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Chest pain (Finding: (• The pain began six hours ago and has become more…
Chest pain
Finding:
• The pain began six hours ago and has become more severe over the past hour prompting him to call emergency services.
• He describes the pain as retro-sternal, pressure-like, and non-radiating.
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ACS v.s Angina
Angina
定義angina:Stable angina is used to describe a clinical syndrome of predictable chest pain or pressure precipitated by activities such as exercise or emotional stress, which increase myocardial oxygen demand. 心絞痛：穩定型心絞痛用於描述可預測的胸痛或因運動或情緒壓力等活動而增加的心肌需氧量引起的壓力的臨床綜合徵
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diagnosis of angina
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type： discomfort and heaviness or breathlessness，其心絞痛可以透過休息或含NTG緩解。discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms precipitated by physical exertion
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Canadian Cardiovascular Society angina classification 
Management options in patients with suspected
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risk factors
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family history of CAD (first degree relative - male <55 years/female <65 years of age) y hyperlipidaemia
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Pharmacological
CCBs
無法使用Ｂ阻斷劑下選擇Prinzmetal (vasospastic) angina：amlodipine, nifedipine
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Family History
• His father died of a myocardial infarction at 62 years of age.
• There is no other adverse family history.
Examination
• Physical exam: no special finding except chest pain.
• Allergy history: no allergies associated with food, medication.
Problem:
66 歲林女性，主訴胸痛至急診
Vital signs:
T:36.8°C, P:94 bpm, R:18 bpm, BP:172/102 mmHg
• Body height: 170 cm • Body weight: 83 Kg
-BMI:28.7
• Tobacco use: 20 cigarettes for the past 35 years.
• Alcohol consume: approximately 2 bottle bears per week.
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病人表徵IN ANGINA
Medication ：
Prescription
cholesterol = 123 mg/L; HDL cholesterol = 22 mg/L; LDL cholesterol = 72 mg/L; triglycerides = 63mg/L
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Conditions ：
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Echocardiography shows hypokinesis of the interventricular septum and apex with a left ventricular ejection fraction of 32%.
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