During a late night at 9:35 PM on 01/02/2023, Emergency Department of Vinmec Nha Trang admitted a 64-year-old American male patient presenting discomfort in epigastric and the region behind sternum along with vomiting, which has occurred 5 hours before hospital admission
At the Emergency Department, the patient was quickly received and examined. After 7 minutes, the electrocardiogram result came in, however there was no sign of elevated ST (ST-Elevated Myocardial Infarction). However, based on professional experience, doctors still managed to identify signs of acute coronary syndrome and strictly monitored the patient, performing ECG every 15 minutes and performing basic blood tests.
At 22:22 on the same day, the patient felt increasingly discomforted behind the sternum and appeared mildly agitated. ECG demonstrated elevated ST in inferior leads. Emergency physicians indicated STEMI (ST-elevation Myocardial Infarction) and immediately consulted Dr.Le Thanh An, an interventional cardiologist at Vinmec Nha Trang to perform intervention and activate CodeSTEMI. Code STEMI is an emergency protocol designed for seamless coordination between doctors from multiple departments like Emergency, Cardiac Intensive Care, Anesthesia and the core is the interventionist team, with the aim to minimize treatment time for patient.
Within 20 minutes after the activation of codeSTEMI, the team was present at the hospital and ready to perform emergency intervention. The patient was immediately delivered into the Digital Subtraction Angiography lab (DSA) for coronary artery revascularization to treat the blocked coronary which causes the myocardial infarction. After 1 hour, the intervention team had images of coronary arteries anatomy: complete occlusion of Left Circumflex branch (LCx) at proximal segment with extensive thrombus. The team then inserted a guidewire through the occlusion in the LCx branch, repeatedly performed balloon dilation to temporarily restore blood flow and placed 2 advanced stents covered with drug to open the blocked segment. 15 minutes later, the intervention successfully ended, saving the patient. During the intervention, there were several episodes of arrhythmia and hypotension but managed effectively.
After intervention, the patient was transferred to the Intensive Care Unit (ICU) for monitoring. After 24h, the patient appeared stable and he was transferred back to the inpatient cardiology department for continued treatment.There, the patient was taken care of in a private room, and his vital signs monitored. Due to significant size of LCx artery and wide affected cardiomyocyte, the patient has signs of Heart failure (EF 40%) and hypotension. However, with close monitoring, vasopressor medication use to raise blood pressure and other cardiac support medications as well as modern equipment, technology in Vinmec Nha Trang along with healthcare professionals caring, the patient successfully overcame the critical phase and recovered heart function, back to normal life after 7 days of treatment.
By actively applying advanced interventional cardiology around the world,Vinmec Nha Trang hospital has and will implement multiple advanced protocols by American Heart Association (AHA) to take care of and treat cardiovascular patients. Many patients have been successfully saved, minimized their severe complication including heart failure following acute myocardial infarction
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