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Abstract: A 67-year-old female patient with paroxysmal chest tightness and chest pain for 1 week, aggravated for 2 days, and more likely to experience chest tightness and chest pain after exertion or emotional agitation, and sometimes at night while sleeping. After hospitalization, we optimized the treatment and medication regimen and urged the patient to pay attention to the improvement of lifestyle interventions, and the symptoms were significantly relieved. We suggested that the patient should undergo further coronary interventions, which the patient and her family refused, and the symptoms were relieved through the use of medication.
[Basic information] Female, 67 years old
Disease Type】Unstable angina pectoris
Hospital】Harbin First Hospital
Date of consultation】May 2022
Treatment plan】Medication (low molecular weight heparin sodium injection + isosorbide nitrate injection + aspirin enteric dissolve tablet + risuvastatin calcium tablet + metoprolol tartrate tablet + perindopril tablet + clopidogrel hydrogen sulfate tablet + ezetimibe tablet + isosorbide mononitrate tablet)
Treatment Period】7 days of inpatient treatment, 3-6 months of outpatient follow-up
Treatment effect] The symptoms have been controlled and improved, and all the indexes are improving. The symptoms of chest tightness and chest pain rarely occur after regular medication.
I. Initial interview
Through detailed communication, we learned that the patient had not been hospitalized or examined systematically in the outpatient clinic in the past. He was diagnosed with hypertension 10 years ago, and his blood pressure is controlled at 150/90 mmHg with amlodipine benzoate tablets. In the past week, recurrent chest tightness and chest pain occurred, and the episodes became more and more frequent, sometimes waking up at night with pain.
II. Treatment history
The patient was initially considered to be suffering from unstable angina pectoris, and was given subcutaneous injection of low molecular weight heparin sodium injection and intravenous pumping of isosorbide nitrate injection on the day of consultation. The patient was instructed to take aspirin enteric-coated tablets, risuvastatin calcium tablets and metoprolol tartrate tablets orally, and the dose of metoprolol tartrate tablets was adjusted according to the follow-up blood pressure until the heart rate was controlled, and the antihypertensive drugs were changed to perindopril tablets. The patient and his family refused to have coronary angiography, so they settled for coronary CT. The coronary CT showed severe stenosis in the lumen of the left main stem-left anterior descending branch mixed plaque, moderate stenosis in the lumen of the gyrus branch mixed plaque, and mild stenosis in the lumen of the right coronary artery mixed plaque, and dual antiplatelet therapy with clopidogrel sulfate tablets. Low-density lipoprotein: 4.7 mmol/L. Ezetimibe tablets were added for intensive lipid lowering. Coronary intervention was communicated, which the patient and his family still refused. After the symptoms were gradually relieved, isosorbide nitrate injection was discontinued and replaced by oral isosorbide mononitrate tablets for alternative treatment.
III. Treatment effect
After improvement by 7 days of good lifestyle intervention combined with optimal therapeutic drug regimen, the patient’s symptoms of chest tightness and chest pain improved significantly. However, chest tightness and chest pain still occurred during heavy physical work or emotional excitement, and blood pressure could be basically controlled below 130/80 mmHg, and heart rate could be maintained at about 60 beats per minute. The LDL in blood lipids could be controlled below 1.4 mmol/L after intensive lipid lowering. The patient was discharged from the hospital and was advised to take medication regularly after discharge and to come to the hospital for review every 3-6 months. The patient was advised to take the medication regularly and come to the hospital for review every 3-6 months. The patient was also advised to undergo coronary intervention as soon as possible because of the severe stenosis of the coronary vessels and the limitations of the medication alone.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but for patients with unstable angina, it is important to pay attention to regular oral medications to prevent disease progression, especially drugs such as aspirin enteric tablets, clopidogrel hydrogen sulfate tablets, and resulvastatin calcium tablets. It is also important to monitor heart rate and blood pressure, and to control heart rate and blood pressure in order to prevent discomfort and disease progression. In addition, we should pay attention to coronary intervention as soon as possible, so as to better reduce the risk of sudden death. During the day, we should pay attention to low-salt and low-fat diet, eat more fresh fruits and vegetables, and avoid full meals, emotional excitement and exertion to avoid triggering acute myocardial infarction. Be careful to go to the hospital every 3-6 months for physical examination and review, and also pay attention to control LDL below 1.4 mmol/L.
V. Personal insight
Unstable angina is one of the more dangerous types of coronary heart disease, usually between stable angina and myocardial infarction. For patients with unstable angina, coronary angiography should be performed as early as possible to help understand the severity of coronary vascular stenosis. For patients with severe coronary stenosis, early coronary intervention is recommended. At the same time, attention should be paid to optimizing the therapeutic regimen to help reduce the risk and improve the patient’s prognosis. The patient had a history of hypertension, and although he took oral antihypertensive medication on a regular basis, he did not control his blood pressure to the standard, and he also smoked secondhand smoke. For elderly people with underlying diseases, they must pay attention to strengthening their awareness of medical checkups, and actively treat and review their underlying diseases to help prevent the emergence of serious coronary vascular lesions.