Author + information
- Gen Matsuura1
Patient initials or identifier number
Relevant clinical history and physical exam
He was diagnosed with paroxysmal atrial fibrillation at the age of 64 and started oral administration of an anticoagulant. However, due to an appearance of stomach discomfort by side effects of a drug, He was interrupting himself to take medicine. On 3 September he was aware of sudden chest pain and was taken to the hospital by ambulance.
Relevant test results prior to catheterization
An electrocardiogram test, atrial fibrillation, complete right bundle branch block, a slight ST elevation in II, III, aVf induction was shown. And in cardiac ultrasound examination showed a slight decrease in wall motion of the rear wall.
Acute posterior wall myocardial infarction was suspected and emergency coronary angiography was performed.
Relevant catheterization findings
No arteriosclerotic lesions were found in the right coronary artery and the left anterior descending branch.
The results of the inspection showed the complete obstruction of thrombotic to the left circumflex branch # 14.
Because I was worried about the possibility of developing an atrioventricular block, I inserted a 5Fr sheath from the right internal jugular vein and inserted a temporary pacemaker.
A 6Fr slim sheath was inserted by puncturing from the right radial artery.
Using a guide catheter with MALT 3.75, coronary angiography was performed.
As a result, thrombotic occlusion was observed in the left circumflex coronary branch #14.
Launcher 6Fr EBU 3.5 was used for the guide catheter and Run through NSEF was used for the first wire.
Although it was very difficult to pass through the lesion, it was possible to pass by using the coated wire (Fielder FC) and a child catheter (Caravel).
Using the KUSABI, a child catheter (Caravel) was removed.
Because thrombotic occlusion was suspected, thrombus aspiration therapy was performed with TVAC2.
As a result, a large amount of red thrombus was collected and became TIMI 2.
Since no arteriosclerotic lesion was recognized, it was judged that stent treatment was unnecessary, and treatment was terminated.
This case suspected aortic dissection underwent a contrast CT. As a result recognized a contrast defect area under the left ventricular inferior wall in the film, it led to the diagnosis of myocardial infarction.
With CT performed to evaluate aortic dissection, it is a demand to Careful slice observation.
This is because myocardial ischemia can be diagnosed.