Supervisor :Dr TARIQ ALMOFLEHI

prepared by: Dr A.AZiZ Aonallah

Case Presentation

8/5/2014

Personal Information

Name : Abdulkareem Mohammed Hassen

Age : 65 years old

Residence: Sana’a

Martial status: Married & has 8 offspring

Occupation: solider

Special habits :Irregular Qat chewing

Date of admission :23th march 2013

Source of History The patient himself

Chief Complain

Chest pain for three hours

The Condition of pt started two days PTA

as recurrent chest discomfort

lasted for about 15 min. increased by exertion

relived by rest

Three hours before admission the pateint developed in-tense continuous chest pain

Sudden onsetRetrosternal Radiated to his lt. shoulderHeaviness in nature Associated with sweating

No history of shortness of breath , palpitation nor synco-

pal attack. Also no fever nor LL edema.

Review Of Other Systems

Respiratory: NAD

Abdomen : NAD

Renal :NAD

Endocrine: NAD

CNS: NAD

Hematology: NAD

Past History

Medical Hx.: No Hx. Of DM, HTN

Surgical Hx. :None

Drug Hx. : None

Family History

No Hx. Of DM, HTN

No Hx. Of CAD

On Examination

pt was conscious, oriented and coopera-tivethere was no jaundice no cyanosis nor pallor.

JVP is not rised, no lymph node enlarge-ment

No lower limb edema

Vi-tal signs • BP= 150/110 mmhg• PR=76 b/m• T=37.3 c• RR=16 c/m

Ex-amination

Heart= S1+S2+0Chest=ClearAbdomen= Soft, no organomegly

ECG

ECG

• ST segment elevation from V1 to V4 and in I &

AVL.• T inverted in lead III ,AVF

and V6

Lab Investigations:CBC: WBC=14.17Hb=17 g/dlPLT=219CK-MB= 33Serum creatinine= 0.9 mg/dlSerum K=3.9

• The case was diagnosed as

Antero septo lateral Myocardial Infarction

Initial Manage-ment in ER:

• General :Complete bed rest. Inform CCU doctor Close monitoringMorphine 3 mg +plasil IV STATO2 inhalationAspirin 100 mg 3 tab chewable Plavix 75 mg 4 tab STAT Cardiology consultation (Dr Fikri ,Dr Abdulmalek and The visitor Saudian

team)

The decision was to prepare the patient for

PRIMARY PCI

Within 35 minutes the patient was ready

in CATH LAB

FROM CATH LAB

After discussion the decision was to send the patient for

thrombolytic then control CAG

and surgical consultation.

The patient shifted to CCU and received

Actylase 15 mg IV bolusthen 50 mg IVI over 30 minutes

then 35 mg IVI over 1 hour.

• Stabilization in CCU.• cardio surgical consultation done by Dr Yahia Rajeh with advice to

transfer the patient to the surgical ward and to prepare him for CABG next week.

• During admission in surgical ward the patient refuse CABG .

• Consultation by Dr Tariq done with advice to prepare the patient for PCI to LM and total LAD.

• Reevaluation and preparation by Dr Tariq,• confirm the date of Intervention

2/4/2014

One day before the intervention every thing was ready (patient fit ,

cardio-surgical pack up and OT with (6 units of plasma,6 units of PLT and 6 units of blood AB nega-tive) for possible complication ,

Next day the patient sent to CATH LAB with high risk consent

for

PCI to LM and total ostial LADfor first time in YEMEN

FROM CATH LAB

ECG post PCI

Observation in CCU post PCI

Patient shifted to the ward for observation and follow up

Then the patient discharged with good general condition

by Dr Areej

Thank you