Ischemic heart disease
S.G., 67 years old, male Patient presents with severe left-sided chest pain. he indicates a 5 in a range from 1 to 10 He notes that similar pain associated with physical exertion and emotional stress has occurred periodically (but not frequently) over the last 8 years. He visited his physician, who referred him to a cardiologist; the resulting diagnosis was “IHD, angina of effort,
Current episode of pain was related to the fact that this day the elevator was out of order and the patient had to climb the stairs to the 8th floor. When he reached the 5th floor, he suddenly felt acute pain in sternal area, which was stinging and squeezing in nature and radiated to the left forearm. Pain did not pass even after he had stopped to rest and used two nitroglycerin tablets with a short interval. Nitroglycerin relieved the pain to some extent so he was able to get home. However, the pain worsened again and did not respond to repeated nitroglycerin doses. Relatives called emergency medical service.
He reported approximately a 25 pack year smoking history, drank alcohol socially on weekends, and denied cocaine or amphetamine use ,His father had been quite healthy but died suddenly at age 72 of a massive heart attack . mother a live and well. The patient is married and has two sons and a daughter, all healthy.
Current medications: aspirin 100 mg daily, clopidogrel ( Plavix) 75 mg daily, perindopril (Coversyl) 4 mg daily, simvastatin (Zocor) 20 mg daily. Further discussion identifies Jock’s lack of understanding of the purpose of his medicines and he admits to not always being compliant. On examination Breathing movements appear to be symmetrical (respiration rate - 18 breaths per minute). Lung auscultation reveals vesicular respiration. His blood pressure is 145/85 mmHg, pulse rate 80 per minute regular and his chest is clear on auscultation. Abdomen is soft and painless on palpation. CNS examination reveals no abnormality. Body mass index is 23.5 kg/m2. (EKG) revealed a normal sinus rhythm with normal intervals (Figure 1). There were no ischemic ST-T wave changes. A portable chest X-ray study showed clear lungs with no evidence of pulmonary edema or airspace disease.
Na 137mEq/L, K 4.8 mEq, Cl 103 mEq, BUN 24mg/dL, SCr 1.2mg/dL, Glu 98 mg/dL , Hgb 11.8 g/dL, Fasting lipid profile:total cholesterol of 5.5 mmol/L, (LDL) 3.9 mmol/L, (HDL) cholesterol 0.8 mmol/L and Trig 1.8 mmol/L.