版權(quán)說明:本文檔由用戶提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡介
1、Percutaneous Coronary Interventions for Patients with Relative Contra-indications: Severely Depressed Left Ventricular Function Great Wall International Conference on Cardiology. Beijing 11.5.2005 Thach Nguyen MD FACC FACP FSCAIWhat is the most Common Cause of Death among Patients Undergoing PCI? In
2、 Which Scenario I Will Do PCI Even The EF Is Low (25%) ? 3Scenario 1: AMI (EF25%) Patient A: ST Segment Elevation. Heart Rate=70 and Blood Pressure 130/80Patient B: ST Segment Elevation in Inferior leads, 2,3,F and V2R, V3R = RV MI HR:120 BP: 80/60. Mortality = ?Patient C: ST Segment Elevation in An
3、terior leads V1-V6. HR:120 BP: 80/50 How much is the mortality after PCI?Scenario 2: Stable Angina (EF25%) Patient has low EF however there is a large area of ischemia on Nuclear scan What Do These 2 sets of Patients Have in Common? Moderate Risk Patient (Ejection Fraction 25%) 1. Frank Heart Failur
4、e No2. Mitral Regurgitation Mild 3. Diagonal or Posterior Descending Artery or Obtuse Marginal OPEN Why I am Interested in Patency of PDA and Diagonal Branch? Right dominantRCAPDALeft dominantPDALADLCxLAO viewsScenario 3: Stable Angina (EF25%) Patient has low EF and no other non-invasive data Resear
5、ch Question 2 2. Is mitral regurgitation a passive event secondary to left ventricular dilation or it is an important part of LV remodeling as programmed by intelligent design? Scenario 4: Which One I refuse to Do?Dilated cardiomyopathy and frank heart failure Scenario 4: Which One I refuse to Do?CL
6、INICAL CRITERIASevere dilated cardiomyopathy withModerate to severe Mitral Regurgitation Moderate to severe Tricuspid Regurgitation Moderate to severe aortic regurgitation Scenario 4: Which One I refuse to Do?HEMODYNAMIC CRITERIASevere dilated cardiomyopathy withElevated LVEDPClosed Diagonal and clo
7、sed Posterior Descending Artery from either a dominant RCA or dominant Obtuse Marginal branch Research Question 3. 3. We can open and secure a good epicardial flow however, I strongly believe that the microvascular system is regulated more by receptors than by passive gradient between upstream and d
8、ownstream pressure. In patients with diffuse triple vessel disease and severe LV dysfunction, the problem is not just flow disturbances and it is more suspected by inability of translation from energy brought by blood flow to contraction. What Do I Look When I Come To Evaluate a Patient with Very Lo
9、w Ejection Fraction (25%) For PCI ? When I Start the PCI, How I Know I am Getting into Trouble ? 1. Slow Rate of Rise 2. Widening of QRS THE PATIENT IS GOING INTO SHOCKCheck LVEDP and Rate of RiseConclusions Conclusions: 1. What is the patient subset with highest mortality? 2. How to know which AMI patients will die in the near future? 3. Which patient has end-stage
溫馨提示
- 1. 本站所有資源如無特殊說明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁內(nèi)容里面會有圖紙預(yù)覽,若沒有圖紙預(yù)覽就沒有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫網(wǎng)僅提供信息存儲空間,僅對用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對自己和他人造成任何形式的傷害或損失。
最新文檔
- 關(guān)于求職面試一分鐘自我介紹范文
- 2024年卸氣柱項(xiàng)目合作計(jì)劃書
- 2024年工業(yè)清洗清理設(shè)備:工業(yè)吸塵設(shè)備項(xiàng)目發(fā)展計(jì)劃
- 2024年食品干燥機(jī)械項(xiàng)目建議書
- 2024年地面氣象單要素觀測儀合作協(xié)議書
- 家長會課件教學(xué)
- 初一學(xué)生自我評價(jià)
- 2024年橡膠型密封膠項(xiàng)目發(fā)展計(jì)劃
- 2024年溶劑綠7合作協(xié)議書
- 2024年橡膠加工專用設(shè)備項(xiàng)目建議書
- 高三畢業(yè)綜評研究性學(xué)習(xí)及創(chuàng)新成果
- 2 化學(xué)熱力學(xué)基礎(chǔ)
- 社會學(xué)理論專題風(fēng)險(xiǎn)社會理論
- 環(huán)氧樹脂結(jié) 構(gòu) 與 性 能
- 初中英語單詞大全分類(帶音標(biāo)完美打印版)
- 貯水花盆案例總結(jié)-2015天津中心修改
- 內(nèi)陸漁業(yè)船舶證書申請和年審業(yè)務(wù)審批表
- 新人教版二年級數(shù)學(xué)上冊第一單元解決問題
- 發(fā)泡陶瓷保溫板施工組織設(shè)計(jì)
- 有關(guān)場地使用安全承諾書(精選3篇)
- 2021新蘇教版五年級科學(xué)上冊2.2《熱對流》課件
評論
0/150
提交評論