急性左主干闭塞病例报告.pptVIP

Followup随访（14months）处理：造影Management:angiography03诊断：心绞痛Diagnosis:anginapectoris02活动时牙痛Ophthalmalgiawhenmovement01CaseReport

病例报告ShengjingHospitalofChinaMedicalUniversity中国医科大学附属盛京医院WenyuePang庞文跃ClinicData临床资料Patientname:PanXX,Sex:Male,Age:64years患者潘XX，男，64Washospitalizedwiththechiefcomplaint“remittentchestpainfor5yearswithattenuationfor1week”.因“间断胸痛5年，加重1周”为主诉入院Pasthistory:hypertensionfor7years.Smoke20cigarettesperdayfor30years.既往有高血压病史7年。吸烟20支/天30年Physicalexamination:BP150/95mmHg，thecardiacboarderenlargedtotheleftandlower.HR72bpm,withoutcardiacmurmur.体检：BP150/95mmHg，心界左下扩大，HR72次/分，无杂音ClinicData临床资料ECG：LeadsV1-V5STsegmentsdepressedfor0.05mVECG：V1-V5导联ST段下移0.05mV；PDE：LV=57.4mm；EF=61%ClinicData临床资料CoronaryarteryCT：Leftmajor-leftanteriordescending(LAD)branchproximalandmedialsegmentsseverestenosis;leftcircumflex(LCX)proximalsegmentmoderatestenosis.01冠脉CT：左主干-前降支近中段重度狭窄；旋支近段中度狭窄。02ClinicData临床资料冠心病：不稳定心绞痛高血压病3级临床诊断：01coronaryheartdisease:unstableanginapectorisHypertensionClinicaldiagnosis:02CoronaryAngiographyInthepreparationofrightcoronaryangiography,beforeangiographiccatheterreachedtheorificeoftherightcoronaryartery,BPdepression,from135/85mmHgto80/40mmHgin30seconds.1准备右冠造影过程中，造影导管未到达右冠开口时，患者血压下降，30秒内由135/85下降到80/402NoobviouschangesofHR心率无明显减慢Noobviouschangeswasobservedintheleadsofelectrocardiography(ECG)monitoring.心电监测导联未见明显变化。Thepatientsaidchestskinitch,withoutchestpain.患者自述胸前皮肤搔痒，无胸痛Whathappened?发生什么了？Pressuremonitoringpathwayleakage?压力监测通道漏气？contrastmediahypersensitivity？造影剂过敏？Vagalreflex?迷走反射？Occlusionofleftcoronaryartery？左冠闭塞？患者心率下降至35次/分Thepatient’sHRdroppedto35bpm开始出现胸痛Chestpainonsetacuteleftmajorocclusion！急性左主干闭塞！IABP/Temporarycardiacpacing,thenPCIIABP/临时起搏器，然后PCIPCI首先PCIDrug药物抢救Other