RESUMO
HISTORY AND ADMISSION FINDINGS: A 76-year old woman presented with a medically refractory chronic pain syndrome of her feet. The patient had a known stable peripheral arterial occlusive disease (PAOD, stage II according to Fontaine Classification). Walk and vessel training according to guidelines did not significantly improve her symptoms. The patient had a one-vessel coronary artery disease with previous myocardial infarction and intervention in the LAD in 2004. Due to the progression of the disease subsequent operative myocardial revascularization in a minimal-invasive LIMA-to-LAD followed 6 years earlier. Since that time, the patient reported an increasingly decrease in exercise capacity and dyspnea at low level of physical stress. CLINICAL INVESTIGATIONS: The patient was in a good general condition. The status after the operative myocardial revascularization showed no evidence for the progression of coronary heart disease. However, the electrocardiographic findings were currently impaired compared to preoperative findings. The left ventricular ejection function was severly restricted with diffuse hypokinesia of all segements of the left ventricle and enlargement of all cardiac chambers. A paradoxical septal motion emerged after surgery. Doppler and color Doppler examinations showed a mitral valve insufficiency I and tricuspid valve insufficiency I. TREATMENT AND COURSE: The medical treatment was intensified by additional treatment with torsemide 10 mg 2 × 1. The given diagnostic findings indicate the implantation of a defibrillator for primary prevention of sudden and arrhytmogenic cardiac death. Furthermore, a spinal cord stimulation (SCS) had a positive influence. Subsequently, a neurostimulator was successfully placed. No interaction could be detected after implantation or follow-up examinations after month 1 and 4. CONCLUSION: A therapeutic combination of an ICD and a neurostimulator to reduce pain is possible. Interferences may arise during the later follow-up.
