急性左主干闭塞病例报告-庞文跃课件

1、急性左主干闭塞病例报告-庞文跃,Case Report病例报告,Shengjing Hospital of China Medical University 中国医科大学附属盛京医院 Wenyue Pang 庞文跃,急性左主干闭塞病例报告-庞文跃,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“间断胸痛5年，加重1周

2、”为主诉入院,Clinic Data 临床资料,急性左主干闭塞病例报告-庞文跃,Clinic Data 临床资料,Past history: hypertension for 7 years. Smoke 20 cigarettes per day for 30 years. 既往有高血压病史7年。吸烟20支/天30年 Physical examination: BP150/95mmHg，the cardiac boarder enlarged to the left and lower. HR 72 bpm, without cardiac murmur. 体检：BP150/95mmHg，心

3、界左下扩大，HR72次/分，无杂音,急性左主干闭塞病例报告-庞文跃,Clinic Data 临床资料,ECG：Leads V1-V5 ST segments depressed for 0.05mV ECG：V1-V5导联ST段下移0.05mV； PDE：LV=57.4mm；EF=61%,急性左主干闭塞病例报告-庞文跃,Clinic Data 临床资料,Coronary artery CT：Left major-left anterior descending (LAD) branch proximal and medial segments severe stenosis; left cir

4、cumflex (LCX) proximal segment moderate stenosis. 冠脉CT：左主干-前降支近中段重度狭窄；旋支近段中度狭窄。,急性左主干闭塞病例报告-庞文跃,Clinic Data 临床资料,临床诊断： 1.冠心病：不稳定心绞痛 2.高血压病3级 Clinical diagnosis: 1. coronary heart disease: unstable angina pectoris 2. Hypertension,急性左主干闭塞病例报告-庞文跃,Coronary Angiography 影像,急性左主干闭塞病例报告-庞文跃,Coronary Angiog

5、raphy 影像,急性左主干闭塞病例报告-庞文跃,Coronary Angiography 影像,急性左主干闭塞病例报告-庞文跃,Coronary Angiography,In the preparation of right coronary angiography, before angiographic catheter reached the orifice of the right coronary artery, BP depression, from 135/85 mmHg to 80/40 mmHg in 30 seconds. 准备右冠造影过程中，造影导管未到达右冠开口时，患

6、者血压下降，30秒内由135/85下降到80/40,急性左主干闭塞病例报告-庞文跃,No obvious changes of HR 心率无明显减慢 No obvious changes was observed in the leads of electrocardiography (ECG) monitoring. 心电监测导联未见明显变化。 The patient said chest skin itch, without chest pain. 患者自述胸前皮肤搔痒，无胸痛,急性左主干闭塞病例报告-庞文跃,What happened? 发生什么了？,Pressure monitorin

7、g pathway leakage? 压力监测通道漏气？ contrast media hypersensitivity？ 造影剂过敏？ Vagal reflex? 迷走反射？ Occlusion of left coronary artery？ 左冠闭塞？,急性左主干闭塞病例报告-庞文跃,The patients HR dropped to 35 bpm 患者心率下降至35次/分 Chest pain onset 开始出现胸痛,急性左主干闭塞病例报告-庞文跃,acute left major occlusion！ 急性左主干闭塞！,急性左主干闭塞病例报告-庞文跃,Which first? 首

8、先做什么？,IABP /Temporary cardiac pacing, then PCI IABP/临时起搏器，然后PCI PCI 首先PCI Drug 药物抢救 Other 其他,急性左主干闭塞病例报告-庞文跃,Management 处理,XB3.5GC Catheter was emergently sent in, approving the 100% occlusion of left major (LM) body part. 紧急予XB3.5GC导管送入，证实左主干体部100%闭塞 遗憾：没有留下影像 Regret: no video made,急性左主干闭塞病例报告-庞文跃,

9、GC:XB3.5 GW:BMW STENT:3.5*18mm Cypher,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,IABP 3.0*13 Cypher,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,3.0*18 Cypher,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,PCI治疗四:LCX,3.0*23 Cypher T支架技术,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,after

10、Kiss balloon,急性左主干闭塞病例报告-庞文跃,右冠造影,急性左主干闭塞病例报告-庞文跃,Follow up 随访（14 months）,Ophthalmalgia when movement 活动时牙痛 Diagnosis: angina pectoris 诊断：心绞痛 Management: angiography 处理：造影,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,How to manage?,PCI CABG Drug Other,急性左主干闭塞病例报告-庞文跃,3.0*10 cutting balloon,急性左主干闭塞病例报告-庞文跃,3.0*10 cutting balloon,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,LCX:3.5*18Indeavor step by step crush,急性左主干闭塞病例报告-庞文跃,急性左主干闭塞病例报告-庞文跃,LM-LAD:3.5*15 Ind