Introduction
According to the American hHeart aAssociation, heart attack or myocardial infarction (MI), is when the heart occurs when one or more of the vessels (coronary arteries) that supply blood to the heart get (Coronary arteries) closedobstructed, and the blood is unable tocan’t reach the heart muscle, causing which cause the muscle to maldysfunction function (AHA, 2007). There are two major risk factors that can cause a patient have two risk factors to cause heart attack; which they are high serum cholesterol level represented also known as as hyperlipidemia and high blood pressure represented also known as hypertension. The Heartheart attack can be of have two types: NSTEMI (Non-ST segment Elevation Myocardial Infarction) and STIMESTEMI (ST Elevation Myocardial Infarction). Th they are differ from each other in terms of the damage caused to the heart muscle. different from each other in due to the damage for the heart muscle in which the In NSTEMI, a part of the heart muscle is damaged caused due to part of the heart muscle had been damage a, while in nd the STEMI, the entire caused when the full thickness of the heart muscle is affected and damaged. An EKG can differentiate between STEMI and NSTEMI as it illustrated in fFig.ure 1. (Dr. M.A. Wadud, 2014).
Figure 1: EKG illustrating the difference between NSTEMI and STEMI (Thrombosis Advisor, 2014)
Figure SEQ Figure \* ARABIC 1: Illustrate the different between NSTEMI and STEMI. (THROMBOSIS ADVISOR,2014).
A 66- year old African- American female, non-smoker, with no history of alcohol or drug use, arrived to at the emergency department triage center, complaining of chest discomfort (Aatypical unstable aAngina) with difficulty in breathing. The patient had had no past medical history of any heart diseases or any other diseases. The patient informed the emergency physician that she was allergic to Morphine; this allergy was, which was d discovered after after she had undergone a had hysterectomy surgery., After examination by the the pPhysician and using examined her and used the information from the triage, the official diagnosed was hypertension (High blood pressure)and , hyperlipidemia (high lipids level) induced . ST Elevation Myocardial Infarction (STEMI). , for that the The patient was had been admitted the patient with for for immediate Percutaneous Coronary Intervention (PCI).
Procedure
The procedure was explained in detail to the patient. The risks, benefits, conscious sedation, and complication were reviewed and informed consent was obtained. The patient was brought to the Cath lab and the team placed the patient on the table. The puncture sites were prepped and draped in the usual sterile fashion. Conscious sedation (Versedversed) was used to relieve patient anxiety, discomfort, and pain to start initiate the procedure. Percutaneous access was performed through the left radial artery and the left femoral was prepared as a secondary location in case of emergency. A 6 Fr sheath was inserted. After Next,that, a 20 gauge Jetco angiocatheter was inserted to guide to the coronary area, with while administradministering ation of nitroglycerin and cardene to prevent vasospasm. A 5Fr JL 3.5 was used to engage the left coronary system, inject contrast media, and take a fluoroscopy shots to diagnose the system. A 5 Fr JR was used to engage the right coronary system and cross the aortic valve for LVEDP.
Percutaneous Coronary Artery Intervention
A 6 Fr XB 3 guide catheter was used to engage with the left main artery and a BMW wire was advanced down the lesion. Direct stenting was then performed using a XienceAlpine 2.75 x 15mm DES. The stent was then post-dilated using a NC Trek 3.0 x 12 mm balloon to 20 atm, and then a NC trek 3.25 x 8 mm balloon was used to obtain excellent angiographic results. Unsuccessful closure attempt was performed using Mechanical mechanical compressioned. Hemostasis was successfully obtained using R band. Estimated blood loss was 7ml.
Findings
The anatomy was a rRight dominant coronary system. The procedural indication was for Non-STEMI/Unstable Angina. Two vessel severe CAD: 1) Mid LAD stenosis with 80% and TIMI III flow was noted with good runoff was being present. 2) LAD ostial diagonal with 70% stenosis, 12mm length, and TIMI III flow was noted in the. Author wise, Besides this, tthe coronary system was patent and normal.
The intervention was a direct stenting of the mid LAD with Xience Alpine 2.75 x 15 mm DE. The vessel was postdilatedpost-dilated with a NC trek 38mm to 20 atm. The physician recommended dual antiplatelet therapy for at least a 1 year owing to the , because formation of clots due caused byto the the insertion of a foreign body (the stent) inside the vascular system.
Figure SEQ Figure \* ARABIC 7:Re-inflate the Balloon to be sure for the right stent size.
RIFERANCEReferences
- American Heart Association. (2007). What Is a Heart Attack. Retrieved from:
http://www.heart.org/idc/groups/heartpublic/@wcm/@hcm/documents/downloadable/uc
m_304570.pdf
- Dr. M.A. Wadud. (September 26, 2014). NSTEMI. Retrieved from:
- http://nstemi.org/
- THROMBOSIS ADVISOR. (2ND December 2014). Acute coronary syndrome: a leading case of mortality. Retrieved from:
- http://www.thrombosisadviser.com
