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CaseReport病例报告,ShengjingHospitalofChinaMedicalUniversity中国医科大学附属盛京医院WenyuePang庞文跃,Patientname:PanXX,Sex:Male,Age:64years患者潘XX，男，64Washospitalizedwiththechiefcomplaint“remittentchestpainfor5yearswithattenuationfor1week”.因“间断胸痛5年，加重1周”为主诉入院,ClinicData临床资料,ClinicData临床资料,Pasthistory:hypertensionfor7years.Smoke20cigarettesperdayfor30years.既往有高血压病史7年。吸烟20支/天30年Physicalexamination:BP150/95mmHg，thecardiacboarderenlargedtotheleftandlower.HR72bpm,withoutcardiacmurmur.体检：BP150/95mmHg，心界左下扩大，HR72次/分，无杂音,ClinicData临床资料,ECG：LeadsV1-V5STsegmentsdepressedfor0.05mVECG：V1-V5导联ST段下移0.05mV；PDE：LV=57.4mm；EF=61%,ClinicData临床资料,CoronaryarteryCT：Leftmajor-leftanteriordescending(LAD)branchproximalandmedialsegmentsseverestenosis;leftcircumflex(LCX)proximalsegmentmoderatestenosis.冠脉CT：左主干-前降支近中段重度狭窄；旋支近段中度狭窄。,ClinicData临床资料,临床诊断：1.冠心病：不稳定心绞痛2.高血压病3级Clinicaldiagnosis:1.coronaryheartdisease:unstableanginapectoris2.Hypertension,CoronaryAngiography影像,CoronaryAngiography影像,CoronaryAngiography影像,CoronaryAngiography,Inthepreparationofrightcoronaryangiography,beforeangiographiccatheterreachedtheorificeoftherightcoronaryartery,BPdepression,from135/85mmHgto80/40mmHgin30seconds.准备右冠造影过程中，造影导管未到达右冠开口时，患者血压下降，30秒内由135/85下降到80/40,NoobviouschangesofHR心率无明显减慢Noobviouschangeswasobservedintheleadsofelectrocardiography(ECG)monitoring.心电监测导联未见明显变化。Thepatientsaidchestskinitch,withoutchestpain.患者自述胸前皮肤搔痒，无胸痛,Whathappened?发生什么了？,Pressuremonitoringpathwayleakage?压力监测通道漏气？contrastmediahypersensitivity？造影剂过敏？Vagalreflex?迷走反射？Occlusionofleftcoronaryartery？左冠闭塞？,ThepatientsHRdroppedto35bpm患者心率下降至35次/分Chestpainonset开始出现胸痛,acuteleftmajorocclusion！急性左主干闭塞！,Whichfirst?首先做什么？,IABP/Temporarycardiacpacing,thenPCIIABP/临时起搏器，然后PCIPCI首先PCIDrug药物抢救Other其他,Management处理,XB3.5GCCatheterwasemergentlysentin,approvingthe100%occlusionofleftmajor(LM)bodypart.紧急予XB3.5GC导管送入，证实左主干体部100%闭塞遗憾：没有留下影像Regret:novideomade,GC:XB3.5GW:BMWSTENT:3.5*18mmCypher,IABP3.0*13Cypher,
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