Unstable angina pectoris after PCI revascularization with thrombus aspiration

Abstract

Introduction: Percutaneous coronary intervention (PCI) is a non-surgical procedure used in the treatment of coronary artery stenosis. Repeated stenoses of the coronary arteries may develop 6 months later in 40-50% cases of PCI, this resulting in clinical manifestations of cardiac ischemia. Early postinfarction angina pectoris is a form of unstable angina, developing in up to 2 weeks after a myocardial infarction. The present clinical case describes a patient L., male, 50 years old, hospitalized on 26.03.14 in the Cardiology Recovery Department of MCF1 “Holy Trinity”. Complaints: constrictive retrosternal chest pain with irradiation in the left shoulder, general weakness. History of the disease: The patient had an anterior extended myocardial infarction 2 weeks ago, he was hospitalized in Medpark clinics and angiocoronarography was performed, as a result three coronary atherosclerotic lesions were determined with moderately severe stenoses on RCA III and unimportant stenoses on LAD and CX (OM I). In consequence, he was submitted to PCI revascularization with thrombus aspiration. He was discharged for treatment at home with Tab. Aspirini 75 mg daily, Tab. Clopidogrel 75 mg daily for 2 months and was recommended a future stent implantation. Clinical examination: General state o f medium severity. Clear conscience, skin of pale colour. Heart sounds were rhythmic, diminished, with HR=80 beats/minute, Ps=80 beats/minute, BP=110/80 mmHg. Other organ systems had no pathological changes. Paraclinical investigations: ECG: Sinus rhythm, HR=75/minute, EHA - intermediate, pathologic Q wave in III, signs of LV hypertrophy, repolarization disturbances. Echo-CG: Induration of ascending aortic walls, aortic and mitral valves, EF=64%, contraction function of the LV is sufficient. General and biochemical blood analysis: within normal ranges. Markers of myocardial necrosis: negative. Treatment: Beta-blockers, nitrates, antiplatelets, ACE inhibitors, anticoagulants, metabolic drugs and diuretics. Clinical diagnosis: Ischemic heart disease. Unstable angina pectoris. State after PCI revascularization (09.03.14). Congestive heart failure II (NYHA). Conclusion: The patient L., 50 years old, develops an early postinfarction angina pectoris after being submitted to PCI revascularization with thrombus aspiration, as a result of a myocardial infarction experienced 2 weeks ago. The antiischemic treatment received during hospitalization had a positive effect, leading to symptoms’ resolution and the patient is recommended a future stent implantation.