روائع مختارة | بنك الاستشارات | استشارات طبية وصحية | اضطرابات.. القلب

MEDICAL & CATH REPORT
HISTORY:
Mr. Mansour is a 50- year- old Saudi gentleman seen in the clinic on the 24th of May 2006 with recurrent history of severe epigastric and retrostemal chest discomfort radiating to the left and right precordium occurring at rest. Over the last few months he had 5 episodes unrelated to exertion. He was thoroughly investigated with an ECG, Echocardiogram, and exercise treadmill test which were negative. He had upper G. I endoscopy which showed only mild reflux with gastric erosions. His symptoms did not improve on Pentazol treatment.
CAD RISK FACTORS:
Include age and gender, in addition to smoking 1- 2ppd. He is diabetic for the last 8 years managed with OHG. His lipid profile is unknown. He is not hypertensive. He had family history of IHO in his father in his 70's.
PAST MEDICAL AND SURGICAL HISTORY:
Include radio- frequency ablation for supraventricular arrhythmias and history of
appendectomy.
MEDICATIONS AND ALLERGIES:
Include Glucophage OD, Avandia 00, Pentazol 00, Lipitor 20mg at HS OD,
Juspirin 81mg OD, and Motilium 10mg TID.
ON EXAMINATION:
He was in no apparent distress. His Ht is 165cm and his B. Wt is 96Kgs. His HR is 80/ minute regular, of good volume, no special character. His B/ P right arm supine and sitting is 130/ 80mmHg.
His head and neck, chest, cardiovascular, abdominal, and extremity examination showed no significant abnormality except for mild tenderness in the epigastrium which does not reproduce his pain.
The patient had recurrent symptoms despite treatment with Pentazol. He was advised to undergo either nuclear perfusion scan (thallium or sestamibi) which gives the sensitivity of 80% for detection of CAD or undergo coronary angiography which gives the sensitivity of 100% for detection of CAD with quoted risk of 1 in a 1000.
The patient elected to undergo coronary angiography since he lives in a area remote from medical services. He was admitted to SFH after loading dose of Plavix, in addition to ASA for coronary angiography. That was done on the 25th of May 2006 using right femoral approach with 6F sheath and catheters. The left main
coronary artery is normal. The LAD had multiple mild plaques in its mid portion of about 15- 20% severity. The circumflex artery is non- dominant and had very small 2nd and 3rd obtuse marginal. He had 50- 60% plaque at its distal circumflex artery before the 3rd obtuse marginal branch. The right coronary artery is large and dominant and again had mild plaques in the origin of the PDA branch.
There were no complications. The sheaths were removed and the patient will be
discharged in the evening of the 25th of May.
He was advised to abstain smoking and have a tight control of his BIP and lipid profile. His Lipitor was increased to 40mg OD and he was prescribed Dilzem 60mg BID. His symptoms will be reassessed in one- week time.
ASSESSMENT:
50- year- old Saudi gentleman with recurrent episodes of epigastric and C/ P,
hyperlipidemia, mild coronary artery disease, will be managed as discussed.

السيد منصور المحترم: 

العملية السابقة كانت لاستئصال حزمة ناقلة شاذة في القلب، و قد تم ذلك بنجاح. الآن أنت سليم من الناحية القلبية، والتضييق الموجود في نهاية الشريان المنعكس، ليست له قيمة حقيقة.

أعتقد أن الأعراض التي تشكو منها هي أعراض التوتر العصبي والنفسي، لذلك أنصحك بتناسيها، و ممارسة الرياضة بشكل منتظم، والابتعاد عن المنبهات (تبغ 0 قهوة - كولا)، و أخذ عدد كافي من ساعات الاسترخاء يومياً.

مع تمنياتي بالصحة الوافرة.

الكاتب: د. مازن محمد اللجمي

المصدر: موقع المستشار