Thrombosis or dissection ? TianJin Third Central Hospital Liu Yingwu

HistoryFemale, 73yrsIntermittent dyspnea for four yearsaggravated 1 day accompanied by chest discomfort Historychronic branchitisfibrosis of lung Hypertension T2DMEx-smoker

ECG at admission2009.7.26

Laboratory Test (1)Cardiac Marker CK-MB 3.5 ng/ml0-4.3 Myo 500 ng/ml0-107 cTnI0.30 ng/ml0-0.4BNP99.6 pg/ml0-100 pg/ml Blood Sugar at admission15.46 mmol/LBUN8.07 mmol/LCr 85 umol/LK+ 4.15 mmol/L

Laboratory Test (2)CK3991 U/LCK-MB518 U/La-HBDH1040 U/LcTnI(+)TG: 1.01 mmol/LTC4.20 mmol/LLDL-c2.34 mmol/LHDL-c1.70 mmol/L HBA1C7.0%HsCRP3.75 mg/L

Diagnosis

1. Coronary Heart Disease ACS2. Chronic bronchitis Chronic pulmonary fibrosis 3. T2DM4. Primary Hypertension ,very high risk

CAG-LCALMd50%LADm100%No

CAG-RCARCAm60%

PCI for LAD(1)Wire1.5*15mm balloon

Dicussion1 What do you think about the diagnosis What should we do PCI for LAD is necessary

PCI for LAD(2)After 1.5mm balloon dilatation2.0*20mm balloon

PCI for LAD(3)After 2.0 balloon dilatationAfter 2.0 balloon dilatation for 5 times

Dicussion2 The patient didnt compliant any discomfort No chest pain No dyspenea What should we do next? Stop here? Stent it ?

Post-procedure ECG2009-7-28

Laboratory Test After ProcedureBUN 3.60 mmol/LCr 68 umol/LAST 23 U/LLDH 164 U/L-HBDH130 U/LCK 39 U/LCK-MB5 U/LCTnI: -K+ 3.96 mmol/LNa+ 142.0 mmol/LCl- 102.5 mmol/L

ECG Before Discharge2009.8.3 No significant changes by ECG

Your advice is expected Thrombosis or Dissection What do you think and WHY?Unfortunatelythe patient refused to accept another CAGand we havent got any experience...... Your advice is of valuable

Thank You for Your Atrtention!