Emergency PCI for AMI with acute occlusion of LAD RCA精选.pptVIP

Emergency PCI for AMI with acute occlusion of LAD RCA Yin Zhao-fang Ren Yi-rong Shanghai 9th Peoples Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine 73-year-old Chinese man Smoking history Angina pectoris for 4 years Repeated chest pain for 10-hour ECG - Emergency 1 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 ECG - Emergency 2 Emergency room to the cath.lab. … Dopamine 20mg bolus; dopamine 240mg / Metaraminol 60mg intravenous drip 5% SB50ml bolus Temporary pacing electrode placement Femoral artery pressure: 50/30 mmHg ECG: III degree AVB Temporary pacing: 60ppm IABP ? Continued application of vasoactive drugs Aspiration ? Which branch vessel prior PCI? 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 TnT-T ： 2.0 ng/ml Creatinine ：122 umol/L CK：2743u/L, CK-MB：117u/L(instantly )； CK：7670u/L, CK-MB：440u/L(day 1 )； CK：9650u/L, CK-MB：560u/L(day 2 ) ECG- PCI day ECG- 2 days after PCI Tirofiban maintain 48-hour Vasoactive drugs to maintain 14 days, left heart failure attack 4 times Clopidogrel, cilostazol, Lipitor, diuretics, etc. After14 days, to give ACEI / Concor UCG: LVEDD-58mm, LVEF-40%; no significant aortic valve regurgitation Acute occlusion of left anterior descending artery and right coronary artery at the same time, ECGs usually have important tips. “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 1 “Simultaneous occlusion of 2 coronary arteries: plaque rupture acute thrombosis in a single coronary artery low coronary perfusion pressure multiple thrombosis.---Mechanism 2 Openin