Interdisciplinary Approach in a Complex Case of STEMI
Cristian A Udroiu1, Alexandru Cotoban1, Adrian Ursulescu2
1Department of Cardiology, Emergency University Hospital, Bucharest, Romania.
Insights
This case study highlights a complex STEMI patient who recovered with interdisciplinary care. Advanced cardiac surgery significantly improved his quality of life and long-term prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- A 43-year-old male presented with inferior ST-Segment Elevation Myocardial Infarction (STEMI) complicated by ventricular fibrillation and cardiogenic shock.
- Initial coronary angiography revealed chronic total occlusion of the left anterior descending artery (LAD) and severe stenosis with thrombus in the right coronary artery (RCA).
Observation:
- The patient underwent successful thrombus aspiration and stenting of the RCA, but the LAD remained occluded.
- Despite initial complications, including the need for an intra-aortic balloon pump and failed attempts to open the LAD, the patient was discharged with significant functional limitations.
Findings:
- The patient later required an implantable cardioverter-defibrillator (ICD) for persistent ventricular tachycardia.
- A year after initial presentation, he underwent successful aneurismectomy with left ventricle (LV) reconstruction and mitral valve repair by a cardiac surgery team.
Implications:
- This case underscores the critical role of a comprehensive, interdisciplinary approach involving clinical cardiologists, interventional cardiologists, electrophysiologists, intensivists, and cardiac surgeons.
- High-performance cardiac surgery, following complete interventional treatment, can substantially enhance the quality of life and long-term outcomes for patients with severe cardiovascular disease.
Abstract:
We reported the case of a young man with ST-Segment Elevation Myocardial Infarction (STEMI), with ventricular fibrillation on debut and cardiogenic shock, who needed a complex interdisciplinary approach for a favourable long term outcome. A 43-year-old man was admitted with inferior STEMI and cardiogenic shock. First coronary angiography revealed total chronic occlusion of left anterior descending artery (LAD) and tight stenosis with thrombus on right coronary artery (RCA). Thrombus aspiration and stent implantation on RCA was performed with good results. LAD couldn't be opened. Intraaortic balloon pump was implanted. Forty-eight hours later, we try again to open LAD, without success. After a lot of complications, all solved with difficulty, patient was discharged cachectic and with progressive exertion on mild exercise. Two months later an implantable cardioverter-defibrillator (ICD) was decided for persistent ventricular tachycardia and after one year he was referred to a cardiac surgery centre abroad for aneurismectomy with left ventricle (LV) reconstruction and mitral valve repair. The patient is currently asymptomatic with a normal social and professional life. In conclusion, high performance cardiac surgery, after a complete interventional treatment, can improve quality of life and long-term outcome to a patient with severe cardiovascular disease. Team work between clinical cardiologists, interventional cardiologists, electrophisyologists, intensi-vists and cardiac surgeons is the key to success.
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