Question

Patient N. 52 years old a driver, went to the doctor with complaints of paroxysmal
pain behind the sternum radiating to the left shoulder, scapula, arising during fasty
walking, intense physical activity, accompanied by a feeling of fear, arrested at resy
Considers himself ill for two months, was treated at neurologist diagnosed with
intercostal neuralgia. Took analgin diclofenac, physiotherapy procedures no effect
From the anamnesis it is known that for about 5 years he has been suffering from
arterial hypertension with the maximum increase in blood pressure figures uplo
175/100 mm Hg, constant does not receive antihypertensive therapy,
Heredity father and older brother suffered myocardial infarction before the age of
55 vears Bad habits smokes 20 cigarettes a day for 20 years, alcohol
uses moderately
Objectively the condition is relatively satisfactory. Height 170 cm, weight 98 kg
BMI - 3391 kg/m2. Hypersthenic physique skin and visible mucous membranes of
normal color. There are no peripheral edema. In lungs breathing vesicular, carried out
in all departments, no wheezing Percussion above the surface lungs clear lung
sound NPV 17 per min. Auscultatory at the apex of the heart weakening of the
tone, above the aorta the accent of the Il tone Heart sounds are muffled, rhythmic.
HELL
170/100 mm Hg. Heart rate - 88 beats / min. The abdomen is soft, painless on
palpation during all departments. The liver is not enlarged A symptom of tapping in
the lumbar region negative Physiological functions are normal in the analyzes: total
cholesterol -5.6 mmol/L, TG - 24 mmol/L, HDL-C-09 mmol/l, cholesterol-LDL-
357 mmol/lcreatinine. 89 umol/L.GER (according to the CKD-EPI formula) = 84
ml/min ECG sinus rhythm, correct with a heart rate of 88 beats / min Myocardial
hypertrophy left ventricle.​

Answer 1

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