August 15, 2023 midnight
A 41-year-old young man
Due to "sudden chest pain for 8 hours"
He was rushed to the emergency department of Gansu Provincial Central Hospital
A multidisciplinary joint "heart-saving" operation began
Emergency ECG shows extensive elevation of ST segment of the anterior thoracic lead, with "tombstone-like" changes, and diagnosis: acute extensive anterior and lateral myocardial infarction. The patient sits upright breathing, coughs up pink foamy sputum, and is considered complicated by acute left heart failure, and is critically ill with a life hanging in the balance.
The emergency department immediately opened the green channel, started the chest pain center with one button, and the team of Professor Chen Yongqing of the Department of Cardiology was quickly in place, and the patient was sent to the cath lab after rapid assessment, and the entire chest pain treatment process was standardized and orderly, and the treatment process was seamless. Contrast after further examination showed that the coarse left anterior descending branch was occluded.
Attending physician Wang Weizu of the Department of Cardiology, deputy chief physician Zhang Yujie, and nurse in charge of Liu Ling assisted and cooperated, quickly opened the "criminal" blood vessel for the patient, quickly implanted a stent in the anterior descending branch, and TIMI blood flow level 3.
Before surgery
After surgery
The operation was very successful, but due to the patient's extensive myocardial necrosis, postoperative acute pulmonary edema, cardiogenic shock is difficult to correct, and conservative treatment with conventional drugs is not effective. The hospital quickly started the ECMO team, and after the evaluation of the team of Professor Chen Yongqing of the Department of Cardiology, the team of Professor Zhang Honghong, the Department of Critical Care Medicine and the team of Professor Tang Hanbo of the Department of Cardiac and Macrovascular Surgery, the patient was immediately intubated by trachea, ventilator-assisted ventilation, routine ultrasound evaluated the vascular conditions of the patient's double lower limbs, and the patient's vital signs were stable after the successful transfer of ECMO (extracorporeal membrane oxygenation).
However, the patient's treatment is far from over. The post-management of ECMO patients is crucial to determine whether patients can safely wean and turn the crisis into safety. As one of the important aspects of ECMO treatment, anticoagulation management should not be flawed, because both membranous pulmonary thrombosis and bleeding from important organs are fatal to patients.
Qiang Yi, deputy chief physician of the Department of Cardiac and Macrovascular Surgery, guards the ECMO machine 24 hours a day, adjusts each parameter with precise titration, and adjusts the anticoagulant dose at any time. As the doctor in charge, Liu Jianjun's attending physician is meticulous and meticulously manages patients throughout the process. Under multidisciplinary management, the patient did not develop thrombosis or bleeding from important organs. In the process of ECMO management, whether it is anticoagulation, volume management, ultrasound evaluation, or comprehensive treatment such as anti-infection, enteral nutrition, bedside blood purification (CRRT), intensive care medicine is finely managed, and the cardiovascular medicine and cardiac and macrovascular surgery teams assist the whole process, and the entire treatment chain is orderly and orderly.
In the later stage, cardiac ultrasound evaluates the patient's cardiac function to be extremely poor, and the prethrombotic state appears, which is easy to form ventricular wall thrombosis, and after detachment, it is easy to cause serious complications such as cerebral embolism and systemic embolism. After re-evaluation by the cardiovascular medicine and intensive care medicine teams, Deputy Chief Physician Zhang Yujie implanted IABP (aortic balloon counterpulsation) at the bedside, and after implantation, the cardiac ultrasound was reviewed, the aortic valve opened and improved, and the "cloudy" thrombotic state in the ventricular basically disappeared.
With the deepening of treatment, the patient's cardiac function is significantly improved. After multidisciplinary re-evaluation, the ECMO was successfully evacuated on August 20 and 23, IABP was removed, and the patient's blood pressure and heart rate were stable after weaning, and the patient's consciousness was now clear, and the vital signs were relatively stable.
