Biography
Biography: Manuela Stoicescu
Abstract
Objectives: The main objectives of this clinical case presentation is to attract attention about the situation from our medical practice when we can have a patient with typical constrictive chest pain like in ischemic heart disease but with normal EKG in crisis. Confers this normal EKG us safe that the patient is not in dangerous situation?
Material And Methods: I present the clinical case of a women patient 46 years old, in early menopause because of stressful situation in she’s family, who came at consultation with sudden constrictive chest pain, high intensity, irradiation in to the left shoulder, anxiety and sweating. Mention, very important, that the EKG was normal without ischemic – lesions changes in crisis of chest pain, but the pain disappeared immediately in 2 min after one drug 0,5mg of Nitroglycerine under the tongue. Because the patient was in menopause (so lost the estrogen protection for atherosclerosis and heart attack) in this stressing condition at home I have decided to be hospitalized for more safe indifferent that the pain stopped at the moment and the EKG was normal without any changes. After hospitalization however the EKG was normal the patient start the correct protocol for ischemic heart disease: beta-blocker, nitrate, aspirin, statine drugs and NTG under the tongue if she need. The blood tests were in normal range and cardiac enzymes as well. Only the level of cholesterol=250mg/dl was increase.
In the second day, in the morning, the patient present severe chest pain, constrictive, sweating, anxiety and was necessary perfusion with nitroglycerin to stopped the pain in 10min, but unusual the EKG in crisis was again normal and the level of cardiac enzymes were the same in normal range. In the third day in the morning the patient presented again constrictive chest pain, anxiety, sweating and was necessary again administration the perfusion of nitroglycerin to stopped the pain in approximate 15 minutes, because wasn’t stopped after NTG drug 0,5 mg under the tongue, but the EKG repeated in crisis was again normal and the level of cardiac enzymes remained normal as well. An echocardiography of the heart was performed to exclude the dissection of the aorta but was normal and the therapy was completed with Fraxiparine 0,4UI sc twice per day at 12 hours. In the third day because of repeated crisis of chest pain the patient was referred to the Surgery Cardiovascular Department and a heart coronarography was performed and surprising three coronary arteries were narrowing with 75%. So a severe left main or three-vessel disease stenosis of coronaries arteries was discover and the patient performed three stents implantation with good evolution.
Results and Discussions: How was possible that the EKG to be normal three days consecutively in context of these severe repetitive constrictive chest pain? when perfusion with nitroglycerin was necessary to be administrated repeated to stoped the pain and the level of specific cardiac enzymes were normal as well and excluded a heart attack.
Conclusion: The most important conclusion of this clinical case presentation is that a normal EKG (without ischemic - lesions changes) in a typical crisis of constrictive chest pain, don’t give us safe that the patient don’t have nothing and is better to start the standard protocol of therapy for ischemic heart disease, if the characteristics of chest pain are so typical clinic for angina pectoris, to protect our patient and to be in safe. A normal EKG in typical crisis of chest pain doesn’t exclude the diagnosis of ischemic heart disease. In our actual standard protocol in these situations the effort test should be perform but could be iatrogenic and dangerous. Except this clinical case report, in my medical practice, I have saw many clinical cases in the similar situations, for this reason I start the standard protocol of therapy for ischemic heart disease at these categories of patients with normal EKG to prevent sudden death. The typical chest pain with normal EKG in crisis could hide a very severe and risky ischemic heart disease with many severe stenosis of the coronaries arteries and don’t give us safe that the patient is not in danger.