Patient V.T.T (born in 1977, residing in Ho Chi Minh City) was admitted to the hospital about 5 hours after experiencing severe pain behind the sternum, accompanied by sweating and shortness of breath. The patient has a history of high blood pressure and smoked about 30 packs-years.
When admitted to the hospital, the patient was still conscious but struggling, chest pain, rapid breathing, fatigue, and low blood pressure. The electrocardiogram recorded ST elevating to the wide anterior wall area. A cardiac ultrasound showed that the heart muscle contractility was only 19%.
Doctors diagnosed the patient with acute myocardial infarction, ST elevated to a wide front wall, cardiac shock complication and quickly activated the emergency coronary angiography and intervention procedure.
Coronary angiography results showed that the patient had triangular coronary artery disease, in which the anterior ventricular artery was completely blocked from the proximal segment. This is an important coronary artery branch that supplies blood to most of the anterior region of the heart muscle.
Faced with unstable hemodynamics, the team both performed coronary revascularization and used IABP to support circulation.
BSCKI Nguyen Tien Nhan, Department of Cardiovascular Resuscitation and Interventional Cardiology, Thu Duc General Hospital, said that in cardiogenic shock due to acute myocardial infarction, rapid diagnosis, stable hemodynamics and timely coronary revascularization are important for the patient's prognosis.
According to BSCKII Le Duy Lac, Head of Cardiovascular Resuscitation and Interventional Cardiology Department, IABP is a mechanical circulatory support device, using a special ball placed in the aorta. The ball is pumped and collapses according to the heart cycle, contributing to improving coronary irrigation and supporting the heart in the acute phase.
After intervention, the patient continued to receive intensive treatment, combined with IABP, respiratory support and blood pressure-raising drugs, and cardiac support. The condition quickly improved, and the patient's chest pain and shortness of breath gradually subsided.
After 3 days, the patient was discontinued from IABP. Vasodial and cardiac antagonists were also reduced in dose and discontinued when hemodynamics stabilized. Notably, myocardial contractility recovered from 19% to 48%.
After more than 2 weeks of treatment, the patient stabilized, no longer had chest pain, shortness of breath and could live on her own in bed. On August 18, the patient was discharged from the hospital.
BSCKI Nguyen Tien Nhan assessed that this result was achieved thanks to patients coming to the hospital in time, being diagnosed quickly and intervened early, and the team choosing appropriate circulatory support measures.
Cardiac shock is one of the serious complications and leading cause of death in patients with acute myocardial infarction. In particular, anterior myocardial infarction is often predicted to be severe due to the wide area of myocardial damage.
From the above case, doctors recommend that people be vigilant about signs such as chest pain or tightness, shortness of breath, sweating, nausea, dizziness or sudden fatigue. This may be a sign of acute myocardial infarction.
When symptoms suspected of myocardial infarction appear, patients need to go to the nearest medical facility, and should not be subjective or delay," BSCKI Nguyen Tien Nhan advised.
People with risk factors such as high blood pressure, smoking, diabetes, dyslipidemia or a history of cardiovascular disease need to control risk factors well and have regular health check-ups.
Time is the heart muscle. Early diagnosis and timely intervention help limit heart muscle damage, increase survival and improve prognosis," Dr. Nhan emphasized.
