冠状动脉瘤样扩张(1)PPT课件.pptxVIP

1,CORONARYECTASIA,2,Age:65yearsold,Chiefcomplaint:chestpainfor1day,AdmittedonNov6th,2015,Pasthistory:hypertentionfor3years(poolcontrol),nosmokingordrinking,PATIENTDEMOGRAPHICS,Gender:female,3,Domesticargumentmakesymptomsworse,ECG:leadsV1-4ST-Tsegmentchanges,Tn0.07ng/ml,CKMB18.79U/L,Echo:LVD52mm,LA35mm,LVEF68%,PRESENTILLNESS,Chestpainaccompaniedbybackpainandheadache,4,2019/12/12,4,CORONARYECTASIA,CIT2016,5,CORONARYECTASIA,CIT2016,DIAGNOSIS,Unstableangina,Hypertention,Hyperlipidaemia,Coronaryarterydisease,6,CORONARYECTASIA,CIT2016,MEDICATION,Rosuvastatin10mgqn,Ezetimibe10mgqd,Perindopril4mgqd,Aspirin0.1qd,Ticargrelor90mgbid,Trimetazidine20mgtid,7,2019/12/12,7,CORONARYECTASIA,CIT2016,CAGNov9th,LAD:proximal-ectasiamiddle-poolcontrastagentfilling,8,2019/12/12,8,CORONARYECTASIA,CIT2016,CAGNov9th,LAD:proximal-ectasiamiddle-poolcontrastagentfilling,LCX:noobviousabnormalities,9,2019/12/12,9,CORONARYECTASIA,CIT2016,10,2019/12/12,10,CORONARYECTASIA,CIT2016,IVUSNov9th,11,2019/12/12,11,CORONARYECTASIA,CIT2016,IVUSinjectedwithsaline,LAD:intramuralhematomasintimaldissectionintimalcalcifications,12,2019/12/12,12,CORONARYECTASIA,CIT2016,IVUSintramuralhematomas,NSinjection,Intimaldissection,13,CORONARYECTASIA,CIT2016,DISCHARGENov13th,Rosuvastatin10mgqn,Ezetimibe10mgqd,Perindopril4mgqd,Aspirin0.1qd,Clopidogrel75mgqd,Trimetazidine20mgtid,14,CORONARYECTASIA,CIT2016,FOLLOWUPDec13th,Rosuvastatin10mgqn,Ezetimibe10mgqd,Perindopril4mgqd,Aspirin0.1qd,Clopidogrel75mgqd,Trimetazidine20mgtid,Nochestpain,goodemotionalcontrol,15,CIT2016,DISCUSSION,spontaneouscoronaryarterydissection(SCAD)traditionalgoldstandard:CAGnowadays:intracoronaryimaging-OCTorIVUS-improvesthediagnosisIVUSacompletevesselvisualizationandassessmentmorphometricinformationsabouttheunderlyinghematoma,CORONARYECTASIA,16,CIT2016,DISCUSSION,theunderlyingpathogenicmechanismofthecoronaryhematoma1-2intramuralhemorrhagedisruptionofthevasavasorumCausesanalysis3femalesexhormonelevelalterationshemodynamicstressandshearingstresssmokingandhypertentioninourcase,thepatientwasspontaneouscoronarydissection,hemodynamicallystableandchestpainrelieved,noongoingischemia,therefore,aconservativetreatmentstrategywaschosen.,CORONARYECTASIA,1MortensenKH,ThuesenL,KristentenIB,etal.Spontaneouscoronaryarterydissection:aWesternDenmarkHeartRegistryStudy.CatheterCardiovascInterv2009;74:710-72VrintsCJ.Spontaneouscoronaryarterydissenction.Heart010;96:801-83TweetMS,HayesSN,P