I Can Hear the Heart's Voice of Traditional Chinese Medicine-Chapter 331 - 146: Emergency Coronary Angiography and Stent Implantation_2

Chapter 331: Chapter 146: Emergency Coronary Angiography and Stent Implantation_2

City First Hospital, the director is quite authoritative in the field of cardiology.

At this moment, he would rush back, as expected.

Moreover, even if he’s not a cardiology expert, he must come back at this time.

Thinking of this, Zhou Qihua quickly sat down in his position.

Once Zhou Qihua was seated, Director Zheng directly said, "I won’t introduce the patient too much, this task is different from before."

What makes it different, Director Zheng didn’t say.

Those sitting in this consultation room are at least at the level of associate chief physician, and also extremely capable. He didn’t call those without skill since it would be useless. These people surely understand what the patient in the special needs ward signifies.

This is no longer just a medical task.

Upon hearing this, everyone nodded in agreement.

Director Zheng continued, "This patient previously had an ECG check at Eastern Hospital and was diagnosed with coronary heart disease for more than a month. During this time, he rested for a while, but he didn’t listen to advice. Lately, he’s been working overtime daily, even reviewing reports and making instructions at midnight.

According to his secretary, he had an episode of angina in the afternoon, took nitroglycerin tablets sublingually, which relieved him for half an hour. At the time, he didn’t pay much attention, though his secretary advised him, but it was of no use; he completely dismissed it. Around 4 PM, the angina reoccurred, nitroglycerin was ineffective, and ultimately he was brought to our hospital for rescue.

Before you came, I also used inhalable nitrite and isopropyl nitrite, but it was ineffective.

I’ve invited all of you to listen to your opinions, what should be done in this situation? How should medication be administered? What medication should be used?

The director is on his way, he had already spoken with me on the phone earlier, sparing no effort to save the patient, but medications must not be used indiscriminately, considering the patient’s age is not young, if something goes wrong, no one will bear that responsibility."

"Old Zheng, from what you’ve said, the patient should have acute myocardial infarction!" Zhou Qihua interjected.

Director Zheng nodded: "Yes, angina attacks from coronary heart disease."

"Having used the prescribed medications without effect, it’s very troubling, and if the disease strikes, it could easily be fatal," Zhou Qihua said gravely.

Acute myocardial infarction is myocardial necrosis caused by acute, persistent coronary artery ischemia and hypoxia.

Clinically, it often involves severe and persistent pain behind the sternum, which can’t be completely relieved through rest and nitrate drugs, accompanied by elevated serum myocardial enzyme activity and progressive ECG changes, potentially leading to arrhythmia, shock, or heart failure, often threatening life.

Additionally, considering the patient’s advanced age, the situation is even more serious, a single misstep and it could result in death within an hour.

The key is that the best time for rescue is within half an hour, and a lot of time has already passed, if other treatments aren’t administered, the consequences will be too grave.

"We must fight for every second!"

"Old Zheng, we understand the situation now, let’s go to the scene and take a look. It’s best to also invite traditional Chinese Medicine doctors to evaluate, perhaps they have a solution, the Traditional Chinese Medicine Hospital isn’t far away, have them come over, maybe they’ll have good advice, otherwise stalling is not an option." Zhou Qihua thought for a moment and offered his opinion.

Old Zheng said: "I’ve already mentioned it to the director, he contacted the director of the Traditional Chinese Medicine Hospital, they should be arriving soon."

"But you’re right, discussing here leads nowhere, seeing the scene might yield other solutions, right now Old Ye is there administering emergency care."

"Let’s go then, so we don’t waste the best rescue time."

Everyone stood up and headed towards the special needs ward.

When Zhou Qihua and others arrived, several chief traditional Chinese medicine doctors from the Traditional Chinese Medicine Hospital also reached the scene.

Not only the traditional Chinese medicine doctors from the Traditional Chinese Medicine Hospital but even those who sit in United South Chinese Medicine Association also came over.

Huang Beishan, Ye Haishen, Zhang Jingcai all were present.

At this moment, as these doctors arrived, Director Zheng gave a concise overview of the situation.

And as City First Hospital’s director Zhang Jiwei was discussing with everyone how to save the patient, he hurriedly walked in: "How is the situation?"

Everyone exchanged glances, all shaking their heads: "The situation is not optimistic, we’ve used every medication available, but none have been effective."

"What about rapid sublingual administration of nitroglycerin?"

Rapid sublingual administration of nitroglycerin allows nitrate medications to quickly reach the affected blood vessels through circulation, dilating the affected vessels and relieving symptoms.

Having a background in cardiology, Zhang Jiwei has often participated in cardiology emergencies over the years, so he’s very familiar with these drugs and understands their effects, thus immediately mentioning nitroglycerin administration.

"It’s been tried, but it didn’t work."

As the attending physician, Director Zheng shook his head and stepped forward: "The patient had already prepared for this medication when coronary angina was detected beforehand, during the afternoon angina episode, he self-administered and relieved symptoms for a while.

However, as he’s been consistently working overtime and hasn’t sufficiently rested, nitroglycerin only provided minimal effect, but shortly after, angina recurred. After the second episode, he was brought here, and nitroglycerin didn’t work this time."

After speaking, Director Zheng seemed helpless.

"Dual antiplatelet therapy, plaque stabilization, reducing myocardial oxygen consumption, vasodilation, etc. treatments?" Zhang Jiwei frowned deeply, indicating that if nitroglycerin hasn’t worked, it signifies that the patient’s condition is already very severe.

"They have been used, yet no effect as of now."

Taking a deep breath, Zhang Jiwei decisively said, "Then we can only proceed with emergency coronary angiography and stent implantation."

"Wouldn’t that be too risky?" Director Zheng hesitated.

Coronary artery stent implantation is a mechanical intervention treatment, and is the most effective means to handle acute vascular occlusion from PTCA. A metal stent is permanently placed at the coronary artery’s affected area, supporting the vessel wall through balloon expansion or self-expansion, maintaining open coronary artery lumens, and lowering the mortality rate from acute myocardial infarction.

Stent placement requires aspirin and clopidogrel pre-administration to prevent thrombosis. Diabetics need timely blood glucose monitoring, relieve patient tension and anxiety, ensure good sleep, and eliminate mental stress; pre-operative skin preparation is necessary.

Post-coronary angiography, based on percutaneous coronary angioplasty, puncturing the femoral or radial artery, then using a specialized catheter to send the stent to the coronary artery’s narrowed region and expanding it, aiming to re-open occluded vessels or minimize vessel residual narrowing.

Stents can treat acute occlusion from balloon dilation, enhancing interventional treatment safety. They provide better outcomes for complex lesions compared to balloon dilation, reduce re-stenosis rates from balloon dilation, improving long-term treatment results.

However, during coronary artery stent implantation, puncturing the vessel can easily cause femoral pseudoaneurysm, retroperitoneal hematoma, dissection, thrombosis, embolization, arteriovenous fistula, etc.

Operating inside coronary vessels can lead to coronary spasm, coronary dissection, various arrhythmias, severe ventricular arrhythmias, acute vessel occlusion, thrombosis inside the stent post-implantation, no-reflow phenomenon, coronary perforation, coronary ventricle fistula, cardiac tamponade, acute pulmonary embolism.

There might also be other complications like sudden hypotension, stroke, cardiac function damage. Contrast agent use may lead to contrast-induced nephropathy or allergic reactions.

Given the patient’s age, no one can ensure serious postoperative complications won’t occur.