Coronary Heart Disease—A Protracted Treatment Course

Figure

A 65-year-old male patient that had undergone coronary bypass surgery and multiple coronary interventions presented with typical resting angina without ST elevations on ECG but an elevated troponin T level (142 ng/L). Cardiovascular risk factors included hypertension, hyperlipoproteinemia, former nicotine abuse, and positive family history. The patient, who had an active lifestyle, had no other diseases with the exception of stage IIa PAD. The patient did not have a living will. During cardiac catheterization, we placed two stents in highly stenosed vessels— these were stents number 39 and 40. Over the preceding 14 years, the patient had undergone altogether 29 cardiac catheterizations, with stent placement in the native coronary arteries (arrows) as well as the four aortocoronary vein bypasses (asterisks) (Figure). The overall length of the implanted stents was 75.4 cm. This case illustrates that in isolated cases, extensive measures are sometimes required in CHD patients in order to achieve freedom from symptoms. This calls for an approach tailored to the wishes of the patient as well as treatment planning that includes palliative measures/treatment limits in late-stage CHD. No new coronary interventions have been required over the course of the patient’s meanwhile 2-year follow-up.

Prof. Dr. med. Marc-Alexander Ohlow, Dr. med. Martin Winterhalter, Medizinische Klinik 1, SRH Wald-Klinikum Gera, [e-mail]

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the orignal German by Christine Rye.

Cite this as: Ohlow MA, Winterhalter M: Coronary heart disease—a protracted treatment course. Dtsch Arztebl Int 2023; 120: 98. DOI: 10.3238/arztebl.m2022.0392