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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 ♂
Stable angina pectoris, CCS II
• Angina for last 6 month
• No smoking
• No hypertension
• No diabetes
• Mother died 64 because MI
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Medical treatment:
– ASA 75 mg
– Clopidogrel 75 mg
– Ramipril 2,5 mg
– Metoprolol succinate 25 mg
– Atorvastatin 20 mg
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• 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 ♂
Stable angina pectoris, CCS II
• 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 ♂
Stable angina pectoris, CCS II
• 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 ♂
Stable angina pectoris, CCS II
• ECG:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• 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 ♂
Stable angina pectoris, CCS II
• Angiography:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Angiography:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Angiography:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Angiography:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• EuroSCORE: 5
• SYNTAX SCORE: 33
COMPLEX LAD LESION WITH STABLE ANGINA
CASE OUTCOME
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI LAD/DIA1:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI LAD/DIA1:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI LAD/DIA1:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI LAD/DIA1:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI LAD/DIA1:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI LAD/DIA1:
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Medical treatment post PCI:
– ASA 75 mg
– Clopidogrel 75 mg
– Ramipril 5 mg
– Metoprolol succinate 50 mg
– Atorvastatin 40 mg
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• 5 month later
– Reoccurence of Angina CCS 2/3
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Angiography(5 month):
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• Angiography(5 month):
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI(5 month):
CASE: 80 yo ♂
Stable angina pectoris, CCS II
• PCI(5 month):
THANKS FOR YOR ATTENTION