Abdomen: remarkably normal No clinical sign of thyroid dysfunction - PDF document

A patient waiting for gastric surgery (gastric carcinoma), suffering ACS with RCA and LM stenosis requiring urgent cardiac treatment Case # 2 proposed by Dr Vojko Kanic, Maribor, Slovenia Hexacath Case in Point Session EuroPCR 2016 Room 351 – Thursday 19 th - 12:30-14:00 Clinical Presentation: A 79-year-old lady was admitted with a clinical presentation of ACS: – progressive worsening of the shortness of breath on exertion for the last month – Since 5 days, several typical short episodes of angina and dyspnea going upstairs and at the rest – This morning, the angina occurred in the rest and disappeared completely after nitroglycerine administration at first medical contact. No cognitive dysfunction clears answers to questioning, widow, normal life style in a family house. Previous medical history 2006, 2007 knee replacement, Since 5 years: COPD with multiple deteriorations, still smoker 5-10 cigarettes/day. Since 2 month ago: dyspepsia, positive occult blood in a stool, something wrong on gastroscopy (14 days ago) and hiatal hernia. Surgeon: “you need gastric surgery in a near future” Current treatment  Zaldiar (tramadol/paracetamol)  Seretide (butikazonpropionat 250µg/ salmeterol 50 µg inhaler bid) Clinical examination at admission:  162cm x 78 kg, mild shortness of breath  BP: 118/81 mmHg  Temperature = 36.5ºC.  SpO2 =95% without oxygen  Heart sound regulars, 100 bpm, normal  No pain during thorax palpation  Lungs: basal pulmonary rales  All distal arterial pulses normal Minimal leg edema  No carotid murmur, no femoral murmur 1

 Abdomen: remarkably normal  No clinical sign of thyroid dysfunction ECG: sinus rhythm, 70 bpm, ST depression in V3-V6, aVL, negative T waves in II, III. Key biological markers: Hb = 105 g/L Creatinine =98 μmol/L Troponin = 6.01μg/L (UN L=0.045 μg/L), CRP = 121 mg/L (UNL <5) Echo : EF = 45%, inferior hypokinesia. Chest X-ray: minimal pulmonary congestion, no sign for pneumonia. Clinical impression : ACS- NSTEMI, pulmonary infection, COPD Treatment:  Enoxaparin +ASA: 300 mg+Clopidogrel 75 mg,  Pantoprasol 40 mg,  Glyceryl nitrate  Amoxicillin  Furosemide Patient was stable Inform consent: invasive coronary angiogram planed for the next day. Information about gastric pathology: “gastric carcinoma in fundus, early surgery is required”! Next morning angina reoccurred at rest, did not disappear after NTG and dyspnea worsened. 2

Discussion Point 1 What stent for this particular patient? Discussion Point 2 What management strategy? How long would you postpone gastric operation? Come & discuss this clinical case during the Case in Point Session at EuroPCR 2016 Room 351 Thursday 19 th 12:30-14:00 3

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