ANSWERS ON QUESTIONS

Main part

Patient N. 52 years old, driver, turned to the local GP physician

paroxysmal pain behind the sternum with radiation to the left shoulder, shoulder blade,

arising during fast walking, intense physical activity,

accompanied by a sense of fear, stopping at rest. Considers herself ill in

for two months, was treated by a neurologist with a diagnosis of intercostal neuralgia.

I took Analgin, Diclofenac, physiotherapeutic procedures - without effect.

From the anamnesis it is known that for about 5 years he suffers from arterial hypertension with

the maximum increase in blood pressure to 175/100 mm RT. Art., constant

does not receive antihypertensive therapy.

Heredity: father and older brother suffered a myocardial infarction before

55 years.

Bad habits: smokes for 20 years at 20 cigarettes per day; alcohol

moderately consumes.

Objectively: the condition is relatively satisfactory. Height - 170 cm, weight - 98

kg BMI - 33.91 kg / m 2 . Hypersthenic physique. Skin and visible

mucous membranes of normal color. There are no peripheral edemas. In the lungs breathing

vesicular, performed in all departments, no wheezing. Percussion above the surface

light, clear light sound. NPV - 17 per minute. Auscultatory: at the top of the heart

weakening of the I tone, above the aorta - emphasis of the II tone. Heart sounds are muffled, rhythmic. HELL -

170/100 mmHg Art. Heart rate - 88 beats per minute. The abdomen is soft, on palpation

painless in all departments. The liver is not enlarged. Symptom of striking

lumbar region negative. Physiological administration is normal.

In the analyzes: total cholesterol - 5.6 mmol / L, TG - 2.4 mmol / L, HDL-C - 0.9

mmol / l, XL-LDL - 3.57 mmol / l; creatinine - 89 μmol / L, GFR (according to the formula CKD-EPI)

= 84 ml / min.

On the ECG: sinus rhythm, correct with heart rate - 88 beats per minute. Hypertrophy

left ventricular myocardium.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. What groups of drugs should be prescribed to a patient?

Justify your choice.

5. On stress-ECHO-KG deterioration of contractility was revealed in 4 segments. Your

further tactics of patient management?

Situational task 164 [K002008]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient R., 55 years old, locksmith, turned to the local GP physician

compressive pain behind the sternum with radiation to the interscapular space,

predominantly arising when walking fast or when climbing stairs more

than one span at the usual pace, stopping with 1 tablet

Nitroglycerin sublingual.

From the anamnesis it is known that for the first time chest pains occurred about two years

ago, since then there has been no marked progression of the disease.

Bad habits: smokes for a long time 2 packs a day;

abuses alcohol.

Objectively: the condition is relatively satisfactory. Body temperature 36.6

° C. Height - 162 cm, weight - 95 kg. BMI - 36.2 kg / m 2 . Hypersthenic physique. Skin

integuments and visible mucous membranes of physiological color and normal humidity.

There are no peripheral edemas. In lungs, harsh breathing is carried out in all departments, wheezing

not. NPV - 18 per minute. With percussion, the shift of the left border is determined

relative dullness of the heart to the left by 0.5 cm. Heart sounds are muffled, rhythm

correct. HELL - 130/80 mm RT. Art. Heart rate - 87 beats per minute. The abdomen is soft, with

palpation painless in all departments, increased in volume due to subcutaneous

fat layer. The liver does not protrude from under the edge of the costal arch. Symptom of striking

negative in the lumbar region. Physiological administration is normal.

In the analyzes: total cholesterol - 6.2 mmol / l, TG - 2.5 mmol / l, cholesterol-HDL - 0.8

mmol / L, cholesterol-LDL - 4.2 mmol / L.

On the ECG: sinus rhythm, correct with heart rate - 76 beats / min. EOS deviation to the left.

Left ventricular hypertrophy.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. Prescribe treatment and justify.

5. When conducting stress echocardiography revealed a deterioration in local

myocardial contractility in 4 segments. Your tactics of reference.

Situational task 165 [K002011]