急性左主干閉塞病例報告_龐文躍演示課件

1、Case Report病例報告,Shengjing Hospital of China Medical University 中國醫(yī)科大學(xué)附屬盛京醫(yī)院 Wenyue Pang 龐文躍,Patient name: PanXX, Sex: Male, Age: 64 years 患者潘XX，男，64 Was hospitalized with the chief complaint “remittent chest pain for 5 years with attenuation for 1 week”. 因“間斷胸痛5年，加重1周”為主訴入院,Clinic Data 臨床資料,Clinic D

2、ata 臨床資料,Past history: hypertension for 7 years. Smoke 20 cigarettes per day for 30 years. 既往有高血壓病史7年。吸煙20支/天30年 Physical examination: BP150/95mmHg，the cardiac boarder enlarged to the left and lower. HR 72 bpm, without cardiac murmur. 體檢：BP150/95mmHg，心界左下擴大，HR72次/分，無雜音,Clinic Data 臨床資料,ECG：Leads V1-

3、V5 ST segments depressed for 0.05mV ECG：V1-V5導(dǎo)聯(lián)ST段下移0.05mV； PDE：LV=57.4mm；EF=61%,Clinic Data 臨床資料,Coronary artery CT：Left major-left anterior descending (LAD) branch proximal and medial segments severe stenosis; left circumflex (LCX) proximal segment moderate stenosis. 冠脈CT：左主干-前降支近中段重度狹窄；旋支近段中度狹窄。,

4、Clinic Data 臨床資料,臨床診斷： 1.冠心?。翰环€(wěn)定心絞痛 2.高血壓病3級 Clinical diagnosis: 1. coronary heart disease: unstable angina pectoris 2. Hypertension,Coronary Angiography 影像,Coronary Angiography 影像,Coronary Angiography 影像,Coronary Angiography,In the preparation of right coronary angiography, before angiographic cath

5、eter reached the orifice of the right coronary artery, BP depression, from 135/85 mmHg to 80/40 mmHg in 30 seconds. 準備右冠造影過程中，造影導(dǎo)管未到達右冠開口時，患者血壓下降，30秒內(nèi)由135/85下降到80/40,No obvious changes of HR 心率無明顯減慢 No obvious changes was observed in the leads of electrocardiography (ECG) monitoring. 心電監(jiān)測導(dǎo)聯(lián)未見明顯變化。 T

6、he patient said chest skin itch, without chest pain. 患者自述胸前皮膚搔癢，無胸痛,What happened? 發(fā)生什么了？,Pressure monitoring pathway leakage? 壓力監(jiān)測通道漏氣？ contrast media hypersensitivity？ 造影劑過敏？ Vagal reflex? 迷走反射？ Occlusion of left coronary artery？ 左冠閉塞？,The patients HR dropped to 35 bpm 患者心率下降至35次/分 Chest pain onse

7、t 開始出現(xiàn)胸痛,acute left major occlusion！ 急性左主干閉塞！,Which first? 首先做什么？,IABP /Temporary cardiac pacing, then PCI IABP/臨時起搏器，然后PCI PCI 首先PCI Drug 藥物搶救 Other 其他,Management 處理,XB3.5GC Catheter was emergently sent in, approving the 100% occlusion of left major (LM) body part. 緊急予XB3.5GC導(dǎo)管送入，證實左主干體部100%閉塞 遺憾：沒

8、有留下影像 Regret: no video made,GC:XB3.5 GW:BMW STENT:3.5*18mm Cypher,IABP 3.0*13 Cypher,3.0*18 Cypher,PCI治療四:LCX,3.0*23 Cypher T支架技術(shù),after Kiss balloon,右冠造影,Follow up 隨訪（14 months）,Ophthalmalgia when movement 活動時牙痛 Diagnosis: angina pectoris 診斷：心絞痛 Management: angiography 處理：造影,How to manage?,PCI CABG Drug Other,3.0*10 cutting balloon,3.0*10 cutting balloon