COMPLEX LAD LESION WITH STABLE...

COMPLEX LAD LESION WITH STABLE ANGINA

CASE PRESENTATION

P.Mitkowski, M.Lesiak

University of Medical Sciences

Poznań, Poland

CASE: 80 yo ♂

Stable angina pectoris, CCS II

• 3 month ago PCI + DES (3,5x22 mm) LCxbecause ACS (UA)Angio:

– LM – not significant

– LAD (6,7,9) – 50% stenosis

– LCx (11) – 90% stenosis

– RCA (1) – 50%, PDA (4) – 60%

CASE: 80 yo ♂


• Angina for last 6 month

• No smoking

• No hypertension

• No diabetes

• Mother died 64 because MI

CASE: 80 yo ♂


• Medical treatment:

– ASA 75 mg

– Clopidogrel 75 mg

– Ramipril 2,5 mg

– Metoprolol succinate 25 mg

– Atorvastatin 20 mg

CASE: 80 yo ♂


• Vital signs:

– Weight 73 kg

– Height 173 cm

– HR 55/min

– RR 140/80 mmHg

– No signs of congestion

– Systolic murmur 2/6 over mitral valve

CASE: 80 yo ♂


• Blood Count:

– WBC 4,6 x 109/l

– RBC 4,7 x 1012/l

– HGB 9,12 mmol/l

– HCT 0,42

– PLT 215

CASE: 80 yo ♂


• Biochemistry:

– Total cholesterol - 3,43 mmol/l

• HDL-Ch - 1,35

• TG - 0,64

• LDL-Ch - 1,80

– Glucose - 5,16 mmol/l

– Creatinine - 121 µmol/l

– Na+ 139 mmol/l, K+ 4,3 mmol/l

– AspAT 43 U/l, AlAT 26 U/l

CASE: 80 yo ♂


• ECG:

CASE: 80 yo ♂


• ECHO:

– LVEDD - 46 mm

– LAD - 36 mm

– RVD - 27 mm

– IVS - 10 mm

– PW - 7 mm

– Ao - 23-28 mm

– MI (mild), TI (mild, RVSP 30 mmHg)

– Hypokinesis: apical & medial seg. lat. wall, apical seg. IVS – EF 55%

CASE: 80 yo ♂


• Angiography:

CASE: 80 yo ♂


• EuroSCORE: 5

• SYNTAX SCORE: 33

COMPLEX LAD LESION WITH STABLE ANGINA

CASE OUTCOME

CASE: 80 yo ♂


• PCI LAD/DIA1:

CASE: 80 yo ♂


• Medical treatment post PCI:

– ASA 75 mg

– Clopidogrel 75 mg

– Ramipril 5 mg

– Metoprolol succinate 50 mg

– Atorvastatin 40 mg

CASE: 80 yo ♂


• 5 month later

– Reoccurence of Angina CCS 2/3

CASE: 80 yo ♂


• Angiography(5 month):

CASE: 80 yo ♂


• PCI(5 month):

THANKS FOR YOR ATTENTION

COMPLEX LAD LESION WITH STABLE...

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