CASE PRESENTATION AN ACUTE CORONARY SYNDROME PATIENT

Mehdi Shahriyari AfsharMD, EAPCI

Interventionalist Iranian Hospital Catlab Director, Jun 2011

55 years old gentleman from IndiaRisk Factors: hypertension

Drug history:amlodipin /atenolol 5/50 daily

Brought to ER due to two days on and off chest pain

He was about to fly to his country.

IN EMERGENCY ROOM HE WENT TO AF RHYTHM BUT HIS VITAL SIGN WAS STABLE (B.P.=120/80)

FIRST CARDIAC ENZYMES WERE :TROPONIN 1.38 (NL <0.4 )CK MB 44 (NL<10.4)

QUESTION 1 WHAT IS YOUR DIAGNOSIS?

1.UNSTABLE ANGINA2.ACUTE CORONARY SYNDROME(ACS)3.NON STEMI(NSTEMI)4.STEMI

QUESTION 2 WHAT IS THE INITIAL DOSE OF ASA IN THIS PATIENT?

1.<100 MG 2.100 MG 3.300 MG CHEWABLE 4.300 MG ENTERIC COATED

QUESTION 3WE WOULD ADMINISTER CLOPIDOGREL AT

1.300 MG LOADING2.600 MG LOADING 3.900 MG LOADING 4.NO LOADING

QUESTION 4THE ANTICOAGULANT OF CHOICE FOR THIS PATIENT IS:

1.UFH (UNFRACTIONATED HEPARIN)2.ENOXAPARIN (LOW MOLECULAR WEIGHT HEPARIN)3.FOUNDAPARINUX (INHIBITOR OF ACTIVATED FACTOR X )4.BIVALURIDIN {DIRECT THROMBIN INHIBITOR (DTI)}

QUESTION 5 WE ---------- USE A GP2 A3 B

INHIBITOR IN THIS PATIENT

1 .WOULD2. WOULD NOT

What is GRACE score for this patient?

GRACE SCORE CALCULATOR

CORONARY ANGIOGRAPHY

Cath Lab

6 French Sheath inserted in right femoral arterySelective coronary angiography revealed:

CORONARY ANGIOGRAPHY

100% flush occlusion of left circumflex artery 40% lesion in proximal portion of LAD with mild ectasia90% RCA distal lesion

Percutaneous Coronary Intervention(PCI) :

Guidwire (PT2) inserted into LCXGP 2a3b inhibitor (Aggrastat) startedPredilation by Mini trek 1.5/12 balloon was donethen we put stent Xience v 2.75 /18

Finally we fix the RCA distal lesion by direct stenting by Xience prime 2.5/15 stent

PCI on LCX and RCA

ECG after PCI

ThanksAcknowledgment: Education Dept. - Hosseini