This multidisciplinary joint successfully treated the patient
Overcoming difficulties, the whole hospital played a game of chess
It has built a solid defense line for medical treatment in our hospital
It also marks our hospital's treatment of acute and critical diseases
It is already at the leading level in the province
Specialized advantages, efficient treatment
At present, cardiovascular disease deaths still rank first among the total causes of death of urban and rural residents, and the demand for medical treatment is huge, and vigorously developing cardiovascular disciplines is undoubtedly crucial. After rapid development and accumulation in recent years, the cardiovascular team of Gansu Provincial Central Hospital has been recognized by the industry and the people, and has undertaken the important task of solving difficult cardiovascular emergencies and critical diseases in the region, and its influence has been continuously expanded. Professor Chen Yongqing of the Department of Cardiology led the team to make continuous efforts on the basis of the key clinical specialties of the hospital, continuously make new breakthroughs, promote the Department of Cardiovascular Medicine to enter the domestic first-class discipline, and build a cardiovascular regional medical center at a higher level.
Department and expert introduction
The Department of Cardiology of Gansu Provincial Central Hospital is a new clinical discipline with reference to the standard construction of national regional medical centers, advanced equipment and forge ahead. The department has 90 beds planned and two wards to build the core department of the chest pain center. At present, there are 16 medical staff, including 12 physicians (1 chief physician, 1 deputy chief physician, 4 attending physicians, 6 resident physicians; There are 1 supervisor for master's students, 1 doctor, 9 masters), and 9 nursing backbone personnel (3 in the cath lab). As a joint training unit for master's students in many well-known universities in China, he has published 6 SCI papers and more than 60 papers in national journals in recent years.
Director Chen Yongqing, the leader of the discipline, is a national member of the Hypertension Professional Committee of the Chinese Medical Doctor Association, a member of the National Standing Committee of the Cardiovascular Structure and Metabolism Professional Committee of the Chinese Eugenics and Fertility Association, a member of the National Standing Committee of the Smart Health Education Working Committee of the China Intelligent Engineering Research Association, a member of the Structural Cardiology Branch of the Asia-Pacific Heart Alliance, a youth member of the Heart Failure Special Committee of the Chinese Medical Doctor Association, a youth member of the All-Army Cardiovascular Internal Medicine Professional Committee, and a vice chairman of the Hypertension Professional Committee of the Gansu Medical Doctor Association. Vice Chairman of the Atherosclerosis Committee of Gansu Geriatric Association, Vice Chairman of the Gansu Provincial Working Group of the Cardiac Intensive Care Branch of the Chinese Medical Association, Member of the Coronary Heart Disease Expert Committee of the Association of Integrative Chinese and Western Medicine, Member of the Standing Committee of the Cardiovascular Medicine Professional Committee of the Gansu Medical Association, Instructor of Interventional Diagnosis and Treatment Training of the National Health Commission of the Ganqingning National Health Commission of the China Hypertension Alliance, Master Tutor of Lanzhou University and other four universities, Editorial Board Member of the Chinese Journal of Evidence-Based Cardiovascular Medicine, and participated in the editing of "Practical Hypertension" focusing on 1 part.
At present, the main business is:
Internal medicine and interventional diagnosis and treatment of various cardiovascular diseases, rescue of critical emergencies, including: hypertension, coronary heart disease, cardiomyopathy, arrhythmia, heart failure, etc., interventional diagnosis and treatment of coronary heart disease, dual-chamber, three-chamber, defibrillation pacemaker implantation, supraventricular tachycardia, ventricular tachycardia, atrial fibrillation and various premature beats catheter radiofrequency ablation, interventional closure of congenital heart diseases such as atrial deficiency, ventricular deficiency, patent ductus arteriosus, left atrial appendage closure to prevent atrial fibrillation stroke, endovascular ultrasound, coronary internal rotation mill, etc. ECMO and IABP implantation, interventional diagnosis and treatment level ranks the leading level in Northwest China and Gansu Province.
Cardiovascular Medicine Ward:0931-6968010
Chest pain center: 19893119757