FACILITATED PCI FOR ACUTE ANTERIOR CHEST PAIN

- case study -
Cristian Ciurea, Crina Duca, Gabriela Ganea, Bogdan Nu
Laura Antohi, Razvan Radu, Ana Maria Urluescu, Ovidiu Chioncel2

1-Student, U.M.F.Carol Davila, Bucureti, Romnia

2-Institutul de Urgen pentru Boli Cardiovasculare "Prof. Dr. C.C. Iliescu"

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 show the reduced mortality of the PCI done
after efficient thrombolysis in the impossibility of respecting the recommended
time limit (<90 minutes) for a STEMI patient in the following case.

Methods and Materials: 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 cardinal echocardiography 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
Lab results (March 25, 2017) likewise showcase the necrosis of the myocardial
tissue by the elevation of the cardiac biomarkers: CK 225/ u/l, CK-MB 34/ u/l AST
65/ u/l, urea 67/ MG/DL.
The coronarography has found a 90% stenosis situated in the LAD.

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: The singularity of the present case is the absence of the common
reperfusion signs, which could not be determined by the clinical examination or the
ECG in the current patient, that went through a tardy PCI after a successful
thrombolysis.
.. (obiectivul studiului este sa subliniem rolul angioplastiei facilitate prin
tromboliza eficienta la pacientii care nu ajung in primele 90 de min la un centru de
posibilitate de pci )

(pacientul a fost trombolizat in spital judetean unde nu exista posibilitatea de pci ,

tromboliza fiind ineficienta cum reiese din rezultatele de laborator , resectiv valori
crescute ale troponinei , ck,ckmb, transaminaze .Asocindu0se infarctul cu sindrom
de citoliza hepatica si leucocitoza. In clinica cc iliescu se efectueaza ecografie
cardiaca la sosirea pacientului cu :continuare ecocardiografie si coronarografie la
care a fost gasit 90 la suta stenoza in anterioara dreapta )LAD) i nsegmentul
proximal si mediu .IN aceeasi sedinta cu coronarografia se face stentare cu 2
stenturi (cu tipul de stent( cu evolutie favotabilz sutinuta de valorile descrescatoare
ale enzimelor cardiace. troponinina , ckmb in scadere fata de valoriile iinitiale dar
cu sechele considerabile ,respectiv anevrim de ventricul stang si insuficienta
ventriculara stanga .
Desi revascularizarea s0a efectuat cu 2 stenturi nu foarte tarziu dupa 90 de min de
la debutul de la debutul infarctului pacientul avand tromboliza ineficienta a ramas
cu sechele importante.