The case of arrhythmic equivalent of myocardial ischemia in the practice of family doctor

In the practice of the family physician (general practitioner) there are patients with recurrent cardiac arrhythmia (most commonly ventricular extrasystoles) accompanying angina pectoris attacks associated with local myocardial ischemia and manifested by ST-segment depression or elevation on the electrocardiogram. At the same time, there are patients with ischemic heart disease who may have palpable or insensible episodes of cardiac arrhythmia without ST-segment displacement and typical retrosternal pain during exercise. This clinic requires a detailed approach to diagnosing the equivalent of myocardial ischemia, including, exercise tests and coronarography, especially if a diagnosis of ischemic heart disease has been confirmed before. The case of cardiac arrhythmia as an equivalent of angina pectoris in a 67-year-old male patient with a history of myocardial infarction with postinfarction angina pectoris is presented in the article. Stenting of the right coronary artery was performed twice during ischemic heart disease treatment. Knowledge of the signs of myocardial ischemia equivalents determined the tactics of patient management by a general practitioner already at the stage of interview of ischemic heart disease history. Examination and referral of the patient for coronarography contributed to timely angioplasty with stenting of the affected left circumflex coronary artery, which caused local myocardial ischemia and arrhythmia.