Mrs. N, a reasonably fit 82-year-old woman was having central chest pain around 9 am and was taken to her local hospital. Her ECG there showed ST elevation MI (acute heart attack) and she was administered clot-bursting drug there. Unfortunately, this did not work (as in 30% of cases) and the patient became very unwell with more chest pain and her heart started to beat very slowly. She was also disorientated and was losing consciousness. She was immediately transferred to Apollo Main Hospital, Chennai for further management.
On arrival to our hospital, she was in the process of going into coma. She was immediately assessed in ER and was intubated and ventilated to secure the airway. An urgent CT of the brain was done to exclude any bleed in the brain, which thankfully was not there. Her ECG in our hospital continued to show the worst form of heart attack. Therefore, after discussion with the family, she was immediately shifted to our cardiac catheter lab to do emergency angioplasty.
Her coronary angiogram, which was performed via right radial approach showed a totally blocked artery (right coronary artery) with plenty of thrombus, as expected. It was decided to perform angioplasty and therefore a wire was passed to cross the occlusion, which was successful. Then a thrombus aspiration catheter was inserted into the RCA, and a long serpentine clot was removed from the RCA. Further to this blood flow was established in the RCA, which showed a long segment of underlying narrowing of 70%. An OCT (optical coherence tomography) catheter was passed to assess the narrowing and size of the artery to decide about the stent. Then a drug coated stent was deployed in the narrowing to remove the block which was successful. This established a normal and brisk flow in the artery.
She was shifted to the coronary care unit for observation. Her BP improved remarkably without needing for any inotropic support. Her conscious level improved and she was extubated within 24 hrs of admission in our hospital. She was shifted to the room the next day and discharged within 2 days. Her echocardiogram showed a good LV systolic function with no major damage to the heart. She walked out of the hospital within few days of admission and this is mainly due to the holistic approach we adopt in Apollo Main Hospital, Chennai in taking care of patients.
