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1、Emergency PCI for AMI with acute occlusion of LAD & RCA,Yin Zhao-fang Ren Yi-rongShanghai 9th Peoples Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine,A case report,73-year-old Chinese man Smoking history Angina pectoris for 4 years Repeated chest pain for 10-hour,A brief his
2、tory of ,ECG - Emergency 1,2009-9-5-14:30,Acute anterior myocardial infarction, Killip I class Aspirin 300mg Clopidogrel 300mg Tirofiban 12ml IV +12 ml / Hr to maintain, nitrates, etc Preparation for emergency PCI,Emergency Diagnosis and Treatment ,ECG - Emergency 2,2009-9-5-15:10,Emergency room to
3、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 .,Vf,200J,Dopamine 20mg bolus; dopami
4、ne 240mg / Metaraminol 60mg intravenous drip 5% SB50ml bolus Temporary pacing electrode placement,Before CAG,Femoral artery pressure: 50/30 mmHg ECG: III degree AVB Temporary pacing: 60ppm,Before CAG,Emergency CAG ,Emergency CAG ,IABP ?,Strategies ,First of all .,Aortic root angiography ,Significant
5、 aortic valve regurgitation,Continued application of vasoactive drugs,Strategies ,Aspiration ?,Strategies ,Secondly .,Which branch vessel prior PCI?,Strategies ,Thirdly,LAD-PCI,6F BL3.5 GC, 2 Runthrough GW, 2.0*20 Sapphier Bollon, FirebirdII 2.5*33,RCA-PTCA,6F JR4.0 GC, Runthrough GW, 2.0*20 Sapphie
6、r Bollon,Restore sinus rhythm: 112bpm; removed temporary pacing electrode Blood pressure 130/100mmHg, dopamine 120mg /Metaraminol 20mg/500ml Tirofiban 12ml/Hr No use of femoral artery closure device,After PCI.,TnT-T ： 2.0 ng/ml Creatinine ：122 umol/L CK：2743u/L, CK-MB：117u/L(instantly )；CK：7670u/L,
7、CK-MB：440u/L(day 1 )；CK：9650u/L, CK-MB：560u/L(day 2 ),Laboratory test,ECG- PCI day,2009-9-5-17:30,ECG- 2 days after PCI,2009-9-7-10:30,Tirofiban maintain 48-hour Vasoactive drugs to maintain 14 days, left heart failure attack 4 times Clopidogrel, cilostazol, Lipitor, diuretics, etc. After14 days, to
8、 give ACEI / Concor UCG: LVEDD-58mm, LVEF-40%; no significant aortic valve regurgitation,Following days ,1 month later, re-CAG,Final results .,Acute occlusion of left anterior descending artery and right coronary artery at the same time, ECGs usually have important tips. “Simultaneous“ occlusion of
9、2 coronary arteries: plaque instability might be caused, exert adverse effects throughout the coronary vasculature and result in multiple lesions and thrombosis.-Mechanism 1,Summary (1),Brunetti ND, et al. J Electrocardiol, 2010, 43(10) Araszkiewicz A, et al. Am J Emerg Med, 2009, 27(9),“Simultaneou
10、s“ occlusion of 2 coronary arteries: plaque rupture acute thrombosis in a single coronary artery low coronary perfusion pressure multiple thrombosis.-Mechanism 2 Opening IRA as soon as possible, is critical to restore coronary perfusion, to preserve LV function and to improve prognosis More optimal therapeutic strategy? Elective CABG?,Summary (2),Sia SK, et al. Circ J, 2008, 72(6) Tu CM, et al. Am J Emerg Med, 2009, 27(9) Turgeman Y, et al. J Invasive Cardiol. 2007, 19(9),Thanks for your attention,
