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With an effective therapeutic strategy of a patient with syndrome of cardiac cachexia, our team share what we learned from treating a typical case and give some thoughts on new exploratory therapeutic strategies of secondary prevention of coronary heart disease(CHD).
To discuss the operation opportunity and some new exploratory therapeutic strategies of CHD secondary prevention, we studied the pre and post-operative clinical evidence, including symptom, sign, date of cardiac color ultrasound (UCG), especially the ejection fraction (EF) value and left ventricular end diastolic diameter (LVEDD), in the patient with syndrome of cardiac cachexia.
The patient simultaneously received coronary artery bypass grafting, benefiting a gradually improved general status and EF value from rest and conventional CHD secondary prevention. After the operation, the patient get a well general state, with normal EF value and LVEDD and without valvular regurgitation.
UCG on admission: left atrial diameter (LAD) 41mm, LVEDD 71mm,EF:31%. left atrium and ventricular enlargement, mild mitral and aortic regurgitation. The conditions observed in operation and curing: Left atrium and ventricular enlargement. Stiffness and patches, characteristic “string-of-beads” pattern, exist in each branches of coronary artery. And all operating procedures were just went according to plan. UCG before discharge: LAD 38mm, LVEDD 55mm, EF: 56%. Without left atrium and ventricular enlargement or mild mitral and aortic regurgitation.
Specialty of this patient is the narrow, rather than obliterative,lumen in each branches of coronary artery. This makes a non-thromboendarterectomy operative plan. In the other words, this also proves that the curative therapeutic effect may credited itself with abundant collateral circulation. Also,we initiate the deep level from this ponder, with whole treatment experience below.
1.Construction of collateral circulation of coronary artery may do good things to long term prognosis and inhibit apoptosis in cardiac myocytes. Further,the locations, easily occurring that construction, are always near a severer diseased region of their own. From that, we suggest that we should try our best to delay operations, except some acute left main occlusions or high stenosis to give time to the construction. And at the same time we could implement the CHD secondary prevention. And if we do so, the patients may guarantee a good compliance. While our team will make sure some statistically significant objective indicators, such as coronary artery diameter, in further studies.
2.Stiffness and patches,characteristic “string-of-beads” pattern, were hardly to be destroyed or dissolved by operative instruments. So we credited the real mechanism of treatment of nitrate medications with that nitrate medications can dilate all not-so-serious large and medium-sized arteries,rather than direct influence on serious pathological coronary artery,which can decrease the afterload of ventricle and reduce the energy expenditure of heart to relief symptom.
3.To treat the type A personality CHD patients,we suggest that a medication-combination group,containing low doses of sedatives and normal doses of secondary prevention drugs,may be more effective to reduce the cardiovascular events.
4.Diltiazem, a calcium channel antagonist, can improve the initiative myocardial diastolic function because of a reduced calcium concentration in myocardial cell. This also may do good things to secondary prevention of coronary.