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1.
A 57-year-old man, who had suffered an anterior Q-wave myocardial infarction complicated with typical postcardiac injury syndrome (PCIS) 9 years earlier, underwent percutaneous transluminal coronary angioplasty (PTCA) without any immediate clinical, laboratory, or radiological signs of complications. After 4 days he recognized the recurrence of the earlier symptoms of PCIS. The diagnosis was supported by slight fever, elevated inflammatory parameters, and improvement when oral corticosteroids were given. The observations suggest that milder cardiac injury than previously considered, that is, without demonstrated structural damage to pericardium or myocardium, may precipitate PCIS in predisposed individuals. The case adds a differential diagnosis to chest pain and malaise following PTCA.  相似文献   

2.
对84例132支血管行经皮冠状动脉腔内血管成形术(PTCA).术中常规冠状动脉腔内心电图(IC-ECG)进行监测,并与体表心电图(S-ECG)进行对比.发现 IC-ECG 监测心肌缺血的敏感度明显高于 S-ECG(P<0.01).缺血性 ST 段上移幅度也高于 S-ECG。对缺血发生时间,高峰间及减压后缺血变化恢复时间也明显快于 S-ECG。在 PTCA 时,IC-ECG 与 S-ECG 共同监测心肌缺血对判断心肌缺血程度及判断再狭窄有一定指导意义。  相似文献   

3.
Negative U wave during percutaneous transluminal coronary angioplasty   总被引:2,自引:0,他引:2  
To clarify the clinical significance of the negative U wave during acute myocardial ischemia, the appearance of the U wave and ST-segment elevation on electrocardiography during percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending artery (LAD group: 11 patients) or right coronary artery (RCA group: 18 patients) was studied. During PTCA, U-wave inversion (newly developed negative U wave, and increased negativity of the pre-existing negative U wave) was observed in 37 (90%) of 41 patients in the LAD group and in 16 (89%) of 18 patients in the RCA group. The incidence of ST-segment elevation was similar to that of U-wave inversion; however, U-wave inversion appeared before detectable ST-segment elevation in 20 patients (49%) in the LAD group and in 4 patients (22%) in the RCA group. Moreover, U-wave inversion was observed frequently in a wider range of leads than ST-segment elevation. These results suggest that the U wave is a more sensitive indicator of myocardial ischemia than ST-segment elevation in some patients, and that a negative U wave may be produced by a different mechanism than that which produces ST-segment deviation, although both are related to myocardial ischemia.  相似文献   

4.
A 47-year-old man presented with angina, and coronary angiograms showed a significant organic stenosis with spasm in the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty was successfully performed for the organic lesion in the left anterior descending coronary artery. Symptom of angina due to coronary artery spasm recurred, even without restenosis at the site of successful angioplasty.  相似文献   

5.
补救性经皮冠状动脉腔内成形术治疗急性心肌梗塞   总被引:11,自引:0,他引:11  
目的探讨补救性经皮冠状动脉腔内成形术(PTCA)在治疗急性心肌梗塞(AMI)中的作用。方法对溶栓治疗失败的36例患者进行补救性PTCA治疗。患者心功能Kilp分级:Ⅲ级和Ⅳ级4例,Ⅱ级和Ⅰ级32例。冠状动脉造影显示梗塞相关动脉:前降支17例,右冠状动脉14例,回旋支4例,中间动脉1例。PTCA前TIMIⅠ级和Ⅰ~Ⅱ级血流各2例,余32例均为TIMI0级。36例均进行PTCA治疗,其中13例患者置入了支架。结果术中除3例失败外,31例患者病变血管血流达到TIMIⅢ级,2例TIMIⅡⅢ级,残余狭窄≤50%,成功率为91.7%。院内并发症:1例在PTCA成功后当天因顽固性休克和心室纤颤死亡;1例于第3天死于心脏破裂,住院病死率为5.6%。14例患者在术后1~2个月内复查冠状动脉造影,2例发生再狭窄。结论AMI患者在溶栓治疗失败后,在有条件的医院可施行补救性PTCA治疗,成功率高,对改善患者的近期和远期预后可能有利  相似文献   

6.
急性心肌梗塞直接经皮冠状动脉腔内成形术   总被引:34,自引:2,他引:34  
目的观察急性心肌梗塞(AMI)患者应用直接经皮冠状动脉腔内成形术(PTCA)的安全性和有效性。方法对114例AMI患者在发病12小时内行直接PTCA术,其中有5例心原性休克的患者。梗塞相关血管(共115支血管):左主干3例(2.6%),前降支56例(48.7%),回旋支12例(104%),右冠状动脉44例(38.5%)。TIMI血流:0级82例(71.3%),1级17例(14.7%),2级16例(14.0%)。结果111例患者手术成功,TIMI血流3级(97.4%)。住院期间死亡3例(2.6%),均为心原性休克患者,其中2例经紧急冠状动脉旁路移植术后死亡。85例患者置入了冠状动脉内支架(73.9%)。随访95例患者,2例后期死于心力衰竭,9例出院后出现心肌缺血,其中8例再次行PTCA术。结论直接PTCA是治疗急性心肌梗塞的安全有效措施,成功率较高,并发症少;术后复发心肌缺血发生率较溶栓治疗低。  相似文献   

