از دکتر بپرسید
اسپاسم - پرسش ۴۴۳۲
دکتر سعید یزدانخواه یکشنبه ۲۶ مرداد ۹۹( ۳ سال پیش) دکتر سعید یزدانخواه یکشنبه ۲۶ مرداد ۹۹( ۳ سال پیش)
coronary Investigation
Surveys / treatments:
MRI heart:
۲۰۲۰-۰۸-۱۳: Normal-sized left ventricle (LVEDVI) with ordinary wall thickness and ordinary global systolic function (LVEF) without regionality. Increased signal of edema sequence apical anteroseptal (may be an expression of acute inflammation / myocardial involvement), however, no contrast uptake in this area or in the rest of the ventricular myocardium is seen as a sign of myocardial damage by ischemic or non-ischemic genesis. Visually assessed normal-sized right ventricle with normal systolic function.
Care Progress:
The patient is transferred from ViN to us for angiography with SCAD as the issue. Angion shows no signs of dissection but shows signs of vasospasm in RCA, especially in RPD. Based on the patient's pain history, the undersigned orders a diff-diagnostic DT aorta that does not detect any aortic dissection. The patient is examined with an MRI heart to determine any ischemic injury. Answer as above. Printed after receiving information about spasmangina during telephone interpreting and inserted on Glytrin.
Assessment:
Thus 25-year-old patient who arrives from Norrköping after a sudden onset of burning chest pain with radiation to first left, then right arm and pain between the shoulder blades. Ambulance ECG as well as troponin series suggest coronary ischemia. No DT aorta performed. Coming to US for angiography with question SCAD. Turns out to be coronary angiospasm. DT aorta is normal and MRI heart shows increased signal on edema sequence apical anteroseptal, which agrees well with the localization of vasospasm on the angiography. The patient is thus admitted to Glytrin in case of recurrence, receives information and is written home. The patient is informed to avoid active and passive smoking as this is a known risk factor for spasmangina.
Drugs Note:
Drug Story:
Has been loaded on Trombyl and Clopidogrel on ViN despite SCAD suspicion. Exposes these medications.
Planning:
- Follow-up via ViN. - NOTE! Beta-blocking is directly inappropriate for this patient. - The addition of calcium channel blockers can be considered as prophylaxis if the patient has recurrent episodes of centrally located chest pain.
Length of stay:
۲۰۲۰-۰۸-۱۲ - ۲۰۲۰-۰۸-۱۳
Diagnosis:
I214-NSTEMI, type 2-Main diagnosis
AF037-Coronary angiography-Action
AF018-Computed tomography, aortic surgery
AF045-Magnetic Resonance Imaging, Cardiac Surgery
I201-Angina pectoris with documented coronary artery spasm Bidiagnosis
J459-Asthma, unspecified-Bidiagnosis
E039-Hypothyroidism, unspecified-Bidiagnosis
F329-Depressive Disorders-Bidiagnosis
ZV020-Using Interpreter-Action
XV015-Drug Review, Simple-Action
XV017-Drug 'Report-Action
Surveys / treatments:
MRI heart:
۲۰۲۰-۰۸-۱۳: Normal-sized left ventricle (LVEDVI) with ordinary wall thickness and ordinary global systolic function (LVEF) without regionality. Increased signal of edema sequence apical anteroseptal (may be an expression of acute inflammation / myocardial involvement), however, no contrast uptake in this area or in the rest of the ventricular myocardium is seen as a sign of myocardial damage by ischemic or non-ischemic genesis. Visually assessed normal-sized right ventricle with normal systolic function.
Care Progress:
The patient is transferred from ViN to us for angiography with SCAD as the issue. Angion shows no signs of dissection but shows signs of vasospasm in RCA, especially in RPD. Based on the patient's pain history, the undersigned orders a diff-diagnostic DT aorta that does not detect any aortic dissection. The patient is examined with an MRI heart to determine any ischemic injury. Answer as above. Printed after receiving information about spasmangina during telephone interpreting and inserted on Glytrin.
Assessment:
Thus 25-year-old patient who arrives from Norrköping after a sudden onset of burning chest pain with radiation to first left, then right arm and pain between the shoulder blades. Ambulance ECG as well as troponin series suggest coronary ischemia. No DT aorta performed. Coming to US for angiography with question SCAD. Turns out to be coronary angiospasm. DT aorta is normal and MRI heart shows increased signal on edema sequence apical anteroseptal, which agrees well with the localization of vasospasm on the angiography. The patient is thus admitted to Glytrin in case of recurrence, receives information and is written home. The patient is informed to avoid active and passive smoking as this is a known risk factor for spasmangina.
