RESUMO
A 75-year-old female complained of severe chest pain and was emergently admitted to our hospital because of anterior acute myocardial infarction. Emergent coronary angiography was performed and revealed occlusion in segment 7, so a stent was implanted. Lidocaine, carvedilol, amiodarone, magnesium, and nifekalant were administered successively because non-sustained ventricular tachycardia (NSVT) frequently appeared like an electrical storm. After nifekalant administration, QTc was significantly prolonged and torsades de pointes was induced. Overdrive pacing was performed and finally the NSVT was completely controlled. If fatal arrhythmias such as NSVT show resistance to medication, overdrive pacing should be considered to stabilize the arrhythmia associated with acute coronary syndrome.
Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/terapia , Estimulação Cardíaca Artificial/métodos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Idoso , Antiarrítmicos/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Pirimidinonas/uso terapêutico , Stents , Resultado do TratamentoRESUMO
A 68-year-old man taking aspirin and warfarin for ectatic right coronary artery complained of chest pain and was admitted to our hospital with acute myocardial infarction. He had discontinued taking warfarin due to nail bleeding for a month. Coronary angiography revealed total occlusion at segment 3 of the ectatic right coronary artery with massive thrombus. Because of unsuccessful reperfusion by an aspiration device, a 5F straight catheter was inserted into the ectatic right coronary artery to aspirate the massive thrombus, and Thrombolysis in Myocardial Infarction grade 3 flow reperfusion was obtained. Intravascular ultrasonography showed "moyamoya" vessels in the ectatic right coronary artery, suggesting an abnormal coronary flow pattern, but there was no evidence of unstable plaque. Warfarization should be considered to treat ectatic coronary artery.
Assuntos
Anticoagulantes , Trombose Coronária/etiologia , Vasos Coronários/patologia , Varfarina , Idoso , Angioplastia Coronária com Balão , Anticoagulantes/uso terapêutico , Angiografia Coronária , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/cirurgia , Dilatação Patológica , Heparina/uso terapêutico , Humanos , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Trombectomia , Varfarina/uso terapêuticoRESUMO
A 60-year-old man complained of severe chest pain and was emergently admitted to our hospital with a dignosis of anterior acute myocardial infarction. Emergent coronary angiography revealed significant stenosis in segment 7 and filling defect in segment 11 without flow delay. Haziness was observed in segment 5. Coronary thromboembolism was suspected, but the embolic source or culprit lesion was hard to detect. Intravascular ultrasonography detected ruptured plaque with lipid pooling in segment 5. Stent implantation for segment 5 was performed successfully and the patient had an excellent clinical course. Coronary thromboembolism is rare and intravascular ultrasonography may be useful to detect the culprit lesion.