Shanghai East HospitalLai, Yan

Dec 2007 Male, 47 years old Have chest uncomfortable for 2 days No chest pain No HP, DM history Not smoking

EKG: II, III, avF lead Q wave with inverted T wave

TNT, Ckmb elevated more than twice Echo: inferior wall systolic

insufficiency, EF 53% Diagnose: Acute inferior

myocardial infarction

The patent became a reverent Buddhist A strict vegetarian Go to Putuo island every year, pray

everyday Take Aspirin+ Plavix for 1.5 year, after

that take Aspirin only Continue take statins No symptom at all, until recently, have

chest pain for about 15 minutes

EKG: II, III, avF Q wave, no obvious ST wave change

CKMB normal, TNT 0.051ng/ml (normal ＜ 0.01)

So, we do the CAG again……

We decide to do PCI in both LAD and RCA

Guiding: 6F AL 0.75; Wire: Runthrough

The patient never stop praying during the whole operation

Finally, Buddha heard him…….

Did we make

the wrong decision at

the first time , Should

we put the stent? Or

the Buddha is really

listening to him ?

Is a specific kind of angina pectoris

It is involved in multiple mechanisms

A comprehensive therapies should be

used

endothelial dysfunction;

Smooth muscle calcium

hypersensitivity;

Increased autonomic tone;

Genetic susceptibility;

psychological stress

Quit smoking

Calcium channel blocker like diltiazem

Long acting nitrates

Statins

PCI

ICD (life threatening arrhythmias)

Psychological therapy

To give nitrate before make the decision

of PCI is very important

Faith healing is also a kind of therapy, so

maybe his pray really worked……