Emergency PCI for AMI with acute occlusio of LAD RCA

1、emergency pci for ami with acute occlusion of lad & rcayin zhao-fang ren yi-rongshanghai 9th peoples hospital, affiliated to shanghai jiaotong university, school of medicine a case reporta case reportn73-year-old chinese mannsmoking historynangina pectoris for 4 yearsnrepeated chest pain for 10-

2、houra brief history of ecg - emergency 1 2009-9-5-14:30n acute anterior myocardial infarction, killip i classn aspirin 300mg n clopidogrel 300mgn tirofiban 12ml iv +12 ml / hr to maintain, nitrates, etcn preparation for emergency pci emergency diagnosis and treatment ecg - emergency 22009-9-5-15:10e

3、mergency room to the cath.lab. 2009-9-5-15:42 patients transported to cath.lab. door, a sudden loss of consciousness, 200j defibrillation, the disappearance of the radial artery pulse, blood pressure could not be determined, the patient cold sweat dripping, consciousness apathy . vf200jn dopamine 20

4、mg bolus; dopamine 240mg / metaraminol 60mg intravenous drip n 5% sb50ml bolusn temporary pacing electrode placementbefore cagn femoral artery pressure: 50/30 mmhgn ecg: iii degree avbn temporary pacing: 60ppm before cag emergency cag emergency cag n iabp ?strategies first of all . aortic root angio

5、graphy significant aortic valve regurgitation n continued application of vasoactive drugs strategies n aspiration ?strategies secondly . n which branch vessel prior pci? strategies thirdlylad-pci 6f bl3.5 gc, 2 runthrough gw, 2.0*20 sapphier bollon, firebirdii 2.5*33rca-ptca6f jr4.0 gc, runthrough g

6、w, 2.0*20 sapphier bollonn restore sinus rhythm: 112bpm; removed temporary pacing electroden blood pressure 130/100mmhg, dopamine 120mg /metaraminol 20mg/500mln tirofiban 12ml/hrn no use of femoral artery closure device after pci. n tnt-t ： 2.0 ng/mln creatinine ：122 umol/ln ck：2743u/l, ck-mb：117u/l

7、(instantly )； ck：7670u/l, ck-mb：440u/l(day 1 )； ck：9650u/l, ck-mb：560u/l(day 2 )laboratory testecg- pci day 2009-9-5-17:30ecg- 2 days after pci 2009-9-7-10:30n tirofiban maintain 48-hourn vasoactive drugs to maintain 14 days, left heart failure attack 4 timesn clopidogrel, cilostazol, lipitor, diure

8、tics, etc.n after14 days, to give acei / concorn ucg: lvedd-58mm, lvef-40%; no significant aortic valve regurgitation following days 1 month later, re-cagfinal results . n acute occlusion of left anterior descending artery and right coronary artery at the same time, ecgs usually have important tips.

9、n “simultaneous occlusion of 2 coronary arteries: plaque instability might be caused, exert adverse effects throughout the coronary vasculature and result in multiple lesions and thrombosis.-mechanism 1summary (1)brunetti nd, et al. j electrocardiol, 2010, 43(10)brunetti nd, et al. j electrocardiol,

10、 2010, 43(10)araszkiewicz a, et al. am j emerg med, 2009, 27(9)araszkiewicz a, et al. am j emerg med, 2009, 27(9)n “simultaneous occlusion of 2 coronary arteries: plaque rupture acute thrombosis in a single coronary artery low coronary perfusion pressure multiple thrombosis.-mechanism 2n opening ira as soon as possible, is critical to restore coronary perfusion, to preserve lv function and to improve prognosisn more optimal therapeutic strategy?n elective cabg? summary (2)sia sk, et al. circ j, 2008, 72(6)sia sk, et al. circ j, 2008, 72(6)tu cm, et al. am j emerg med, 2009,