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Thrombosis or dissection ?

Thrombosis or dissection ?. TianJin Third Central Hospital Liu Yingwu. History. Female, 73yrs Intermittent dyspnea for four years ， aggravated 1 day accompanied by chest discomfort History ： chronic branchitis ， fibrosis of lung Hypertension ， T2DM ， Ex-smoker.

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Thrombosis or dissection ?

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  1. Thrombosisordissection? TianJin Third Central Hospital Liu Yingwu

  2. History • Female, 73yrs • Intermittent dyspnea for four years，aggravated 1 day accompanied by chest discomfort • History：chronic branchitis，fibrosis of lung Hypertension， T2DM， • Ex-smoker

  3. ECG at admission（2009.7.26）

  4. Laboratory Test (1) • Cardiac Marker： • CK-MB： 3.5 ng/ml（0-4.3） • Myo： 500 ng/ml（0-107） • cTnI：0.30 ng/ml（0-0.4） • BNP：99.6 pg/ml（0-100 pg/ml ） • Blood Sugar at admission：15.46 mmol/L • BUN：8.07 mmol/L • Cr： 85 umol/L • K+： 4.15 mmol/L

  5. Laboratory Test (2) • CK：3991 U/L • CK-MB：518 U/L • a-HBDH：1040 U/L • cTnI：(+) • TG: 1.01 mmol/L • TC：4.20 mmol/L • LDL-c：2.34 mmol/L • HDL-c：1.70 mmol/L • HBA1C：7.0% • HsCRP：3.75 mg/L（<7.44 mg/L）

  6. Diagnosis 1. Coronary Heart Disease ACS 2. Chronic bronchitis Chronic pulmonaryfibrosis 3. T2DM 4. Primary Hypertension ,very high risk

  7. CAG-LCA LMd：50% LADm：100% No

  8. CAG-RCA RCAm：60%

  9. PCI for LAD(1) Wire 1.5*15mm balloon

  10. Dicussion（1） • What do you think about the diagnosis？ • What should we do？ • PCI for LAD is necessary？

  11. PCI for LAD(2) After 1.5mm balloon dilatation 2.0*20mm balloon

  12. PCI for LAD(3) After 2.0 balloon dilatation After 2.0 balloon dilatation for 5 times

  13. Dicussion（2） • The patient didn’t compliant any discomfort No chest pain No dyspenea • What should we do next? Stop here? Stent it ?

  14. Post-procedure ECG（2009-7-28）

  15. Laboratory Test After Procedure • BUN： 3.60 mmol/L • Cr： 68 umol/L • AST： 23 U/L • LDH： 164 U/L • α-HBDH：130 U/L • CK： 39 U/L • CK-MB：5 U/L • CTnI: （-） • K+： 3.96 mmol/L • Na+： 142.0 mmol/L • Cl-： 102.5 mmol/L

  16. ECG Before Discharge（2009.8.3） No significant changes by ECG

  17. Your advice is expected • Thrombosis or Dissection？ What do you think？ and WHY? • Unfortunately，the patient refused to accept another CAG，and we haven’t got any experience...... • Your advice is of valuable！

  18. Thank You for Your Atrtention!

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