We rescued a 28-year-old myocardial infarction patient, who is not the youngest myocardial infarction patient I have ever rescued, but he is also very young.
A 28-year-old boy, born in 1994, is what we usually call a post-90s teenager...
Nowadays, cardiovascular and cerebrovascular diseases have also occurred.
Mr. Zhai, 28 years old, suddenly felt chest tightness and discomfort at dinner, but Mr. Zhai did not think that he was sick at all, let alone that he was heart disease, so he has been at home to endure. One moment lying down, one moment sitting, one moment opening the window, the next drinking some hot water. Anyway, how to stay uncomfortable, endured for more than 2 hours, or held the breath and chest tightness, and worse than before, dizziness, blackening in front of the eyes, sweating, this is only 120.
After arriving at 120, blood pressure was measured at 80/40mmHg, and an electrocardiogram suggested acute inferior myocardial infarction. It is advantageous to administer 300 mg of aspirin and 180 mg of tigrelor, and to give dopamine to boost the pressure. Contacted the hospital chest pain center and activated the catheterization room.
120 Doctors informed the patient's family that the patient had developed an acute myocardial infarction and needed first aid. However, the family and the patient himself did not believe that the patient had a myocardial infarction.
The patient's family has always stressed: Are you mistaken, so young, usually good, how can it be myocardial infarction?
After the patient arrives at the hospital, the cardiovascular doctor consults to give a further definitive diagnosis and recommends an angiography. The family still did not believe it, saying that the doctor must have made a mistake, how could such a young person have a myocardial infarction?
Doctors explain: Although the proportion of myocardial infarction in young people is relatively low, it still occurs, and the youngest myocardial infarction is only in his teens, so it is entirely possible to have myocardial infarction at the age of 28. The most important patients have chest tightness and breath holding + ECG ST-segment elevation, which is enough to diagnose acute myocardial infarction.
After repeated communication, the patient's family finally agreed to do angiography.
Contrast findings: the patient's right side of the blood vessel is completely blocked near the middle of the blood vessel, and a large number of blood clots are found.
First, the blood clot is sucked out
After the angiography develops a thrombosis, intravascular thrombolysis is given, followed by a blood-sucking catheter to draw the thrombus, the largest of which is nearly 2 cm.
This device that sucks blood clots is not the kind of device that some people post on the Internet that can suck the blood clot clean. At present, for the thrombosis of the heart vessels, there is no way in the world to control the thrombus in one area, and then the thrombus is clean and completely sucked out.
At present, the hospital cardiovascular medicine department uses this suction thrombus, simply understood, is a tiny cavity long hose, one end through the blood vessels to reach the site of the thrombosis, the other end in the patient's body, the doctor this head through the syringe suction, you can suck out a part of the thrombus.
This image is the blood clot that we draw from the patient's heart vessels.
A stent is then implanted and the patient is sent back to the intensive care unit.
You may have the same question as your family, you have all sucked out the thrombus, the blood flow has been restored, why give the patient Fan stent back?
Second, why did you also put a heart stent
1. The thrombus can only be partially withdrawn
Let's start by saying that this thrombus is a blood clot, and when we do the angiography, whether it is a guide wire through a thrombus, or a suction catheter touching a thrombus. The blood clots will move and run to the far end, and the large blood clots can easily become small clots.
Therefore, even if you can draw a blood clot, you can only draw a relatively large blood clot, and sometimes you can't draw a blood clot.
2. The thrombus is sucked, but the plaque stenosis is still present
The thrombus is formed by the rupture of the plaque, and it is said that even if we can suck the thrombus cleanly (this is the ideal state, it does not exist in reality, there will be a lot of small blood clots left in the blood vessels, which need to be controlled and ablated by anticoagulant drugs).
The thrombus is gone, but the plaque does not disappear, the plaque is perennial, gradually growing together with the inner wall of the blood vessel, so it is impossible to remove it by suction. The plaque is very hard, together with the blood vessels, and since the plaque is there, the narrowing will be there. It may also cause myocardial ischemia, slow blood flow, and even re-trigger blood clots.
Therefore, for most myocardial infarction, even if the thrombus is sucked, it is eventually necessary to solve the problem of stenosis and solve the problem of severe myocardial ischemia through the method of stenting.
Does that mean that all myocardial infarctions have to be stented?
Not all myocardial infarctions require stents
For a patient with myocardial infarction, stent treatment is recommended if they successfully arrive at a hospital that can stent. Because stent treatment has a clear effect, it can save more lives.
But not every myocardial infarction must be stented:
1. The blood vessels are reconnected, and there is no serious stenosis
There are a very small number of myocardial infarction patients, when the angiography, found that the blood vessels have been self-opened, blood flow has recovered to level 3, and there is no obvious severe stenosis, then it can not be stented.
2. Tiny blood vessel blockage
If it is a small blood vessel blockage, on the one hand, there is no such a small stent, on the other hand, the degree of danger is relatively low, so no stent is used.
3. Very serious lesions
After doing the angiography, it was found that the stenosis was very complicated and could not be stented, so it could not be stent treatment, and could only turn back to the bypass treatment.
4. The blood clot is particularly serious
If the thrombus is particularly serious, then it can not be stented, because the stent is put in, the blood vessel is blocked, this situation is based on anticoagulation therapy, antiplatelet therapy, and then recheck the angiography after the condition is stable.
After listening to our explanation, the family understood, held our hands, and kept thanking us...
In short, for the vast majority of myocardial infarction, even if the blood clot is sucked, the balloon expansion stent is finally implanted!