傅向华心肌梗死现代诊断与治疗-培训课件.pptVIP

LCX TOTAL OCCLUSION 河北医科大学第二医院干部心血管病房制作 RCA TOTAL OCCLUSION 河北医科大学第二医院干部心血管病房制作 a-72-year-old man has suffered from angina pectoris for 3 years, and aggravated for 12 hours. He has associated with hypertension for 4 years, average level of blood pressure was about 130-150/80-90mmHg, and type 2 diabetes for 10 years. Positive sign was not found in physical examination. ECG showed pathological Q wave in leads II，III，avF, ST segment depressed 1-2mm in leads V1-V5. Myocardial enzymes showed CK 1066 IU/L, CKMB 142 IU/L, LDH 292IU/L, AST 122IU/L, cTnT(+). Coronary angiogram by radial access showed 90-95% stenosis in the proximal and mid LAD; an total occlusion before the PDA and PLD of RCA. Left ventriculogram showed the movement of inferior ventricular wall was weak. LVEDP=20mmHg. PTCA+STENTING was performed in RCA successfully, two stents (Cordis BX2.75×23mm, AVE S660 2.5×12mm) were implanted in the second curve and PLA with TIMI III grade. 上次手术前后对比 本次手术血管情况 A 68-year-old man with typical angina pectoris for 3 years ,and symptom of acute chest pain episoded for 3 days.The patient have a history of chronic duodenal ulcer accompanied by upper digestive bleeding and anemia. The patient had smoking for 20 years (20 cigarettes/day) and was diagnosed diabetis after admitted .No positive sign was found in physical examination. Myocardial enzymes showed CK 294u/l CKMB 45u/l.cTnT was positive. ECG showed that Q wave was found in V1—V3. CAG showed 50% lesion in distal of LM,90%--95% stenosis in the ostial ,proximal, middle and distal of LAD,70% stenosis in the middle of LCX, RCA angiogram showed 70% stenosis in proximal and trifarcational lesion in distal of RCA . LAD PTCA was successfully performed. A stent of BX 2.5×8mm was planted in the ostial of LAD.A stent of 2.5×23mm was planted in the proximal of LAD and a 2.5×9mm stent was planted in the middle of LAD . 上次手术前后对比 本次手术血管情况 A 62-year-old man had suffe