The case of arrhythmic equivalent of myocardial ischemia in the practice of family doctor

Abstract

In the practice of the family physician (general practitioner) there are patients with recurrent cardiac arrhythmia (most commonly ventricular extrasystoles) accompanying angina pectoris attacks associated with local myocardial ischemia and manifested by ST-segment depression or elevation on the electrocardiogram. At the same time, there are patients with ischemic heart disease who may have palpable or insensible episodes of cardiac arrhythmia without ST-segment displacement and typical retrosternal pain during exercise. This clinic requires a detailed approach to diagnosing the equivalent of myocardial ischemia, including, exercise tests and coronarography, especially if a diagnosis of ischemic heart disease has been confirmed before.

The case of cardiac arrhythmia as an equivalent of angina pectoris in a 67-year-old male patient with a history of myocardial infarction with postinfarction angina pectoris is presented in the article. Stenting of the right coronary artery was performed twice during ischemic heart disease treatment.

Knowledge of the signs of myocardial ischemia equivalents determined the tactics of patient management by a general practitioner already at the stage of interview of ischemic heart disease history. Examination and referral of the patient for coronarography contributed to timely angioplasty with stenting of the affected left circumflex coronary artery, which caused local myocardial ischemia and arrhythmia.

Keywords

general practitioner (family doctor) / coronary heart disease / arrhythmia / physical activity / angina pectoris / coronarography / stenting

References

[1] Drapkina OM, Bubnova MG, Samorodskaya IV, et al. Changes in mortality rates from acute types of coronary artery disease in Russia for the period from 2015 to 2019. Russian Journal of Cardiology. 2021;26(5):4441. DOI: 10.15829/1560-4071-2021-4441

[2] Драпкина О.М., Бубнова М.Г., Самородская И.В. и др. Динамика показателей смертности от острых форм ишемической болезни сердца в Российской Федерации за период с 2015 по 2019 годы // Российский кардиологический журнал. 2021. Т. 26, № 5. С. 4441. DOI: 10.15829/1560-4071-2021-4441

[3] Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.). DOI: 10.15829/1560-4071-2020-4076

[4] Стабильная ишемическая болезнь сердца. Клинические рекомендации 2020 // Российский кардиологический журнал. 2020. Т. 25, № 11. С. 4076. DOI: 10.15829/1560-4071-2020-4076

[5] Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–477. DOI: 10.1093/eurheartj/ehz425

[6] Knuuti J., Wijns W., Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes // Eur. Heart J. 2020. Vol. 41, No. 3. P. 407–477. DOI: 10.1093/eurheartj/ehz425

[7] Treshkur TV, Tatarinova AA, Ryngach EA, Tikhonenko VM. “The portrait” of ventricular arrhythmias in a patient with coronary heart disease during holter monitoring is a basic step in the choice of management tactics. Profilakticheskaya Meditsina. 2018;21(6):93-105. (In Russ.). DOI: 10.17116/profmed20182106193

[8] Трешкур Т.В., Татаринова А.А., Рыньгач Е.А., Тихоненко В.М. «Портрет» желудочковой аритмии у больного ишемической болезнью сердца при холтеровском мониторировании — базовая ступень в выборе тактики ведения // Профилактическая медицина. 2018. Т. 21, № 6. С. 93-105. DOI: 10.17116/profmed20182106193

[9] Myerburg RJ, Huikuri HV, Castellanos A. Origins, classification and significance of ventricular arrhythmias. In: Foundations of Cardiac Arrythmias. Basic concepts and clinical approaches. M.P. Spooner, M.R. Rosen (editors). New York, Basel, Marcel Dekker Inc.; 2001. P. 547–569.

[10] Myerburg R.J., Huikuri H.V., Castellanos A. Origins, classification and significance of ventricular arrhythmias // Foundations of Cardiac Arrythmias. Basic concepts and clinical approaches. Ed. by M.P. Spooner, M.R. Rosen. New York, Basel, Marcel Dekker Inc., 2001. P. 547–569.

[11] Oei HH, Vliegenthart R, Deckers JW, et al. The association of Rose questionnaire angina pectoris and coronary calcification in a general population: the Rotterdam Coronary Calcification Study. Ann Epidemiol. 2004;14(6):431–436. DOI: 10.1016/j.annepidem.2003.09.009

[12] Oei H.H., Vliegenthart R., Deckers J.W. et al. The association of Rose questionnaire angina pectoris and coronary calcification in a general population: the Rotterdam Coronary Calcification Study // Ann. Epidemiol. 2004. Vol. 14, No. 6. P. 431–436. DOI: 10.1016/j.annepidem.2003.09.009

[13] Simonyan MA, Kalyuta TYu, Genkal EN, et al. Pretest probability of coronary artery disease as a factor for optimizing invasive diagnostics in routine clinical practice. Russian Journal of Cardiology. 2022;27(1):4765. DOI: 10.15829/1560-4071-2022-4765

[14] Симонян М.А., Калюта Т.Ю., Генкал Е.Н. и др. Предтестовая вероятность ишемической болезни сердца как фактор оптимизации инвазивной диагностики в реальной клинической практике // Российский кардиологический журнал. 2022. Т. 27, № 1. С. 4765. DOI: 10.15829/1560-4071-2022-4765

[15] Ansheles AA, Sergienko IV, Denisenko-Kankiya EI, et al. Current state of the problem of pretest probability assessment of ischemic heart disease. Bulletin of Pirogov National Medical and Surgical Center. 2020;15(3–2):124–132. (In Russ.). DOI: 10.25881/BPNMSC.2020.30.69.023

[16] Аншелес А.А., Сергиенко И.В., Денисенко-Канкия Е.И. и др. Предтестовая оценка вероятности ишемической болезни сердца // Вестник Национального медико-хирургического Центра им. Н.И. Пирогова. 2020. № 3–2. DOI: 10.25881/BPNMSC.2020.30.69.023

[17] Tatarinova AA, Ryngach EA, Treshkur TV. Сhoice of ventricular arrhythmia therapy in coronary artery disease. Russian Journal of Cardiology. 2020;25(7):3707. (In Russ.). DOI: 10.15829/1560-4071-2020-3707

[18] Татаринова А.А., Рыньгач Е.А., Трешкур Т.В. О выборе лечения желудочковых аритмий при ишемической болезни сердца // Российский кардиологический журнал. 2020. Т. 25, № 7. С. 3707. DOI: 10.15829/1560-4071-2020-3707

[19] Prikaz Ministerstva zdravookhraneniya RF ot 15 noyabrya 2012 g. No. 918n “Ob utverzhdenii poryadka okazaniya meditsinskoi pomoshchi bol’nym s serdechno-sosudistymi zabolevaniyami”. (In Russ.)

[20] Приказ Министерства здравоохранения РФ от 15 ноября 2012 г. № 918н «Об утверждении порядка оказания медицинской помощи больным с сердечно-сосудистыми заболеваниями».

[21] Prikaz Ministerstva zdravookhraneniya Rossiiskoi Federatsii ot 15 marta 2022 g. No. 168n ‘Ob utverzhdenii Poryadka provedeniya dispansernogo nablyudeniya za vzroslymi’. (In Russ.)

[22] Приказ Министерства здравоохранения Российской Федерации от 15 марта 2022 г. № 168н «Об утверждении Порядка проведения диспансерного наблюдения за взрослыми».

RIGHTS & PERMISSIONS

Eco-Vector