A 57-year-old male with heart failure due to acute coronary syndrome consulted our
outpatient and admitted emergently. Three days before the admission, he had been aware
of chest pain and dyspnea, and at the admission, the electrocardiogram revealed ST-elevation
at the precordial leads of V1–3. Emergent CAG was performed and it showed 3 vessels
disease including total occlusion of proximal LAD and obtuse marginal branch, a 90%
stenosis of mid LCx and diffuse distal RCA lesions. PCI was carried out to the proximal
LAD and obtuse marginal branch, but the guide wire did not pass easily. The operator
could not identify the real culprit lesion and stopped the procedure. Then IABP and
Swan-Gantz catheter was employed. The HF was managed with furosemide and dobutamine.
On the day 4, PCI for LCA was tried again. In this time, obtuse marginal branch was
spontaneously re-canalized, and we realized it was the real culprit. We successfully
performed PCI for LCx and also tried PCI for the CTO lesion of proximal LAD to stabilize
his hemodynamics. Although the procedure was successfully performed, refractory Torsades
de Pointes (TdP) occurred. Because medical treatment failed, PCI for RCA distal lesions
was performed on the day 18. After the third procedure, the arrhythmia disappeared
and the hemodynamics stabilized completely.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiac FailureAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
