Conservative Approach Might Be the Strategy by Default in Stable Angina Patients: A Case Report
| Autor: | Mame Madjiguene Ka, Serigne Cheikh Tidiane Ndao, Djibril Marie Ba, Pape Diadie Fall, Mouhamed Cherif Mboup, Khadidiatou Dia |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Heart disease business.industry medicine.medical_treatment Ischemia Chest pain medicine.disease Stable angina law.invention Ostium medicine.anatomical_structure Randomized controlled trial law Internal medicine Angioplasty medicine Cardiology cardiovascular diseases medicine.symptom business Artery |
| Zdroj: | World Journal of Cardiovascular Diseases. 10:769-774 |
| ISSN: | 2164-5337 2164-5329 |
| DOI: | 10.4236/wjcd.2020.1011073 |
| Popis: | Management of stable angina is still a matter of debate. Whether a conservative or invasive approach is better remains unclear. Even though recent large-scale randomized trials depict the conservative strategy as safe and efficient. In this report, we present a case of a 53-year-old male patient with cardiovascular risk factors of hypertension and hypercholesterolemia. He complained about typical chest pain at exertion. The coronary angiogram (CA) revealed severe stenosis of the proximal left anterior descending artery (LAD) ostium. After heart team discussion, coronary artery bypass graft (CABG) was advocated. However, due to a lack of means, the CABG was postponed. Meanwhile, he was managed with guideline-based medical therapy. In addition, he exercised regularly and adopted a healthy diet. Evolution was favorable with excellent symptoms control. A regular follow-up was organized with his cardiologist. A new CA before an eventual CABG six years later showed a significant plaque volume regression of the proximal LAD. We decided to continue conservative management. The stress echocardiogram to assess symptoms and exercise tolerance was normal. Our patient was sent to surgery on top of optimal medical therapy even though angioplasty was a good indication and was feasible. However, while he was struggling to afford the CABG procedure, he adopted a very healthy lifestyle along with medical therapy. Six years later, the result of that approach was without appeal, suggesting and reinforcing the conservative management of stable heart disease over invasive strategy. The recent ISCHEMIA trial is a major argument supporting that approach. |
| Databáze: | OpenAIRE |
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