Chest Discomfort and Pain That Worsens With Activity? Don't Ignore the Issue of Atherosclerosis

At 66 years old, Mrs. Zhang visited the hospital due to intermittent chest discomfort and pain that had persisted for a week. She had a history of coronary stent placement and was diagnosed with severe stenosis in the left anterior descending artery during angiography. After undergoing a second stent procedure and adjustments to her medication, her condition improved significantly. This case highlights the importance of lifestyle changes, long-term medication, and regular follow-ups to address cardiovascular issues at their root.

Understanding Coronary Artery Disease

Coronary artery disease (CAD) is often caused by atherosclerosis — a buildup of plaque in the arteries that restricts blood flow to the heart. This can lead to symptoms like chest pain, shortness of breath, and fatigue, especially during physical activity. If left untreated, it can result in serious complications such as heart attack or heart failure.

Case Overview

Patient: Female, 66 years old
Condition: Coronary artery disease with severe left anterior descending artery stenosis
Hospital: Renmin Hospital of Wuhan University
Treatment: Coronary stenting, optimized medication regimen
Duration: 7-day hospitalization, 1-month follow-up
Outcome: Improved symptoms, stabilized heart function, and enhanced kidney and glucose control

Initial Evaluation and Diagnosis

Mrs. Zhang reported experiencing chest discomfort that worsened with activity. Despite no fever or respiratory symptoms, her history of hypertension, diabetes, chronic kidney disease, and previous stent placement raised concerns. Her physical examination revealed a blood pressure of 123/47 mmHg and a heart rate of 68 bpm. Based on her symptoms and medical history, she was admitted for further cardiac evaluation.

Medical and Interventional Treatment

During hospitalization, blood tests showed elevated BNP levels (1564 pg/mL), reduced kidney function (eGFR 43.54%, creatinine 141 µmol/L), and heart imaging revealed left atrial enlargement and a reduced ejection fraction of 42%. On the third day, she underwent coronary angiography, which revealed severe calcified stenosis in the mid to proximal left anterior descending artery. Three stents were successfully implanted, and high-pressure balloon post-dilation was performed to optimize stent expansion.

Her medication regimen included:

Sacubitril/valsartan for heart failure
Leezatin (lercaserin?) for blood pressure control
Evolocumab for lipid-lowering and plaque stabilization
Metroprolol for heart rate control
Aspirin and ticagrelor for antiplatelet therapy
Isosorbide mononitrate for angina relief
Repaglinide and acarbose for blood sugar management
Uradetox granules to support kidney function

Positive Outcomes After Treatment

One month after the procedure, Mrs. Zhang showed remarkable improvement:

Fasting glucose: 6.1 mmol/L, postprandial glucose: 7.8 mmol/L
eGFR improved to 53.54%, creatinine dropped to 121 µmol/L
BNP decreased to 14 pg/mL
Significant relief from chest discomfort and improved heart function
Successful revascularization of the left anterior descending artery
Effective long-term management of heart disease, diabetes, and kidney function

Post-Treatment Recommendations

While stent placement is effective in restoring blood flow, it is not a cure. Long-term management is essential:

Lifestyle Changes: Adopt a heart-healthy diet, maintain a healthy weight, avoid smoking, and engage in regular physical activity.
Medication Adherence: Take prescribed medications consistently, including antiplatelet agents, statins, beta-blockers, and blood pressure or glucose-lowering drugs.
Regular Monitoring: Schedule routine check-ups to monitor heart function, kidney health, and metabolic markers.

Key Takeaways for Long-Term Heart Patients

Mrs. Zhang's case illustrates the importance of comprehensive cardiovascular care:

Regular Health Screenings: Adults, especially those over 50, should undergo annual checkups for blood pressure, cholesterol, glucose, and body fat levels.
Chronic Disease Management: CAD is a lifelong condition. Proactive lifestyle changes and medical therapy are crucial to prevent disease progression.
Consistent Follow-Up: Stent placement is just one part of treatment. Ongoing care through medications and regular medical evaluations is vital to long-term success.