| Research background:Heart failure is a common complication after myocardial infarction.The local ventricular wall contraction abnormality after myocardial infarction makes the balance between the ventricular papillary muscle's suppository force on the bond line and the occlusion valve leaflet closure force,leading to mitral regurgitation.Reflux.According to statistics,the incidence of ischemic mitral regurgition(IMR)caused by myocardial infarction is as high as 40%,and occurs mostly in the inferior wall and anterior wall myocardial infarction,and the diseased blood vessels are left circumflex occlusion.The incidence of ischemic mitral regurgitation is only 1%,which is very rare in clinical practice.If the degree of mitral regurgitation cannot be effectively controlled,the ventricular preload will increase continuously,and ultimately decompensation will lead to heart failure.At present,the treatment of ischemic mitral regurgitation in the country is mainly anti-heart failure,anti-reversal ventricular remodeling and other drug treatment,although the surgical treatment of mitral regurgitation has matured,but the patient is abandoned for personal reasons.More,foreign transcatheter interventional treatment of mitral regurgitation technology is becoming more and more mature,and the country is still in its infancy,so the optimal treatment plan for ischemic mitral regurgitation needs further improvement.Objective:To improve the comprehensive understanding of PCI in elderly patients with myocardial infarction,especially to prevent complications,because elderly patients with poor disease response,poor expression,post-myocardial infarction complications and complications after PCI are prone to delay,In this paper,we report the repeated acute left heart failure after PCI in an elderly patient.After analyzing the causes of the disease and the cause of heart failure,we can grasp the prevention and treatment of complications after myocardial infarction and postoperative PCI.The ischemic mitral valve is effective;and review related literature at home and abroad,summed up the new ideas of IMR treatment.Case report:Patient,female,80 years old.The main reason was "intermittent chest pain for more than 20 days,aggravated for 4 days" was transferred from the outer court on 2017-10-09.There was no obvious cause of chest pain and sweating in 09-16 patients.The symptoms were relieved after 2 hours.The second day was seen in the external hospital.The examination was completed and the diagnosis was acute myocardial infarction.Coronary angiography + PCI was performed after more than 10 days of conservative treatment.The first acute left heart failure occurred 10 days after surgery and was relieved after active rescue treatment.For further diagnosis and treatment in the 10-09 from the external hospital transferred to our department,the previous history of hypertension for 20 years,the highest blood pressure 160/70 mmHg,regular medication,blood pressure control;2 years of diabetes history 20 years,oral medication plus insulin treatment,blood sugar control good.Admission examination: mitral auscultation area can smell 2/6 systolic hairy murmur.Admission diagnosis: coronary heart disease acute high-wall myocardial infarction after PCI.On the 4th day after admission,the patient developed acute left heart failure and immediately ligated the lower limbs with intravenous injection of furosemide and cedilan.The symptoms were relieved.Immediate ECG shows that ST-T has no significant changes compared to admission.Please consult with the heart surgery,it is recommended to change the valve at an elective time.The patient does not accept the procedure for discharge,and gives oral anti-heart failure and reverse ventricular remodeling.After August,the patient's outpatient review,the general situation can be,after the absence of activity,tightness.Cardiac color Doppler showed that the degree of mitral regurgitation was less than before.Discussion:For the elderly patients with myocardial infarction after PCI treatment management should be more rigorous,improve myocardial infarction complications such as mitral papillary muscle disorders caused by heart failure,embolic events,ventricular aneurysm formation,and postoperative complications such as stents The understanding of thrombosis,stent dislocation,etc.,combined with auxiliary examination to prevent preventive measures;for patients with acute heart failure similar to this case,urgent treatment,avoiding exacerbations,giving strict capacity management,the best drugs Treatment slows the progression of the disease and improves the prognosis of patients;the selection of the best treatment options for patients with ischemic mitral regurgitation and heart failure,the current study confirmed that anti-heart failure,inhibition of ventricular remodeling and other drugs are effective.For active surgical treatment of surgical mitral valve repair and annuloplasty indications,reduce reflux and improve heart failure.At the same time,with the continuous development of catheter technology,the interventional treatment of ischemic mitral regurgitation has entered a new stage.Significance:To review the overall treatment of the patient: patients with old-age myocardial infarction who have undergone PCI should be fully combined with adjuvant examination to prevent complications after myocardial infarction and PCI-related complications;to combine the inevitable complications that have occurred The patient's personal condition is treated reasonably.Long-term treatment aims to improve the patient's symptoms and improve the quality of life.The patient's followup results show that ischemic mitral regurgitation combined with heart failure and regular medication can reduce reflux.Therefore,it can improve the symptoms of heart failure in patients,which has important reference significance for clinicians;it pays enough attention to the new technique of transcatheter intervention for ischemic mitral regurgitation,which can minimize the pain of patients,improve the quality of life and improve patients. |
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