Angina de novo in dyslipidemic patients, a clinical case

Abstract

Introduction: Angina is the most frequent pathology of coronary heart disease (CHD ) with a prevalence of between 0.76 to 15.1 % for men and 0.73 to 14.4 % for women. Angina de novo represents 31% of total patients with unstable Angine, predominantly affecting patients 52-71 years old with concomitant pathologies: hypertension ( HA) in 54.8 %, dyslipidemia (51.6 % ), diabetes ( DM ) in 29.0 % and smoking (51.6 % ). If we can reduce cholesterol levels by 25 % achieve a 50% reduction in the risk of acute myocardial infarction (AMI).Materials and Methods: Patient X., 64 years Diagnosis: Ischemic heart disease. Angina de novo ( from 2/5/2016 ). Hypertension gr. II, very high additional risk. IC II NYHA st. B ACC / AHA. Subcompensated type 2 diabetes. Dyslipidemia. Results. Accusations: constrictive chest pain triggered by minimal physical exertion, lasting 5 minutes ceding 1 nitroglycerin pill, inspiratory dyspnea, palpitations, congestion. The CBC: Hb-144g / l, Er.- 4.9x1012 / l, L.- 9,2x109 / l, ESR - 31mm / hour. Biochemistry: Urea - 10.7 mmol / l; creatinine - 120 mmol / l; uric acid - 470 mmol / l; glucose - 8.7 mmol / l; Cholesterol - 7.9 mmol / l, triglycerides - 3.60 mmol / L, K - 4.9mmol / l; N & lt; 146 mmol / l; Prothrombin - 90%, fibrinogen -3.5 g / l. The glycemic profile: 700- 9 mmol/l, 1300-10.8 mmol/l, 1700- 10,7 mmol/l; 2000- 9,4 mmol/l. ECG: sinus rhythm with 75 b / min. Heart Axis - horizontal deviation. Repolarization disorders in region of LV; EcoCG: Ao gracious walls ascend., V.Ao VM. LA moderate dilatation. Moderate concentric hypertrophy LV. Pump function of LV is preserved. LVEF-53%. Echo-Doppler CS: Vmax-N. Etc Not. VM gr.II. Etc Not. VT gr. II. Doppler intima media - 0.9 mm. Coronary angiography: LAD stenosis at the bifurcation of DIAI 40-50%. IMA: non-dominant. IMA stenosis in the segment average of 70%. Stenosis of the proximal RCA 70-90%. Conclusion: trivasculare atherosclerotic lesions, stenosis important IMA, RCA, LAD stenosis moderate. Treatment: Percutaneous Coronary Intervention on RCA, IMA, Atorvastatin 80 mg / day, Plavix 75 mg / day, Bisoprolol 5 mg / day Ramipril 5 mg / day, Diaprel 60 mg / day Conclusions: Patients with AP de novo in 76 % evolves AP stable and 24 % in AMI. AP de novo early detection, diagnosis by coronary angiography significant coronary lesions and facilitate prompt treatment prevent AMI development.