Angina Pectoris „de novo”

Abstract

Background. Angina Pectoris (AP) „de novo” represents 31% of the total patients with unstable AP. The annual incidence of AP „de novo” is 3 cases per 1000 persons, affecting mainly patients between 42-71 years old. The rate of men/women being of 66.6-80.6% compared with 19.4-33.3%. Patients present concomitant pathologies: Arterial Hypertension - 54.8%, dyslipidemia - 51.6%, Diabetes Mellitus - 29.0 % and smoking - 51.6% [3, 4, 5]. This pathology is characterized by constricting retrosternal pain at rest or at exertion, with the onset up to 30 days. Symptoms can evolve, depending on the structure of the atherosclerotic plaque, as either stable AP - 76%, or Acute Myocardial Infarction - 34 %. Both groups have been admitted to inpatient treatment in specialized Cardiology Departments [1, 2]. Case report. We report a case of a 54 year old patient, teacher, admitted in the Cardiology Department nr.3 of SMH „Holly Trinity” with the diagnosis: Unstable Angina Pectoris „de novo”. HF II NYHA. Patient presented with: constricting retrosternal pain at moderate effort and at rest, dyspnea at low physical effort, palpitations, occipital headache, dizziness, fatigue. History: the symptoms started about 3 weeks ago, when for the first time, after psychological stress, palpitations and retrosternal pain appeared. Symptoms have diminished after the rest. The pain reappeared after low physical effort (walking 10-15 m), after smoking, after cold exposure and excessive coffee consumption. The patient went to the family doctor and he was urgently admitted to the cardiology department to establish the diagnosis and to choose the appropriate treatment. Risk factors: aggravated family history, smoking, dyslipidemia, hyperuricemia. Objective data: moderate severity. The skin is pink, clean. Pulmonary auscultation: there is vesicular murmur, murmurs are absent, RR - 22 b / min. The apex beat is determined in the V intercostal space, on the left of the medioclavicular line. Rhythmic cardiac noises with HR 100 beats/min, BP - 130/90 mm/Hg. The abdomen is soft, painless at palpation. The liver and spleen are not palpable. Intestinal transit present. Giordano sign – negative bilaterally. Osteo-articular system – no pathologies. Paraclinical examination: ECG – Sinusal tachycardia with HR 106 beats/min. Left axis deviation. Signs of hypertrophy of the LV myocardium. Echocardiographic conclusion: Induration of the ascending aorta walls. Moderate dilatation of LA, RA. Moderate hypertrophy of LV. Insufficiency of the VTr., VM gr.II, VAP gr. I. Moderate HTP. Laboratory analysis: Hemoleucogram: Hb. - 146 g/l, RBC - 4.6x1012/l, WBC - 5.8 x109, SR - 25 mm/h. CK-MB - 20, Troponines - negative, glucose - 4.9 mmol/l, cholesterol - 6.0 mmol/l, triglycerides - 1.44 mmol/l, LDL - 4.0, HDL - 1.31, urea - 6.0 mmol/l, creatinine - 79 mmol/l, total bilirubin - 10.2 mmol/l, bound bilirubin - 2.0 mmol/l, free bilirubin - 8.2 mmol/l, ALAT - 40 U/l, ASAT - 30 U/l. Treatment: Fraxiparin 0.6 s/c, Sol Isosorbide dinitrate 10 mg i/v lineomat infusion, Sol Meldonium 500 mg i/v, Ramipril 5 mg/day, Bisoprolol 5 mg/day, Rozuvastatin 10 mg/day, Adenuric 40 mg/day. Conclusions. "De novo" Angina Pectoris is a form of unstable AP, characterized by retrosternal pain and progressive dyspnea, with transient changes of the ST segment on EKG in 15-30% of cases. The prognosis of "de novo" AP is favorable in the early diagnosis of this pathology with the administration of the appropriate treatment and the cessation of risk factors.