Ho Chi Minh City Mr. Man, 59 years old, was working on a construction scaffold when he had pain in his left chest and difficulty breathing. He was taken to the emergency room by his colleagues and was diagnosed with acute myocardial infarction.
The patient received first aid at a hospital in Binh Duong, then transferred to Tam Anh Hospital in Ho Chi Minh City.
On November 25, Dr. Phan Tuan Trong, Emergency Department, Tam Anh General Hospital, Ho Chi Minh City, said that the patient was admitted to the hospital with severe chest pain and difficulty breathing. The electrocardiogram (ECG) results showed that the patient had an acute ST-elevation myocardial infarction (the most severe acute coronary syndrome) in the 4th hour, in critical condition. The patient had diabetes, high blood pressure, and had been a long-time smoker.
Immediately, the patient's heart blood vessels were revascularized. Dr. Huynh Ngoc Long, Dr. Vo Anh Minh and the team at the Cardiovascular Center performed coronary angiography with the support of the digital subtraction angiography (DSA) system, and the robotic arm rotated 360 degrees. The results showed that a blood clot completely blocked the right coronary artery for a segment longer than 30 mm. The entire process of coronary angiography and threading a guidewire through the completely blocked right coronary artery to restore blood flow to the heart took 10 minutes.
Dr. Minh said that in this case, the team did not dilate the balloon before and after placing the stent to reduce the risk of thrombus dislodging, causing blockage of distant blood vessels. Instead, the doctors used the Direct Stenting technique to place the stent after aspirating the blood clot in the vessel. Thanks to the intravascular ultrasound system (IVUS), the doctor assessed the condition of stenosis, atherosclerosis and accurately measured the diameter of the blood vessel to place the maximum sized stent, close to the blood vessel wall, preventing restenosis.
According to Dr. Minh, the process from receiving the patient at the emergency room to inserting the guidewire to clear the blockage (door to wire) takes 29 minutes, 50% shorter than the time recommended by the World Heart Association (70 minutes).
Doctors place stents to re-open a patient's heart vessels. Photo: Tam Anh Hospital
Dr. Minh said that acute myocardial infarction requires rapid diagnosis and treatment. Cases of right coronary artery occlusion like that of patient Man, if not treated promptly, will result in ventricular arrhythmia, bradycardia, and cardiac arrest during the procedure.
After the intervention, the patient no longer had chest pain or difficulty breathing and was discharged after 5 days of follow-up.
Tue Tram
* Patient name has been changed
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