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FACILITATED PCI FOR ACUTE ANTERIOR CHEST PAIN

- case study -

Background: Myocardial infarction is the irreversible necrosis of heart muscle


secondary to prolonged lack of oxygen supply produced by a variety of etiologies.
The aim of this study is to underline the role of facilitated angioplasty through
efficient thrombolysis, intended for the patients that could not reach, in the
recommended time limit (<90 minutes), a cardiovascular center with possibility of
PCI.

Methods: A 61-year-old male sought medical care at the hospital with a 5 hour
history of severe retrosternal chest pain. He was hospitalized in the CCU and has
undergone the investigational and curative process. This wasnt the first episode of
UA from the PMH. The patient was aware of being hypertensive (stage 2) and was
a smoker (10 years). Also, he is a known patient with hypothyroidism (treated
with levothyroxine), dyslipidemia and a former alcoholic.
At physical examination (March 20, 2017) he had a HR of 95 bpm and blood
pressure of 140/80 mmHg. Lung examination showed no alterations (SO2=97%)
and heart examination was normal.
The initial ECG (Ibid. date) showed a heart rate of 95 bpm, sinus rhythm and
extensive ongoing anterior-lateral wall infarction (ST elevation in V2 to V6,lead 1
and aVL), Killip class I. No reperfusion signs were found in the clinical
examination and ECG (which is abnormal).
The current patient sustained the thrombolysis procedure in a county hospital,
where there did not exist the possibility of PCI. The thrombolysis being inefficient
as it is displayed in the laboratory results, respectively in the elevated amounts of
the troponin, CK, CK-MB and transaminases.The cardiac infarction was associated
with a hepatic cytolisis syndrome and leukocytosis. In the present clinic (Iliescu)
the patient goes through an ecocardiography: the cardinal echo concludes the prior
investigations (moderate dysfunction of the left ventricle LVEF 40%, akinesia in
the 2/3 anterior and 1/3 apical of the IVS, mild mitral insufficiency, no PHTN,
aorta 20/32 mm). The second Doppler cardiac eco investigation has found an
remaining aneurysm. The coronarography has found a 90% stenosis situated in the
LAD (proximal and medium segment). In the same sitting with the
coronarography, the angioplasty with 2 stent implants was performed , with a
favorable evolution sustained by the decreasing value of the cardiac enzymes
(troponin, CK-MB) reporting to the initial levels, but with considerable sequelae,
respectively an left ventricle aneurysm and and cardiac insufficiency.

Results: Firstly, the treatment was initiated with the pharmaceutical combination
of a thrombolytic, an anticoagulant and an antiaggregant-2 hours post AMI.
Secondly, angioplasty was performed with stent implant in the LAD-4 hours
after the outset of the chest pain.
Conclusions: Although, the revascularization was performed with 2 stents not to
late-after 90 minutes from the beginning of the AMI, the patient having an
inefficient thrombolysis, he was left with considerable sequelae.