Drugs Note:
Drug Story:
Has been loaded on Trombyl and Clopidogrel on ViN despite SCAD suspicion. Exposes these medications.
Planning:
- Follow-up via ViN. - NOTE! Beta-blocking is directly inappropriate for this patient. - The addition of calcium channel blockers can be considered as prophylaxis if the patient has recurrent episodes of centrally located chest pain.
Length of stay:
۲۰۲۰-۰۸-۱۲ - ۲۰۲۰-۰۸-۱۳
Diagnosis:
I214-NSTEMI, type 2-Main diagnosis
AF037-Coronary angiography-Action
AF018-Computed tomography, aortic surgery
AF045-Magnetic Resonance Imaging, Cardiac Surgery
I201-Angina pectoris with documented coronary artery spasm Bidiagnosis
J459-Asthma, unspecified-Bidiagnosis
E039-Hypothyroidism, unspecified-Bidiagnosis
F329-Depressive Disorders-Bidiagnosis
ZV020-Using Interpreter-Action
XV015-Drug Review, Simple-Action
XV017-Drug 'Report-Action
۲۵-year-old patient who is admitted to ViN 200811 due to the onset of burning chest pain with radiation to the back and radiation first to the left arm and then to the right arm. At the same time pale and cold sweaty. The pain lasted for 20-25 minutes and subsided spontaneously. According to ant from ViN 200811, ST elevations are seen on the ambulance ECG, but the ECG in the emergency room is then completely normal. Completely normal eco. TnT 7-123-85, thus great suspicion of ischemic coronary event. Admitted to the heart department in ViN. Develops another episode of chest pain during the morning of 200812 that releases spontaneously. Comes to us for angio due to suspicion of SCAD. According to oral information, no completely certain signs of coronary artery dissection (SCAD) can be seen on angio that could explain the TnT release, whereas signs of coronary spasm are seen. Given pat pain localization and TnT release, pat is also referred for DT aorta that does not show signs of aortic dissection. Overall, her condition is assessed as spasmangina. Grateful for investigation for mapping of possible ischemic damage as part of the investigation.
issue: Signs of ischemic injury?
From Schäfer, Samuel, Answer recipient, 2020-08-12
Definitive answer - Clinical physiology
Opinion: ۲۰۲۰-۰۸-۱۳ ۱۱:۲۸ MRT HEART STANDARD
(Length 164 cm, weight 60 kg, BSA 1.65 m²)
LEFT CHAMBER:
Calculated left ventricular values (women 20-39 years, 95% CI according to Maceira):
LVEDV: 105 ml, ( 99-175)
LVEDVI: 63 ml / m², (۶۵-۹۶)
LVESV: 30 ml, (29-64)
LVSV: 74 ml, (63-117)
LVEF: 71%, (56-75)
Basal diameter in 4Kammar view : 44 mm. Normal wall thickness. Normal wall mobility in all segments.
RIGHT CHAMBER:
Basal diameter in 4K chamber view: 36 mm. Normal wall mobility in the free right ventricular wall, TAPSE 19 mm.
ATTRACTION: Left atrial surface 13 cm², right 12 cm².
FLOW (with phase contrast sequence):
Aorta: Forward volume flow 68 ml, reverse flow <2 ml, regurgitation fraction <2%, SV 68 ml, CO 5.8 l / min. Frequency 85 / min.
TISSUE CHARACTERISTICS:
With edema-sensitive sequence, increased signal is seen in the left ventricle apically anteroseptally.
In case of late imaging after contrast injection, no surely increased signal is seen.
Myocardial native T1 shows normal relaxation time, 1430 ms midventricular septal (ref. 900-1050 ms).
Myocardial extracellular volume (ECV) in the upper normal range is 31% midventricular septal (ref 20-30%).
ASSESSMENT:
Normal-sized left ventricle (LVEDVI) with ordinary wall thickness and ordinary global systolic function (LVEF) without regionality.
Increased signal of edema sequence apical anteroseptal (may be an expression of acute inflammation / myocardial involvement), however, no contrast uptake in this area or in the rest of the ventricular myocardium is seen as a sign of myocardial damage by ischemic or non-ischemic genesis. Visually assessed normal-sized right ventricle with normal systolic function. دکتر سعید یزدانخواه دوشنبه ۲۷ مرداد ۹۹( ۳ سال پیش)
الهی خیر ببینید که جواب مردمو از راه اینقد دور میدید
بحق ابروی حضرت زهرا همیشه سلامت باشید دکتر سعید یزدانخواه دوشنبه ۲۷ مرداد ۹۹( ۳ سال پیش)