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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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Thrombosisordissection? 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
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
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)
Diagnosis 1. Coronary Heart Disease ACS 2. Chronic bronchitis Chronic pulmonaryfibrosis 3. T2DM 4. Primary Hypertension ,very high risk
CAG-LCA LMd:50% LADm:100% No
CAG-RCA RCAm:60%
PCI for LAD(1) Wire 1.5*15mm balloon
Dicussion(1) • What do you think about the diagnosis? • What should we do? • PCI for LAD is necessary?
PCI for LAD(2) After 1.5mm balloon dilatation 2.0*20mm balloon
PCI for LAD(3) After 2.0 balloon dilatation After 2.0 balloon dilatation for 5 times
Dicussion(2) • The patient didn’t compliant any discomfort No chest pain No dyspenea • What should we do next? Stop here? Stent it ?
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
ECG Before Discharge(2009.8.3) No significant changes by ECG
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!