Patient K., 48 years old, an economist,

Patient K., 48 years old, an economist, turned to a local general practitioner with complaints of compressive pain behind the sternum and in the region of the heart, radiating to the left shoulder, occurring when walking after 100 meters, sometimes at rest, stopped by taking 1-2 tablets of Nitroglycerin through 2-3 minutes, shortness of breath, palpitations with little physical exertion. Pain in the heart first appeared about 5 years ago. Takes Nitroglycerin for pain relief, Kardiket 20 mg 2 times a day – for the prevention of pain in the heart, Aspirin 100 mg at night. I took statins for about two years, and have not taken them for the last two years. Over the past six months, exercise tolerance has decreased. The patient has been smoking for about 20 years, 1 pack a day. Heredity: father died at the age of 62 from myocardial infarction. The general condition is satisfactory. Normosthenic constitution. There are no peripheral edema. Respiratory rate – 18 per minute, vesicular breathing in the lungs, no wheezing. The borders of the heart during percussion: right – the right edge of the sternum IV intercostal space, upper – III intercostal space, left – 1.0 cm medially from the left midclavicular line V intercostal space. The heart sounds are muffled, the rhythm is correct, the accent of the second tone is over the aorta. Heart rate – 82 beats per minute. BP – 135/80 mm Hg. Art. The liver and spleen are not palpable. The symptom of tapping in the lumbar region is negative. Blood lipids: total cholesterol – 6.8 mmol/l; triglycerides – 1.7 mmol / l; high density lipoprotein cholesterol – 0.9 mmol / l. ECG at rest: rhythm – sinus, heart rate – 80 beats per minute. EOS is not rejected. Single ventricular extra-systole. Echo-KG: compaction of the walls of the aorta. The thickness of the posterior wall of the left ventricle is 1.0 cm; the thickness of the interventricular septum is 1.0 cm. The chambers of the heart are not dilated. The ejection fraction of the left ventricle – 57%. Violations of local and global contractility of the left ventricle were not detected. VEM test: when performing the first step of the load, compressive pain behind the sternum appeared, accompanied by the appearance of ST segment depression up to 3 mm in I, II, V2-V6, which disappeared in the recovery period. Coronary angiography: stenosis in / 3 of the left coronary artery – 80%, c / 3 of the circumflex artery – 80%. Questions: 1. Formulate a clinical diagnosis . 2. Substantiate the clinical diagnosis. 3. Name the main risk factors for atherosclerosis. 4. Prescribe non-drug and drug treatment. 5. Are there any indications for surgical treatment in this case? SECTION B. A 42-year-old man came to the clinic with a first attack of intense compressive retrosternal pain without distinct irradiation, accompanied by nausea, profuse sweating, shortness of breath. By the time of treatment, the duration of the attack was about 3 hours. Smoked for many years, 10-15 cigarettes a day. There is no history of arterial hypertension and other diseases of the cardiovascular system, diabetes mellitus, neurological diseases, head injuries, coagulopathy and significant bleeding. Consciousness is clear. The skin is pale, hyperhidrosis. Breathing is vesicular, no wheezing. NPV – 18 per minute. Heart sounds are rhythmic. Heart rate – 90 beats per minute, blood pressure – 130/80 mm Hg. Art. The abdomen is soft, painless in all departments. The liver is not enlarged. 1. Suggest the most likely diagnosis. 2. Name the deviations from the norm, visible on the presented ECG, and formulate an ECG conclusion . 3. What is the tactics of a general practitioner in this situation? 4. Among what urgent conditions is it necessary to conduct a differential diagnosis? 5. What laboratory markers are recommended to be used to confirm the diagnosis? SCIENCE HEALTH SCIENCE NURSING NURSING RN 2488

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