7.
BACKGROUND: Increased levels of plasma brain natriuretic peptide (BNP) are observed in patients with congestive heart failure, hypertension, left ventricular hypertrophy, and acute myocardial infarction. However, there are no data on serial changes in plasma levels of BNP in patients undergoing coronary angioplasty. HYPOTHESIS: The study was undertaken to examine plasma concentrations of BNP together with those of atrial natriuretic peptide (ANP) in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). METHODS: Plasma concentrations of BNP and ANP were examined in 13 patients with stable angina pectoris and good left ventricular function undergoing PTCA. Blood samples were taken from the femoral vein at baseline, after the first balloon inflation, after the end of the procedure, and 4 h thereafter. RESULTS: Plasma BNP levels were 14 +/- 4 at baseline, 22 +/- 10 after the first balloon inflation, 28 +/- 12 at the end of the procedure, and 15 +/- 4 pgr/ml 4 h thereafter (F = 13.05, p < 0.00001). Plasma ANP levels were 80 +/- 15, 86 +/- 14, 90 +/- 24, and 75 +/- 6 fmol/l (F = 5.95, p = 0.002), respectively. The increase of BNP at the end of the procedure was related to the increase of ANP (r = 0.78, p = 0.002). CONCLUSION: Plasma BNP levels increase acutely and much more prominently than those of plasma ANP during coronary angioplasty; however, plasma BNP levels return to baseline values shortly after the end of the procedure.  相似文献   

8.
Substantial evidence of postangioplasty vasoconstriction is available, both at the dilated site and distal to balloon injury, demonstrating its frequent occurrence. It is likely that even mild or moderate vasoconstriction at the site of balloon injury may create flow turbulence, promoting platelet aggregation and contributing to thrombotic vessel closure. The regulation of arterial smooth muscle tone is a complex process and should be distinguished from elastic recoil, which occurs at the site of balloon injury due to passive elastic properties of the artery, generally immediately after balloon deflation. The contribution of a variety of messengers generated by humoral, neurogenic, myogenic, and endothelium-derived factors in this regulatory process has been implicated. The possible mechanisms of post-percutaneous transluminal coronary angioplasty vasoconstriction at the dilated site (local) and in segments of coronary artery beyond the dilated site (distal) are reviewed in this article.  相似文献   

9.
Exercise stress testing is often performed following percutaneous transluminal coronary angioplasty (PTCA) in order to evaluate the efficacy of the procedure [1]. Together with thallium-201 (T1-201) scintigraphy, these noninvasive tests provide valuable data for predicting the recurrence of angina and restenosis [2]. However, concerns regarding the safe timing of exercise testing post-PTCA have been raised in 3 previous case reports [3–5]. Each case documents acute coronary occlusion shortly after stress testing performed within several days of successful angioplasty, leading to the recommendation that such testing be deferred up to 4 weeks following PTCA. This paper reports a patient in whom acute thrombotic occlusion of the left anterior descending coronary artery (LAD) occurred immediately after a mildly abnormal exercise T1-201 stress test done 6 weeks after PTCA.  相似文献   

10.
Percutaneous transluminal coronary angioplasty (PTCA) was performed with initial success in 7 patients with variant angina and significant (greater than 60%) coronary stenosis. The mean degree of stenosis was reduced from 77 +/- 12% to 29 +/- 15% and the mean systolic pressure gradient from 78 +/- 18 to 25 +/- 9 mmHg. Apart from a reversible spasm in one patient, PTCA was free of acute complications. Despite long-term treatment with nifedipine, nitrates, and warfarin (patients 1 to 5) or aspirin (patients 6 and 7) restenoses occurred in 4 of 7 patients. An aortocoronary bypass was necessary in 2 patients, 3 respectively 6 weeks after PTCA because of tighter restenoses than before PTCA. Another patient underwent successful repeat angioplasty after 6 weeks and remained improved. During a mean follow-up observation of 21 months (6 to 30 months), 4 patients were asymptomatic, even without medication. In one of these patients, the follow-up angiography (6 months after PTCA) demonstrated a restenosis. These results suggest that PTCA demonstrated a restenosis. These results suggest that PTCA can be performed without a higher risk of acute complications in patients with variant angina. Although the recurrence rate is high in these patients, sustained clinical improvement was achieved in a substantial percentage of patients in our study.  相似文献   

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