Case presentation - Angina pectoris

Introduction
I would like to present Mr. Popescu
Patient’s age and occupation
He is 63 years old, pensioner,
Presenting symptom(s) and duration
who presented to the emergency department with an anterior chest pain that radiated to
the jaw and arms, which appeared to exertion.
Associated symptoms
He also complained of shortness of breath in the last 5 days and ankle swelling that
appeared 3 days ago.
Past medical history
He is known with 3rd degree hypertension, heart failure NYHA class 2, type 2 diabetes
mellitus.
Social history
He is married, father of two sons; he smokes 20 cigarettes a day, denies alcohol or drug use.
Family history: -his father died of acute myocardial infarction at age of 58
-his mother had a stroke at age of 62
Findings on examination
Physical Exam: -initial physical exam revealed temperature 36.8 ᵒC, heart rate
74 bpm, respiratory rate 24, blood pressure 130/80, BMI 40,2 and O2 saturation 90% ;
-constitutional: obese
-cardiovascular: normal rate, regular rhythm and normal heart
sounds with no murmur; edema bilateral lower extremities and strong pulse in all four
extremities.
- pulmonary: the examination was normal
- abdominal: soft, obese, bowel sounds were normal.
- neurologic: alert, awake,moving all extremities, no sensation losses.
Investigation results
We did an EKG which showed an ST segment depression, T - negative; inferior ischemia in
the following leads: D2, D3, aVF; Chest X-ray which showed cardiomegaly; Echocardiogram
showed that the left ventricular cavity was dilated. We also did an angiography which
showed a stenosis on the right coronary artery.
Diagnosis
We concluded he had had angina pectoris.
Treatment
He had treatment with calcium channel blockers, anticoagulants, antiaggregants,
antidiabetics, statins, conversion enzyme inhibitors, diuretics.
Outcome-what happened
He responded well to treatment and was discharged.

Mr. Popescu 63, pensioner

c/o anterior chest pain; dyspnoea 5/365; ankle swelling 3/365
PH 3rd degree hypertension, heart failure NYHA class 2, type 2 diabetes mellitus
SH married; 2 sons; 20 cigs/day; non-alcoholic
FH father d. 58 AMI; mother- stroke
OE HR 74 bpm; BP 130/80; BMI 40,2
obese
EKG inferior ischemia
CXR cardiomegaly
Dx angina pectoris