Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with recurrent episodes of substernal chest pain occurring primarily at rest, often during early morning hours. Pain is described as pressure-like, non-exertional, and transient, typically lasting 5-15 minutes. No significant correlation with physical activity. Associated symptoms include diaphoresis and palpitations. No history of stable exertional angina.
Clinical Examination Findings
Cardiovascular exam reveals regular rate and rhythm, S1 and S2 heart sounds normal, no murmurs, rubs, or gallops. Peripheral pulses are symmetric and full. No signs of congestive heart failure (no JVD, no peripheral edema). Lungs are clear to auscultation bilaterally. Vital signs are stable; blood pressure is within normal limits during asymptomatic periods.
Treatment Protocol
Initiate long-acting calcium channel blockers (e.g., Amlodipine or Diltiazem) as first-line therapy to induce coronary vasodilation. Prescribe sublingual nitroglycerin for acute symptom relief. Advise strict avoidance of known triggers, including tobacco, nicotine products, and sympathomimetic agents (e.g., cocaine, decongestants). Consider statin therapy for underlying endothelial protection.