The Patient for Percutaneous Transluminal Coronary Angioplasty
A 65-year-old man with a history of inferior wall myocardial infarction (M.I.) in 1979 and 1986 was admitted because of unstable angina. He had percutaneous transluminal coronary angioplasty (PTCA) in 1986 following the second MI.
The patient had a 38-year history of insulin-dependent diabetes mellitus. His medical history was unremarkable for any other disease except congestive heart failure (CHF) in 1986 following the MI. No allergies were known. He did not smoke or drink.
The patient was taking diltiazem 60 mg q.i.d.; nifedipine 20 mg t.i.d.; furosemide 40 mg q.d.; nitropaste 5 cm2 q.d.; insulin NPH 12U and regular insulin 6U in the morning and NPH 12U and regular 4U in the evening.
The electrocardiogram showed normal sinus rhythm, old inferior wall MI changes, and nonspecific STT-wave changes in the precordial leads. Chest X-ray was unremarkable.
The patient weighed 70 kg. Vital signs were: blood pressure 100/60 mmHg, pulse 72/min, respiratory rate 18/min, temperature 36.6°C. Physical examination was unremarkable. Serum chemistries and hematologic indices were within normal limits.
Cardiac catheterization showed: ejection fraction of 58%, left ventricular end-diastolic pressure (LVEDP) within normal limits, 70% occlusion of right coronary artery, 50%c left anterior descending (LAD) occlusion, and 50%) occlusion of the first diagonal artery. The patient was scheduled for PTCA and possible coronary artery bypass graft (CABG).
KeywordsCoronary Artery Bypass Grafting Coronary Blood Flow Coronary Artery Disease Patient Left Ventricular Failure Myocardial Oxygen Supply
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