 Chest Pain

 History of past episodes of burning

sensation in the chest described as  Relief occurs with rest
“like acid behind my breast bone”
usually occurs at night
 Pain occurs not more than DIAGNOSIS
15 minutes
 History of Hypertension

PHYSICAL EXAMINATION: Diagnostic Test:

LABORATORY TESTS:
VS:  Chest radiography
BP
 Total cholesterol=280mg/dL o Findings are usually normal in patients with
 Right: 162/94 mmHg Left: 160/92 mmHg
 Weight 176lbs angina pectoris.
 Height 5 7"  LDL=169 mg/dL  Exercise Stress Testing
 RR=18 cpm o Most widely used test for the evaluation of
O  HDL=45 mg/dL patients presenting with chest pain.
 Temperature= 36.8 C  Stress Echocardiography
Cardiovascular examination: reveals a regular, apical heart rate of 85/min. S1 is best heard at the apex, no o Used to evaluate segmental wall motion during
murmurs, no peripheral edema.  TG=200mg/dL
exercise. It detects changes in regional wall
Lungs are clear to percussion and auscultation, abdominal examination is negative for abnormalities.
 Hb = 6.1% motion that occur during myocardial ischemia.
A1C
Past Medical History:  CT Angiography
 20 year history of hypertension  BUA=12 mg/dL o Anatomical assessment of the hemodynamic
 10 year history of gout significance of coronary stenosis. 

Past Medical History:

CHRONIC STABLE ANGINA

TREATMENT

Patient Education: Risk Factor Modification

 Importance of medication adherence Therapy to relieve symptoms Management for gout:
 Cardiovascular risk reduction strategies in patients with stable IHD.  1. Immobilization of the affected extremity
 Daily physical activity recommendations 1. Beta-adrenergic speeds resolution of the attacks
 Self-monitoring to recognize worsening blockers 2. Physical Therapy/Home Exercise Program
symptoms and take appropriate action. 2. Calcium-channel 3. Diet modification includes Hydration,
blockers Avoid soda, alcohol, red meat and seafood
Hypertension 3. Nitrates 4. Uricosurics
Management: 5. Xanthine Oxidase Inhibitors
Anti-hypertensive drug 6. Pegloticase
therapy :
1. Beta
Blockers
Lipid Management: 2. CCB
 Lifestyle Modification (diet, physical activity, Therapy to prevent myocardial
weight management) infarction and death in patients with
 HMG-coenzyme reductase inhibitors stable angina/IHD:
Antiplatelet agents (aspirin
and /or clopidogrel).