63-Year-Old Male Successfully Treated for Unstable Angina with Medication and Stent Placement
Unstable angina can present suddenly and pose serious health risks if not properly managed. This case highlights the successful treatment of a 62-year-old male who experienced recurring chest pain and was eventually diagnosed with unstable angina. After undergoing a combination of medical therapy and coronary stent implantation, the patient's symptoms were effectively resolved and he made a full recovery.
Case Overview
The patient was a 62-year-old male with no prior history of significant health issues. He began experiencing chest discomfort 20 days before seeking treatment. Despite initial care at a local hospital, his symptoms persisted, prompting him to seek further evaluation at Anhui Medical University's First Affiliated Hospital in January 2022.
Diagnosis and Treatment Plan
Following a series of diagnostic tests, including electrocardiogram (ECG) and coronary angiography, the patient was diagnosed with unstable angina. His treatment included a comprehensive medication regimen and percutaneous coronary intervention (PCI) with stent placement. He remained hospitalized for 10 days and experienced significant symptom relief post-treatment.
Initial Consultation and Symptoms
The patient first experienced chest pain during a walk in the evening, accompanied by shortness of breath, nausea, sweating, and palpitations. Rest provided some relief after approximately 10 minutes. Although local hospital tests showed normal cardiac enzyme levels and echocardiogram results, ECG revealed T-wave inversion, leading to a suspected diagnosis of coronary artery disease.
Due to ongoing symptoms, particularly during physical activity and occasional nighttime episodes, the patient sought further evaluation at a higher-level medical facility. Upon admission, additional testing confirmed an 85% stenosis in the left anterior descending artery and 40% stenosis in the circumflex artery, confirming unstable angina.
Treatment Process
Following informed consent from the patient and his family, a dual antiplatelet therapy was initiated using aspirin and ticagrelor. Additional medications included atorvastatin for lipid control, metoprolol to manage heart rate, pantoprazole to prevent gastrointestinal bleeding, and intravenous isosorbide mononitrate to relieve angina symptoms.
Given the severity of the blockage in the left anterior descending artery, the medical team proceeded with stent placement. A single stent was successfully implanted, restoring normal blood flow and alleviating the patient's chest discomfort.
Post-Treatment Recovery
Although the initial medication regimen provided partial relief, complete resolution of chest pain occurred after the stent procedure. After 10 days of hospitalization and follow-up ECGs showing normal results, the patient was discharged in stable condition.
He was advised to continue long-term medication therapy and to attend regular outpatient follow-ups to monitor his condition and adjust treatment as necessary.
Post-Discharge Care and Lifestyle Recommendations
Following discharge, it is crucial for patients with unstable angina to manage risk factors effectively. This includes quitting smoking, limiting alcohol consumption, and engaging in moderate-intensity physical activity such as brisk walking, jogging, or playing light sports like badminton.
Dietary habits should include a high intake of fruits and vegetables, such as tomatoes, spinach, apples, and oranges, to support heart health and digestive regularity. Patients are also advised to carry nitroglycerin or emergency cardiac medication in case of recurrent symptoms and to seek prompt medical attention if chest pain returns.
Clinical Insights and Conclusion
Unstable angina represents a critical phase in coronary artery disease and can progress to acute myocardial infarction if not addressed promptly. In this case, the patient's symptoms were more severe than typical stable angina, but lacked the typical biomarker elevation seen in heart attacks. While conservative treatment offered some benefit, the addition of coronary angiography and stent implantation was essential for symptom resolution.
This case underscores the importance of timely intervention when medical therapy alone is insufficient. A multidisciplinary approach combining pharmacological and interventional strategies can lead to favorable outcomes in patients with unstable angina.