Case 10: The Pain

MBBS
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1

The patient was a 57-year-old obese female with 3-year history of recurrent attacks
of severe squeezing pain in the heart region radiating to the neck, down the inside
of the left arm and to left subscapular region. This pain occurred on slow walking
for a distance 100-200 metres or climbing upstairs to the one flight. Pain was
relieved by the 10-minute rest or by the sublingual intake of nitroglycerine.

  1. What is the clinical diagnosis in this patient? What is its clinical variant?
  2. What symptoms of this disease may be revealed by physical examination
    during pain attack or immediately after it?
  3. What are the possible findings on ECG during pain attack?
2

Most likely - diagnosis is Stable angina pectoris.

Clinical variant - class II

Physical examination may be normal between attacks.
Immediately after an attack:

Anxiety and stress
Tachycardia
Hypertension or hypotension
Pallor, sweating

ECG findings - ST segment depression
T wave inversion
Transient ST segment
elevation .

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