【翻译】威胁生命的冠状动脉狭窄（新英格兰医学杂志系列025）

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【翻译】威胁生命的冠状动脉狭窄（新英格兰医学杂志系列025） [精华]

约瑟福

医博园版主

发贴: 3844
积分: 442

得票: 2

状态: 离线

2008-02-01 08:41

A Life-Threatening Coronary-Artery Stenosis

A 74-year-old man presented with a one-week history of exertional angina and dizziness. Treadmill testing showed deep, prolonged depression of the ST segment and hypotension at a low level of exercise. During urgent cardiac catheterization, the 6-French diagnostic catheter recorded severe pressure damping during cannulation of the ostium of the left coronary artery. A single anteroposterior angiogram was quickly obtained before the catheter was removed. The angiogram showed severe stenosis of the left main coronary artery (arrow) and a total absence of contrast reflux despite forceful injection by hand. Since the left coronary artery was dominant and provided a preponderance of the arterial blood supply, sudden occlusion could cause potentially lethal left ventricular ischemia. A small, nondominant right coronary artery was open. Resting left ventricular function was normal. Myocardial ischemia developed and was stabilized with intraaortic balloon counterpulsation. The patient subsequently underwent coronary bypass surgery, in which the internal thoracic artery was anastomosed to the left anterior descending artery and separate saphenous-vein grafts were placed in three marginal vessels. The patient had a full recovery. A follow-up treadmill test showed no evidence of ischemia.

• 【资源】景岳理集杂证谟

约瑟福

医博园版主

发贴: 3844
积分: 442

得票: 2

状态: 离线

2008-02-01 08:43

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