Management of Severe Angina Following Myocardial Infarction in a Patient with Comorbid Hypertension and Diabetes: A Case Report

Abstract

Background: Managing severe angina in patients with comorbid conditions following a myocardial infarction poses significant clinical challenges. Optimal medical therapy often proves insufficient, necessitating advanced interventional strategies to address persistent symptoms and improve patient outcomes.

Case Presentation: A 50-year-old female with a history of hypertension and type 2 diabetes mellitus presented with severe angina classified as Canadian Cardiovascular Society (CCS) class II-III despite receiving optimal medical therapy after an inferior wall myocardial infarction treated with thrombolysis. Initial evaluations, including electrocardiogram (ECG) and echocardiography, indicated residual myocardial ischemia.

Results: Coronary angiography revealed moderate disease in the mid-left circumflex artery and severe tubular lesions in the mid-right coronary artery (RCA). Percutaneous coronary intervention (PCI) was performed on the RCA, involving the deployment of multiple drug-eluting stents. The procedure was complicated by a distal edge dissection and the breakage of a guide wire, both of which were successfully managed. Final angiographic results demonstrated TIMI III flow with no residual stenosis.

Conclusion: This case highlights the challenges and complexities of managing severe angina in post-myocardial infarction patients with comorbid conditions. It emphasizes the necessity of timely and precise interventional strategies to achieve optimal patient outcomes.