2. This 32 year- old male doctor, currently smoking, presented with
nonspecific chest discomfort for 5 hours with one episode of
fainting attack while he was on duty in the same hospital. He has
no other risk factors. ECG shows mild ST segment elevation in
V1-V3 Leads.
Bedside echocardiogram shows severe hypokinesia in anterior
wall with LVEF-40%.
Patient was immediately brought to the Cathlab with an aim to do
primary PCI.
3. LAD is occluded after a huge diagonal.
There is a big thrombus looking towards the ostium of
a big diagonal branch.
Looking back to RCA, it seems some retrograde filling
to the LAD.
So what happened there?
Is it a CTO?
Or acute on CTO?
Should we proceed to do primary PCI now?
Or thrombolyse and let’s see later?
4. We discussed with the heart team.
The team suggested to deffer primary PCI and do
thrombolysis.
Patient was shifted back to CCU and thrombolysed
uneventfully, keeping the vascular access sheaths in
place.
In the next morning –we took the patient to the
Cathlab again.
5. TAKE HOME MESSAGE-
Primary PCI is the treatment of choice of STEMI in a PCI
capable center but not for every case.
Every patient is unique and coronary anatomy and
pathophysiological characteristics determine the
pathway of therapy.
