造影中左主干急性闭塞_病例报道.ppt

CaseReportShengjingHospitalofChinaMedicalUniversityWenyuePang

Patientname:PanXX,Men,64yearsoldWashospitalizedwiththechiefcomplaint“remittentchestpainfor5yearswithattenuationfor1week”.Pasthistory:hypertensionfor7years.Smoke20cigarettesperdayfor30years.Physicalexamination:BP150/95mmHg，thecardiacboarderenlargedtotheleftandlower.HR72bpm,withoutcardiacmurmur.ClinicData

ClinicDataECG：LeadsV1-V5STsegmentsdepressedfor0.05mV；PDE：LV=57.4mm；EF=61%；Clinicaldiagnosis:1.ACS2.Hypertensiongrade3.

CoronaryAngiography

CoronaryAngiography

CoronaryAngiography

CoronaryAngiographyInthepreparationofrightcoronaryangiography,beforeangiographiccatheterreachedtheorificeoftherightcoronaryartery,thepatientbecame:BPdepression,from135/85mmHgto80/40mmHgin30seconds.NoobviouschangesofHRNoobviouschangeswasobservedintheleadsofelectrocardiography(ECG)monitoring.Thepatientsaidchestskinitch,withoutchestpain.

OurconsiderationPressuremonitoringpathwayleakage?contrastmediahypersensitivity？Vagalreflex?Occlusionofleftmaincoronaryartery？

Thepatient’sHRdroppedto35bpm.ChestpainonsetConsideration:acuteleftmajorocclusion

ManagementXB3.5Catheterwasemergentlysentin,approvingthe100%occlusionofLMbodypart.Regret:novideomade

Whichfirst?IABP/Temporarycardiacpacing,thenPCIFirstPCI,then…..FirstDrug,then…..Other

3.5*18mmCypher

IABP,3.0*13Cypher

PCI治疗四:LCX

右冠造影

Followupresults（14months）OphthalmalgiawhenmovementDiagnosis:anginapectorisManagement:angiography

Howtomanage?PCICABGDrugOther

Followup(24m)CoronaryCT:normal

Thanks