1. Case of The Week PCI replacing CABG R1 유태경

2. CASE 1

3. M/58 M/58 Chest pain o/s) 내원 2 시간전 Chest pain o/s) 내원 2 시간전 Present illness - 04 년 6 월부터 Seizure disorder 로 본원 신경과 외래 F/U 중 내원 2 시간 전부터 상기 증상 있어 ER 통해 내원 Present illness - 04 년 6 월부터 Seizure disorder 로 본원 신경과 외래 F/U 중 내원 2 시간 전부터 상기 증상 있어 ER 통해 내원 1st episode Substernum Pressing Continuous Radiation (+) : Lt shoulder a/w Sx(+) : sweating

4. Past medical history DM / HTN / Hepatitis / TB (-/-/-/-) Past medical history DM / HTN / Hepatitis / TB (-/-/-/-) Seizure disorder (+) Seizure disorder (+) Op Hx (-) Op Hx (-) Personal history Alcohol (-) Smoking (+) : 40 pack years Personal history Alcohol (-) Smoking (+) : 40 pack years

5. Review of system Cardiac Chest pain(+) Orthopnea(-) Palpitation(-) Review of system Cardiac Chest pain(+) Orthopnea(-) Palpitation(-) Physical examination V/S 120/70 mmHg - 68 회 /min -20 회 /min - 36.2 ˚C Thorax Clear breathing sounds without crackle Regular heart beat without murmur Regular heart beat without murmur B&Ext Pretibial pitting edema(-/-)

6. Lab findings CBC/DC 12,360 /mm 3 – 15.5 g/dl – 49.7 % - 226 K ( Seg : 63.6 % ) Chemistry BUN/Cr 18/0.9 mg/dL Na/K/Cl 141/3.5/106 mmol/L Glu 170 mg/dL BNP 19.9 pg/mL Cardiac Biomarker CK 68 U/L CK-MB 1.1 ng/mL TnI 0.05 ng/mL Lipid Profile T-chol 228 mg/dL TG 106 mg/dL HDL-chol 31 mg/dL LDL-chol 128 mg/dL

7. Chest X-Ray

8. ECG

9. Initial Problem List Initial Problem List #1. STEMI #2. Known seizure disorder Diagnostic & Therapeutic Plan Diagnostic & Therapeutic Plan #1. Echocardiography CAG CAG Primary PCI Primary PCI

10. Echocardiography

12. Coronary angiography

15. PCI

19. Post- PCI ECG

20. Final Diagnosis STEMI STEMI Known seizure disorder Known seizure disorder

21. CASE 2

22. M/67 Chest pain o/s) 내원 2 주전 Present illness - DM, HTN medication 중 - 2 주 전부터 상기 증상 발생하여 외래 통해 내원 Substernal Squeezing 5 분 – 10 분 On exertion Relieved by rest a/w Sx(-) Radiation(-) more severe and frequent

23. Past Medical History Past Medical History DM / HTN / Hepatitis / TB (+/+/-/-) DM / HTN / Hepatitis / TB (+/+/-/-) Op Hx (+) : Appendectomy, 30 년전 Op Hx (+) : Appendectomy, 30 년전 Personal History Personal History Alcohol (+) Smoking (+) : 30pack years

24. Review of System Cardiac Chest pain(+) Orthopnea(-) Palpitation(-) Review of System Cardiac Chest pain(+) Orthopnea(-) Palpitation(-) Physical Examination V/S 140/80 mmHg - 72 회 /min -20 회 /min - 36.0 ˚C Thorax Clear breathing sounds without crackle Regular heart beat without murmur Regular heart beat without murmur B&Ext Pretibial pitting edema(-/-)

25. Lab results CBC/DC 5,990 /mm 3 – 11.9 g/dl – 35.4 % - 296 K ( Seg : 58.3 % ) Chemistry BUN/Cr 22/1.1 mg/dL Na/K/Cl 140/5.0/106 mmol/L Glu 113 mg/dL BNP 96.5 pg/mL Cardiac Biomarker CK 62 U/L CK-MB 1.3 ng/mL Tn-I 0.01 ng/mL Lipid Profile T-chol 167 mg/dL TG 138 mg/dL HDL-chol 21 mg/dL LDL-chol 126 mg/dL

26. Chest X-Ray

27. ECG

28. Initial Problem List Initial Problem List #1. Unstable angina #2. Known HTN #3. Known DM Diagnostic & Therapeutic Plan Diagnostic & Therapeutic Plan #1. Stress Echocardiography CAG CAG PCI PCI

29. Stress Echocardiography

33. Coronary angiography

34. PCI

35. Final Diagnosis Stable angina Stable angina Known DM Known DM Known HTN Known HTN

36. CASE 3

37. F/73 F/73 Chest pain Chest pain Present illness - 05 년 8 월 unstable angina 로 PTCA( prox. RCA) 시행 한 환자로 상기 증상 악화되어 내원 Present illness - 05 년 8 월 unstable angina 로 PTCA( prox. RCA) 시행 한 환자로 상기 증상 악화되어 내원 Substernal <1min Squeezing On walking Relieved by rest Radiation (-) a/w symp (+) : Dyspnea NTG response(+)

38. Past medical history Past medical history DM / HTN / Hepatitis / TB (-/-/-/-) DM / HTN / Hepatitis / TB (-/-/-/-) Hypothyroidism(+) : 15 년전 진단 & 1 년간 medication Hypothyroidism(+) : 15 년전 진단 & 1 년간 medication Op Hx (+) : TKR d/t AVN, Rt hip Op Hx (+) : TKR d/t AVN, Rt hip Personal history Alcohol (-) Smoking (-) Personal history Alcohol (-) Smoking (-)

39. Review of System Cardiac Chest pain(+) Orthopnea(-) Palpitation(-) Review of System Cardiac Chest pain(+) Orthopnea(-) Palpitation(-) Physical Examination V/S 130/80 mmHg - 82 회 /min -20 회 /min - 36.3 ˚C H&Neck Neck vein engorgement(+/+) Thorax Clear breathing sounds without crackle Regular heart beat without murmur Regular heart beat without murmur B&Ext Pretibial pitting edema(-/-)

40. Lab results CBC/DC 5,340 /mm 3 – 12.2 g/dl – 37.6 % - 216 K ( Seg : 48.8 % ) Chemistry BUN/Cr 16/1.0 mg/dL Na/K/Cl 145/3.8/106mmol/L Glu 121 mg/dL BNP 12.8 pg/mL Cardiac Biomarker CK 70 U/L CK-MB 1.7 ng/mL Tn-I 0.03 ng/mL Lipid Profile T-chol 189 mg/dL TG 122 mg/dL HDL-chol 40 mg/dL LDL-chol 128 mg/dL

41. Chest X-Ray

42. ECG

43. Initial Problem List Initial Problem List #1. Unstable angina, s/p PTCA #2. Known Hypothyroidism Diagnostic & Therapeutic Plan Diagnostic & Therapeutic Plan #1. Echocardiography CAG CAG PCI PCI

44. Echocardiography

46. Coronary angiography

47. PCI

48. Final Diagnosis Unstable angina Unstable angina Known hypothyroidism Known hypothyroidism