Conservative Approach Might Be the Strategy by Default in Stable Angina Patients: A Case Report

• 作者: Djibril Marie Ba Khadidiatou Dia Mame Madjiguene Ka Mouhamed Chérif Mboup Pape Diadie Fall Serigne Cheikh Tidiane Ndao
• 来源期刊: 心血管病(英文)
• 学科: 医学
• 关键词: Stable Angina Chronic Coronary Syndrome Conservative Treatment Case Report
• 年，卷（期）: 2020,（11）
• 页码范围: 769-774
• 页数: 6页
• 分类号: R54

摘要

Management of stable angina is still a matter of debate. Whether a conservative</span><span style="font-family:""> or invasive approach is better remains unclear. Even though recent large-scale randomize</span><span style="font-family:"">d</span><span style="font-family:""> trials depict the conservative strategy as safe and efficient.</span><span style="font-family:""> </span><span style="font-family:"">In this report, we present a case of a 53-year-old male patient with cardiovascular risk factors of hypertension and hypercholesterolemia. </span><span style="font-family:Verdana;"></span><span style="font-family:"">He complained about typical chest pain at exertion. The coronary angiogram (CA) revealed</span><span style="font-family:""> </span><span style="font-family:"">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</span><span style="font-family:""> </span><span style="font-family:"">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.</span><span style="font-family:""> </span><span style="font-family:"">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.