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PPCI in the setting of acute anterior and inferior STEMI with Cardiogenic shock
Poster Title: PPCI in the setting of acute anterior and inferior STEMI with Cardiogenic shock
Submitted on 08 Jul 2018
Author(s): Mohamed Zahran MD,MSC,PHD , Amr Salah Mohamed MD,MSC
Affiliations: Ain Shams University hospital
This poster was presented at C3 conference 2018 , orlando
Poster Views: 333
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Poster Information
Abstract: ST elevation myocardial infarction(STEMI) is the most serious presentation of atherosclerotic coronary artery disease carrying the most hazardous consequences & patients with ST elevation are candidate for immediate reperfusion therapy (1).
Reperfusion therapy is the cornerstone of the treatment of patients with STEMI; it aims at reducing mortality and morbidity by achieving patency of the epicardial infarct-related artery and by restoring myocardial tissue perfusion either pharmacologically or mechanically(2).
Primary percutaneous coronary intervention (PCI) is considered the preferred reperfusion modality for patients presenting with ST-segment elevation myocardial infarction (STEMI) (1)
This is a 55 year old male driver , smoker , hypertensive who presented to us with typical chest pain of 2 hour duration , on examination the patient is is shocked with blood pressure 70/40 , apical HR is 55 , no audible murmurs, ECG showed ST elevation in the anterior and inferior leads.
The patient was immediately taken to the cath lab after giving 300 mg of aspirin and 180 mg ticagrelor , IV inotropes and vasopressors were initiated but failed to elevate the blood pressure despite high doses.
We suspected that we will find total LAD and RCA , or total LAD that is supplying the RCA retrograde due to chronic total occlusion but we found something different and unexpected we found total left main occlusion.
Two PTCA wires in LAD and LCX , PTCA to LAD and LCX leading to establishment of flow , blood pressure immediately normalized and the patient is much better , the LM lesion became clear to us that it is medina (1,1,1) , we decided to go for the TAP technique as this technique will allow me to stent the LAD at first and is the least time consuming , and the bifurcation anatomy favorable( narrow angle for the LCX ) , the procedure was done was a final TIMI III flow .
The patient was then transferred to our CCU were he spent about 3 days , echocardiography showed EF 45% , SWMA in LAD territory , no mechanical complications ,
The patient followed up in our outpatient clinic 2 weeks later and is chest pain free on optimal medical therapy
Summary: primary PCI for STEMI in the setting of total left main occlusion and cradiogenic shock References: 1. Westfall JM, Van Vorst RF, McGloin J, Selker HP. Triage and diagnosis of chest pain in rural hospitals: implementation of the ACI-TIPI in the High Plains Research Network. Ann Fam Med 2006; 4: 153-158.
2. Hellermann JP, Reeder GS and Jacobsen SJ. Longitudinal trends in the severity of acute myocardial infarction. a population study in Olmsted County, Minnesota. American Journal of Epidemiology 2002; 156:246-264.
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