root, we must first pay attention to our own lifestyle changes, long-term medication treatment, and regular review.
Basic information】Female, 66 years old
Disease Type】Atherosclerotic heart disease of coronary arteries
Hospital】Wuhan University People’s Hospital
Date of Consultation】March 2021
Treatment plan】Surgical treatment (stent treatment to open stenotic lesions), drug treatment (sakubatril valsartan, lercanidipine hydrochloride, iloyuzumab, metoprolol succinate, biaxin enteric tablets, tegretol, isosorbide mononitrate, etc., repaglinide, acarbose to lower sugar, urotoxic pellets to improve renal function)
Treatment period】7 days of hospitalization, 1 month follow-up
Treatment effect] The symptoms of chest tightness were effectively improved, the narrowed and occluded left anterior descending blood vessel of the heart was opened, the ventricular rate was controlled, blood sugar was improved, renal function was improved, and all indicators were improving.
I. Initial consultation
A 66-year-old female patient, Zhang Danyang, came to the clinic with intermittent chest tightness and chest pain for one week. In the past 1 week, Zhang Danyang had symptoms such as intermittent chest tightness and chest pain after activities, and she felt that the chest tightness was aggravated after a little activity. In this week, she did not have fever, cough, wheezing, panic, dizziness, headache and other discomforts, but in the past two days, Zhang Danyang also felt that her chest was stuffy when there was no activity. Zhang Danyang asked about her previous health condition and learned that Zhang Danyang had previously had a stent placed in her heart vessel. Zhang Danyang had a history of hypertension, diabetes, renal insufficiency, renal anemia, and hyperuricemia, all of which were treated with allopathic medications on a regular basis. During the physical examination, Zhang’s blood pressure was 123/47 mmHg and her heart rate was 68 beats per minute, which was thought to be due to coronary artery atherosclerotic heart disease, or coronary heart disease, which caused the symptoms of chest tightness due to insufficient blood supply to the heart. So she was admitted to our cardiology department for further diagnosis and treatment.
II. Treatment process
After admission, Danyang Zhang had a blood test, which showed that the estimated glomerular filtration rate was 43.54%, creatinine was 141.00 μmol/L, B-type natriuretic peptide precursor was measured: 1564 pg/mL, the electrocardiogram had ST-T segment changes, and the cardiac ultrasound found that the aorta of the heart was widened, the ejection fraction was 42%, and the left atrium was slightly enlarged, considering hypertensive changes and chronic cardiac insufficiency. Intraoperative angiography revealed severe stenosis and calcification in the proximal and middle segments of the left anterior descending branch, so three stents were placed in this segment from distal to proximal, and the proximal stent was post-dilated with a high-pressure balloon, and the repeat angiography showed satisfactory stent placement and no residual stenosis. The interventional procedure lasted about one hour and helped Zhang Danyang open the most severe stenotic lesion in the left anterior descending branch of the coronary artery. After admission, Zhang Danyang was treated with sakubatril valsartan for chronic heart failure, lercanidipine hydrochloride for lowering blood pressure, iloclizumab subcutaneously for intensive lipid-lowering, plaque stabilization and cardiovascular event risk reduction, metoprolol succinate for slowing heart rate, bye aspirin enteric tablets and tegretol for antiplatelet and isosorbide mononitrate for long-term treatment of coronary heart disease, and also regeneryl and acarbose for lowering sugar. The symptomatic supportive treatment such as uremic pellets to improve renal function, Zhang Danyang’s postoperative chest tightness was effectively relieved, and she was discharged home after 4 days of postoperative observation.
III. Treatment effect
One month after the operation, the blood glucose was rechecked, fasting blood glucose was 6.1mmol/l, postprandial blood glucose was 7.8mmol/l, estimated glomerular filtration rate was 53.54%, creatinine was 121.00μmol/L, B-type natriuretic peptide precursor was measured: 14pg/mL. The treatment effect of Zhang Danyang was obvious, firstly, Zhang Danyang’s symptoms of chest tightness and chest pain were effectively improved; secondly, Zhang Danyang’s stenosis Second, the left anterior descending branch of Zhang’s stenosis was opened and the blood supply to the myocardium was restored; third, the regular antiplatelet aggregation, lipid-lowering, and plaque stabilization drugs needed for coronary heart disease were used to prevent adverse cardiac events; fourth, symptomatic support such as ventricular rate control, glucose lowering, and improvement of renal function were used to delay the progression of hypertension, diabetes, and coronary heart disease, and to improve the prognosis.
Fourth, precautions
For patients with many years of coronary heart disease, minimally invasive interventional surgery to place stents is only one part of the treatment of coronary heart disease. It can resolve the narrowed blood vessels to restore blood pressure supply to the heart, relieve patients’ symptoms and reduce the risk of death, but it does not guarantee that stenosis will not occur again, and we are glad that patients have got initial improvement after surgical treatment. So to get to the root of the problem, first of all, patients must pay attention to their own lifestyle after discharge; secondly, take coronary drugs and drugs for other underlying diseases on time and on a regular basis, such as treatment of diabetes and hyperlipidemia, because these diseases not only damage the corresponding organs, but are also high-risk factors for coronary heart disease, and must be strictly controlled; finally, remember to follow up and review regularly, because the disease Lastly, remember to follow up regularly, because the condition of the disease can change at any time, so it is necessary to review regularly to assess the condition, adjust the medication and improve the prognosis.
V. Personal insight
The patient, Zhang Daniang, is a typical patient with many years of coronary artery disease. She had a stent placed in her heart vessel in the past, and this time a coronary angiogram revealed a severe stenosis. Therefore, for patients with many years of coronary heart disease like Diana Zhang need to pay attention to the following points.
1, middle and old age healthy people should do a good routine physical examination, annual whole body physical examination, at least check the level of blood pressure, blood sugar, blood lipids, body fat, these are the high risk factors of coronary heart disease, to prevent and control in a timely manner.
2, coronary heart disease is a chronic disease, need to do a good job of chronic disease management, first must improve their lifestyle, reasonable diet, control total calories, limit the intake of alcohol and sugary foods, preventive measures should start as early as possible, and then participate in a certain amount of physical labor and physical exercise.
3. Keep in mind to take drugs for lowering blood pressure, regulating lipids, antiplatelet, improving myocardial remodeling and improving prognosis on a regular basis. Interventional minimally invasive surgical treatment is only a means to solve the narrowed blood vessels and restore blood supply, not a measure to solve the root cause of the problem; changing lifestyle, taking medication on time and regular review are the most basic methods.