PMC9709338_01
The bedside cardiac ultrasound suggested poor cardiac contractile function and left ventricular ejection fraction only 25%.
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F1
Her blood pressure on arrival at the ICU was 92/52 mmHg (at this point the norepinephrine and epinephrine doses were 1.25 and 0.83 mug/kg/min, respectively), but the patient was extremely hemodynamically unstable, and bedside cardiac ultrasound suggested poor cardiac contractile function and left ventricular ejection fraction only 25% (Figure 1).
The after admission to ICU, 18-lead electrocardiogram (ECG) showed that the ST segment of lead I, aVL, V2-V6 depression 0.1-0.3 mV, and the ST segment of lead II, III, avF, V3R-V5R elevation 0.10-0.20 mV.
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F2
ST segment of lead I, aVL, V2-V6 depression 0.1-0.3 mV, and the ST segment of lead II, III, avF, V3R-V5R elevation 0.10-0.20 mV (Figure 2). Serum cardiac troponin I was 22.35 ng/mL (normal range 0-0.05).
(A) Right coronary angiography 1 months ago. Results of coronary angiography. (B) Right coronary artery: stent shadow was seen from the proximal segment to the middle segment, complete occlusion in the middle stent, myocardial infarction (TIMI) blood flow grade 0. (C) Coronary angiography after balloon dilation and thrombus aspiration showed no stenosis, and TIMI flow was grade 3.
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F3
Upon completion of our consultation with the cardiologist, the patient was considered to have had an acute myocardial infarction, which required urgent percutaneous coronary angiography (the right coronary angiography results 1 months earlier was shown in Figure 3A). The results showed stent shadow in the proximal and middle segments of the right coronary artery, mild intimal hyperplasia in the stent, complete occlusion in the middle, and myocardial infarction (TIMI) flow of grade 0 (Figure 3B). TIMI flow of grade 3 (Figure 3C). The patient was sent back to ICU after completion of surgery.
Postoperative electrocardiogram showing ST segment elevation 0.05-0.1 MV in lead III and avF.
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F4
By then, the postoperative ECG showed that ST-segment elevation of lead III and avF was 0.05-0.1 MV (Figure 4).