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1、Case Report,Shengjing Hospital of China Medical University Wenyue Pang,Patient name: PanXX, Men, 64 years old Was hospitalized with the chief complaint “remittent chest pain for 5 years with attenuation for 1 week”. Past history: hypertension for 7 years. Smoke 20 cigarettes per day for 30 years. Ph
2、ysical examination: BP150/95mmHg，the cardiac boarder enlarged to the left and lower. HR 72 bpm, without cardiac murmur.,Clinic Data,Clinic Data,ECG：Leads V1-V5 ST segments depressed for 0.05mV； PDE：LV=57.4mm；EF=61%； Clinical diagnosis: 1. ACS 2. Hypertension grade 3.,Coronary Angiography,Coronary An
3、giography,Coronary Angiography,Coronary Angiography,In the preparation of right coronary angiography, before angiographic catheter reached the orifice of the right coronary artery, the patient became:BP depression, from 135/85 mmHg to 80/40 mmHg in 30 seconds. No obvious changes of HR No obvious cha
4、nges was observed in the leads of electrocardiography (ECG) monitoring. The patient said chest skin itch, without chest pain.,Our consideration,Pressure monitoring pathway leakage? contrast media hypersensitivity？ Vagal reflex? Occlusion of left main coronary artery？,The patients HR dropped to 35 bp
5、m. Chest pain onset Consideration: acute left major occlusion,Management,XB3.5 Catheter was emergently sent in, approving the 100% occlusion of LM body part. Regret: no video made,Which first?,IABP /Temporary cardiac pacing, then PCI First PCI, then First Drug, then Other,3.5*18mm Cypher,IABP, 3.0*13 Cypher,PCI治疗四:LCX,右冠造影,Follow up results （14 months）,Ophthalmalgia when movement Diagnosis: angina pectoris Management: angiography,How to manage?,PCI CABG Drug Other,Follow up(24 m),Coronary CT : normal,Thanks,