Case Report病例报告病例报告Shengjing Hospital of China Medical University中国医科大学附属盛京医院中国医科大学附属盛京医院Wenyue Pang庞文跃庞文跃Patient name: PanXX, Sex: Male, Age: 64 years 患者潘XX，男，64Was hospitalized with the chief complaint “remittent chest pain for 5 years with attenuation for 1 week”. 因“间断胸痛5年，加重1周”为主诉入院Clinic Data 临床资料Clinic Data 临床资料Past history: hypertension for 7 years. Smoke 20 cigarettes per day for 30 years. 既往有高血压病史7年。吸烟20支/天30年Physical examination: BP150/95mmHg，the cardiac boarder enlarged to the left and lower. HR 72 bpm, without cardiac murmur. 体检：BP150/95mmHg，心界左下扩大，HR72次/分，无杂音Clinic Data 临床资料ECG：Leads V1-V5 ST segments depressed for ECG：V1-V5导联ST段下移；PDE：；EF=61%Clinic Data 临床资料Coronary artery CT：Left major-left anterior descending (LAD) branch proximal and medial segments severe stenosis; left circumflex (LCX) proximal segment moderate stenosis. 冠脉CT：左主干-前降支近中段重度狭窄；旋支近段中度狭窄。Clinic Data 临床资料临床诊断： 1.冠心病：不稳定心绞痛 2.高血压病3级Clinical diagnosis: 1. coronary heart disease: unstable angina pectoris 2. HypertensionCoronary Angiography 影像 Coronary Angiography 影像Coronary Angiography 影像Coronary AngiographyIn the preparation of right coronary angiography, before angiographic catheter reached the orifice of the right coronary artery, BP depression, from 135/85 mmHg to 80/40 mmHg in 30 seconds.准备右冠造影过程中，造影导管未到达右冠开口时，患者血压下降，30秒内由135/85下降到80/40No obvious changes of HR 心率无明显减慢No obvious changes was observed in the leads of electrocardiography (ECG) monitoring. 心电监测导联未见明显变化。The patient said chest skin itch, without chest pain. 患者自述胸前皮肤搔痒，无胸痛What happened? 发生什么了？Pressure monitoring pathway leakage? 压力监测通道漏气？contrast media hypersensitivity？ 造影剂过敏？Vagal reflex? 迷走反射？Occlusion of left coronary artery？ 左冠闭塞？The patients HR dropped to 35 bpm 患者心率下降至35次/分Chest pain onset 开始出现胸痛acute left major occlusion！急性左主干闭塞！急性左主干闭塞！Which first? 首先做什么？IABP /Temporary cardiac pacing, then PCI IABP/临时起搏器，然后PCIPCI 首先PCIDrug 药物抢救Other 其他Management 处理XB3.5GC Catheter was emergently sent in, approving the 100% occlusion of left major (LM) body part. 紧急予导管送入，证实左主干体部100%闭塞遗憾：没有留下影像 Regret: no video made GC:XB3.5 GW:BMW STENT:3.5*18mm Cypher IABP 3.0*13 Cypher3.0*18 CypherPCI治疗四:LCX3.0*23 Cypher T支架技术 after Kiss balloon 右冠造影Follow up 随访（14 months）Ophthalmalgia when movement 活动时牙痛Diagnosis: angina pectoris 诊断：心绞痛Management: angiography 处理：造影How to manage?PCICABGDrugOther3.0*10 cutting balloon 3.0*10 cutting balloon LCX:3.5*18Indeavor step by step crush LM-LAD:3.5*15 Indeavor Kissing balloonFollow up 随访结果(22 m) CT: normal 冠脉支架内未见明显狭窄Thanks