Pain in the left forearm as the main performance limitation is not a case of typical angina

 Key words without the limitations of typical angina pain in the left forearm with severe anemia
ECG diagnosis of atrial fibrillation in elderly Abstract high incidence of atypical angina, clinical manifestations are diverse, but to the left recurrent forearm pain as the main performance limitations and lack of chest pain of angina is rare. now a case reported as follows.
1 clinical data
male patients, aged 73. because of thirst, hunger and urination associated with more than 30 years, adding to 3 d, on October 12, 2001 as given appropriate treatment .2002 May 30 to February 2, 2003 more than 8 months time recurrent palpitations about 17 times, 6 of which took place at 0:00 to 3:00, after voiding, a second place at lunch time, no other obvious causes. In addition to heart palpitations, but sometimes accompanied by chest, shortness of breath, fatigue or sweating, the most prominent is the Jieyou limitations of the left forearm soreness, pain can range from discomfort to pain. cardiac auscultation and fast-type electrocardiogram confirmed atrial fibrillation, ST T changes. by oxygen, bed rest, nitroglycerin, intramuscular injection of papaverine, meperidine, stability, such as intravenous infusion of nitroglycerin relieve pain, sedation, oral calm rhythm legal and other treatment, symptoms more than 30 min within a few minutes to ease, atrial fibrillation, sustained a few minutes to 4 d months. After that, occasional episodes of left arm pain without obvious predisposing factors, to a lesser extent, attacks were repeated tracings sinus rhythm are ECG, ST segment and T wave changes is not obvious, since more than 10 tablets containing Suxiaojiuxin Pill few minutes to more than 10 minutes to ease .2004 November 8 from left forearm pain and limitations of reproduction, onset time irregular, quiet or active state has occurred, attack frequency, intensity increase, duration was significantly longer, up to 1 h or so. pain attack, ECG showed ST segment: ��, ��, aVL, V3 lead down 0.05 mV , V4 ~ V6 horizontal type down 0.2 mV, T wave: I, aVL lead shallow inversion, ST segment after the relief of symptoms could be recovered to the equipotential lines, T waves became upright or low and even. many times during the examination of myocardial blood zymography were normal, troponin �� was a transient increase, up to 1.79 ng / ml, hemoglobin from the admission of 108.0 g / L down to November 9, 2004 of 68.0 g / L (minimum 56.0 g / L). give oxygen, expansion of coronary artery, pain, supplementary folic acid, vitamin B12, iron, application erythropoietin, intravenous transfusion of packed red blood cell suspension and other treatment, with the correction of anemia, hemoglobin rose to 70.0 g / L or more (November 22, 2004) after the disappearance of left forearm pain. the final diagnosis: anemia, acute coronary syndrome: unstable angina and acute non-ST segment elevation myocardial infarction.
2 discussions
In this case a rapid atrial fibrillation and severe anemia as an incentive to attack the left forearm soreness of the main clinical manifestations, combined with patient age, there is hypertension, diabetes and other cardiovascular risk factors, suggesting that: For the elderly, especially past have diabetes, hypertension and other risk factors of coronary heart disease who, when there is chest, precordial pain on any part other than the associated diseases with difficult interpretation, should be taken into account