Acute Inferior Wall Myocardial Infarction/ Heart attack treated with PTCA+Stenting to RCA.
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The importance of time is paramount in a case of acute Myocardial infarction/ heart attack.
A patient diagnosed with heart attack needs to be an antiplatelets/ anticoagulants and other supportive measures. If it is a case of STEMI and the patient is in the window period – then the patient has two options – thrombolysis / PTCA. PTCA being the better one. After the window period, especially after 12 hours, PTCA is probably the only intervention with a definite benefit.
This is an educative post citing an example.
Patient presented to us within a period of 18 hours from onset of chest pain. It was an acute STEMI, however the benefit of thrombolysis seemed doubtful. Patient had unstable hemodynamics – with hypotension (low BP) with arrhythmias.
Patient underwent routine test that confirmed MI. Followed by echo on the way to the cath lab.
In cath lab, 100% occluded RCA was seen.
The RCA was tortuous having an almost 70 degree bend to the upperside just before the mid segment, the lesion was beyond this segment, which would make the stent delivery difficult due to the anatomy, due to less support and increased anatomical resistance.
We tried with the workhorse wire initially and took a balloon support for the same, however, it was unsuccessful.
Whisper ES was taken, and lesion was crossed followed by rotaring of balloon OTW.
Cangrelor was used due to high thrombus burden.
Whisper ES was exchanged for a workhorse wire.
Direct stenting was done, followed by adequate post dilatation.
This achieved a good TIMI III flow and alleviation of symptoms.
It is very important to give a loading dose of ticagrelor 180 mg before undergoing any PTCA. If prasugrel is to be given then the loading dose (60mg) is to be given only after knowing coronary anatomy i.e. after Coronary Angiography only.
If the patient does not have any adverse bleeding risks – it is better if the patient stays on DAPT preferably with Ticagrelor and Aspirin for 1 year and minimum of 6 months post DES (Drug eluding stent) implantation.
At Agra Heart Center, patient undergoes 2D echo before and after 45 days of DES implantation (stenting) or before, as indicated.
Agra heart center, specializes and is the only dedicated cardiac center with record of CRT-D implantation in Agra.
For appointment,
Call on 7830000618.
Second opinion clinic – every Sunday – 11am to 1 pm.
Cardiologists-
Dr. Rajat Rawat / Dr. C. R. Rawat
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