Supervisor :Dr TARIQ ALMOFLEHI prepared by: Dr A.AZiZ Aonallah

1. Case Presentation Supervisor :Dr TARIQ ALMOFLEHI prepared by: Dr A.AZiZAonallah 8/5/2014

2. Personal Information Name : Abdulkareem Mohammed Hassen Age : 65 years old Residence: Sana’a Martial status: Married & has 8 offspring Occupation: solider

3. Special habits : • Irregular Qat chewing

4. Date of admission : 23th march 2013 Source of History The patient himself

5. Chief Complain Chest pain for three hours

6. The Condition of pt started two days PTA as recurrent chest discomfort lasted for about 15 min. increased by exertion relived by rest

7. Three hours before admission the pateint developed intense continuous chest pain • Sudden onset • Retrosternal • Radiated to his lt. shoulder • Heaviness in nature • Associated with sweating

8. No history of shortness of breath , palpitation nor syncopal attack. Also no fevernor LL edema.

9. Review Of Other Systems Respiratory: NAD Abdomen : NAD Renal :NAD Endocrine: NAD CNS: NAD Hematology: NAD

10. Past History • Medical Hx.: No Hx. Of DM, HTN • Surgical Hx. :None • Drug Hx. : None

11. Family History • No Hx. Of DM, HTN • No Hx. Of CAD

12. On Examination • pt was conscious, oriented and cooperativethere was no jaundice no cyanosis nor pallor. • JVP is not rised, no lymph node enlargement • No lower limb edema

13. Vital signs • BP= 150/110 mmhg • PR=76 b/m • T=37.3 c • RR=16 c/m

14. Examination • Heart= S1+S2+0 • Chest=Clear • Abdomen= Soft, no organomegly

15. ECG

16. ECG • ST segment elevation from V1 to V4 and in I & AVL. • T inverted in lead III ,AVF and V6

17. Lab Investigations: • CBC: • WBC=14.17 • Hb=17 g/dl • PLT=219 • CK-MB= 33 • Serum creatinine= 0.9 mg/dl • Serum K=3.9

18. The case was diagnosed as Antero septo lateral Myocardial Infarction

19. Initial Managementin ER: • General : • Complete bed rest. • Inform CCU doctor • Close monitoring • Morphine 3 mg +plasil IV STAT • O2 inhalation • Aspirin 100 mg 3 tab chewable • Plavix 75 mg 4 tab STAT • Cardiology consultation (Dr Fikri ,Dr Abdulmalek and The visitor Saudian team)

20. The decision was to prepare the patient for PRIMARY PCI Within 35 minutes the patient was ready in CATH LAB

21. FROM CATH LAB

23. After discussion the decision was to send the patient for thrombolytic then control CAG and surgical consultation.

24. The patient shifted to CCU and received Actylase 15 mg IV bolusthen 50 mg IVI over 30 minutesthen 35 mg IVI over 1 hour.

28. Stabilization in CCU. • cardio surgical consultation done by Dr YahiaRajehwith advice to transfer the patient to the surgical ward and to prepare him for CABG next week.

29. During admission in surgical ward the patient refuse CABG . • Consultation by Dr Tariq done with advice to prepare the patient for PCI to LM and total LAD. • Reevaluation and preparation by Dr Tariq, • confirm the date of Intervention 2/4/2014

30. One day before the intervention every thing was ready (patient fit , cardio-surgical pack up and OT with (6 units of plasma,6 units of PLT and 6 units of blood AB negative) for possible complication ,

31. Next day the patient sent to CATH LAB with high risk consent for

32. PCI to LM and total ostial LAD for first time in YEMEN

33. FROM CATH LAB

35. ECG post PCI

36. Observation in CCU post PCI

37. Patient shifted to the ward for observation and follow up

38. Then the patient discharged with good general condition by Dr Areej

40. Thank you